MERCER为美国保险业协会做的绝密HR报告

RichBaileyFSA,MAAA,FCARichmond,VAIsitTimeforEmployerstoMoveAwayFromtheTraditionalWaysofProvidingEmployeeBenefits?

November3,2004AgendaTheEnvironmentTheCatch-22PathsAwayfromTraditionalDelivery:TwoCampsOpportunitiesAlongPath2TheAnswerAdditionalTopics1AgendaTheEnvironmentMedicalTrendsLegislationMarketplaceChangesPopulationDemographicsEmployerOutlookTheCatch-22PathsAwayfromTraditionalDelivery:TwoCampsOpportunitiesAlongPath2TheAnswerAdditionalTopics2Double-DigitIncreaseforSecondYearinaRow

Peremployeecostsinexcessof$5,600peryear-2.9%+6.2%+7.3%+8.1%+11.2%+14.7%Source:2002Mercer/FosterHigginsNationalSurveyofEmployer-sponsoredHealthPlans3AnnualCPITrend

U.S.healthcarecostsrise,despitecontinuingeconomicrecessionThegapbetweenCPI-Uandmedicalcarecomponentisincreasing4ComparisonofOverallGrowth

CumulativemedicalcareCPI89%greaterthanoverallCPIsince1967DatabasedonJanuary1CPIvalues5Employers’CostIncreasesOut-PaceOtherIndicators

Largestincreasesince1990(allemployers)Includesmedical,dentalandpharmacySource:2002Mercer/FosterHigginsNationalSurveyofEmployer-sponsoredHealthPlansResultsforEmployerswith500ormorelives6.9%18.6%16.7%17.1%12.1%10.1%8.0%-1.1%0.2%6.1%7.3%8.1%11.2%14.7%2.1%2.5%-2.00%0.00%2.00%4.00%6.00%8.00%10.00%12.00%14.00%16.00%18.00%20.00%1987198819891990199119921993199419951996199719981999200020012002EmployersCPI-MedicalCPI-AllItems6AggregateHealthCareSpending(1980–2010)

Governmentportionofpaymentsincreasing;totalprojectedtobeover$2trillionby2009Source:CMS7MedicalTrendsPopQuizHowmanyyearswillittakegrossmedicalcoststodouble,assumingnospecificemployerinterventionsornationalhealthcare?10ormore98765orfewer8MedicalTrends

Responsesfromagroupof25actuarieswhohadtimetogettheircalculators9LegislationMedicarePrescriptionDrugsIfmadeintolaw,willhavemajorimpactonretireebenefitsandstrategiesInitialconfusionaside,shouldhavepositiveimpactonretireeplansExpectcostshiftingtonegativelyimpactactiveplansEEOCProposedchangesinADEAregulationsClinevs.GeneralDynamicsWellsFargocaseAppearstoallowpre-funding(andtax-deductibility)ofentireretireeliabilityanILPapproachwon’tbeexactlysamenumberasFASliabilityfundinginyears2+wouldbelimitedtoservicecostIRSweighingitsoptions10ProposalstoIncreaseCoverageAmongEarlyRetirees

FewgovernmentprogramsexceptforfinanciallyindigentCOBRAextensionsand/orMedicarebuy-insProhibitionsonpost-retirementbenefitreductionsExpandedpre-fundingforretireemedicalStillfewviableproductsforpre-65inindividualmarketthatovercomeaccessandaffordabilityissues.11ADEAIssues

ImpactonretireemedicalcoverageAgeDiscriminationinEmploymentAct(ADEA)prohibitsdiscriminationagainstpersonsage40orolderintermsandconditionsofemploymentAge-baseddistinctionsinemployeebenefitplansarepermissibleonlyif:Aspecificstatutoryexceptionapplies,orEqualbenefit/equalcosttestissatisfiedPlanmustprovideequalbenefitsforolderandyoungerworkers,orPlanmustincurequalcostsforolderandyoungerworkersThirdandSixthCircuitCourtsreachdifferentconclusionsEEOCreviewingADEAregulations12MarketplaceChanges

ConsolidationofMajorHealthCareCarriers

Employeroptionsaregreatlyreduced,carriershavemorecloutUnitedHealthcareHealthSourceProvidentCIGNAEquicorMetrahealthUSHealthcareAetnaTakeCareFHPPacifiCareHealthSourceCIGNAAetnaUSHealthcareNYLCarePrudentialHealthCareFHPPacifiCareProvidentTransamericaEquitableHCAMetropolitanPartnersAetnaGSDHPLincolnNationalHPsTakeCarePacifiCareHealthPlanofAmericaWellPoint/BlueCrossofCaliforniaHancockMassMutualTravelersUnitedHealthcareAetnaPacifiCareHealthSystemsWellPoint/BlueCrossofCaliforniaCIGNABCBSofGeorgiaMultipleBCBSPlansFewerMajorBCBS13MarketplaceChanges

PBMconsolidationcontinues;threemajornationalPBMsremainCPIAPICPNRxNetValueRxDiagnostekPerformHCSHPIDiagnostekValueRxRxNetColumbiaValueRxExpressScriptsExpressScriptsNPADPSExpressScriptsPAIDMEDCOAdvancedParadigmAdvanceMedcoIntegratedPrescriptionSolutions(IPS)PCSFoundationMerck-MedcoMerck-MedcoProadvantageSystemedParadigmMerck-MedcoMedcoAdvancePCSMajorInsurersMajorInsurersMPSPCSClinicalPharmacyAdvantage14PopulationTrends

AgingbabyboomerswillincreasetheelderlyandnearelderlypopulationsDataSource:U.S.CensusBureauStatePopulationProjectionsBabyBoomersYearofBirth1946to1964Source:U.S.CensusBureauasofJanuary2000U.S.Population,2000ProjectedPopulationMillions15NegativeTidalWaveofAvailableTalent

Poolof“primeworkers”willbedecreasing

Source:DRI,WorldatWorkJournal,fourthquarter2001PercentChangeinPopulationbyAgeGroup,2000-10-20%-10%0%10%20%30%40%50%60%5-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-79The“Echoboom”

ages15-29ShrinkingPoolof

“Primeworkers”

ages30-44Aging“Babyboomers”

ages45-6916ImpactofDemographicsonHealthCareCost

Costincreaseswithage0.000.501.001.502.002.503.0020-2425-2930-3435-3940-4445-4950-5455-5960-6465+AgeRelativeCostbyAgeMaleFemaleAverageemployercost=1.0RelativeCostsByAgeandGender17HealthDeterioration

AcauseandaconsequenceWeeattoomuch--64.5%ofadultsoverweightPopulationwithdiabetesincreasedover50%inlastdecade*Overweightisroughly10to30poundsoveranidealweight.Obesityisroughly30poundsoveranidealweightSource:NationalHealthandNutritionExaminationSurvey45.0%47.0%47.0%56.0%64.5%18IssuesFacingBusinesses

Theperfectstorm

Lowambientinflation;highmedicalinflationAdvancesinmedicaltechnologylikelytoleadtohighercosts,difficultdecisionsLegislativeuncertaintyConsolidatingmedicaldeliveryandfinancingsystemAnagingworkforceIncreasedlongevitySlowingeconomyDisappearingover-fundedpensionplansFew,ifany,obviousandeasyalternativestomanaginghealthcarecosts19Empl阁oyer征Out原lookEnv睬iro您nme独nta赠lo馋utl绞ook欧sp跃urr所ing门em辣plo非yer再ac笔tio压nEmp朋loy帆ers岗ac设ute鸦ly侦awa损re冈of介tre饲ndsHei辰ght效ene视di顷nte倾res神ti嘉nc兽ost轻sa蛾vin愉gs江tra至teg满ies粥(a唱cti己ve钱and肤re狠tir罢ee)Grea梯ter笋emph逢asis剖on谅long踩ert止erm动cost毁pro卖ject隐ions娃and呜on枕the午“bot振tom撤line想”Pro技jec忧tio显nr眼esu回lts乐ha叮ve转ind做uce源d“叉fig拨ht慨or博fli扛ght吧”r拆esp愉ons垄es20Ret屡ire亿eM厘edi竖cal捏Co甲ver充ageEmpl固oyer谋sco弊ntin申uet罩odr皇opr坝etir作eem锻edic姨alc疾over铁agePercentageofEmployersOfferingCoveragetoFutureRetireesBasedonemployersof500ormorelivesrespondingtothe2001Mercer/FosterHigginsSurveyofEmployer-SponsoredHealthPlansWhencoverageisoffered,retireepremiumsandout-of-pocketcostsoftenincrease21Agen宪daThe廉Envi芝ronm祖entThe坝Catc拦h-22Pat瓦hs木Awa郊yf胳rom日Tr饼adi母tio盯nal统De静liv狗ery贪:T罗wo紧Cam盖psOppo近rtun瓜itie屯sAl格ong腰Path喜2The周Answ罪erAddi铜tion岸alT出opic培s22The土Catc弓h-22Red费uci鉴ng剃emp悦loy毙er怒cos侧tt帜ypi凤cal斑ly染imp辞lie腰si葡ncr筋eas往ing溉em怒plo酸yee抹/re饶tir网ee摔cos虾tEve太ntu柴all右yr名uns合ag讽ain饲st终emp厅loy挑er’尺ss钱ens黑ibi顿lit普ies秆re乒gar剪din休gf味air感nes正s,纳pat记ern不ali牢sm劝(if妈pr往ese疼nt)摇,a阅nd腥the废co叨nce架pt老of碎ben也efi苍ts氧gen医era当llyExa迁mpl火e(身FAS涝10严6):推“L哪owe稳rm孙yl灰iab串ili舟tie市ss绪ign史ifi闻can库tly莫bu械td井on’双td疤oa缩慧nyt堤hin爷gh程ars酿ht压oo耽ur尊ret攻ire铺es…押the静yw付on’亩ta慎cce辰pt脖it”Tot航hee正xten细tth纯atr膏etir厅ees脊repr袄esen锁tth压ebu北lko辜fth冈eli液abil纷ity,佛thi松sis垦av谷ery拨diff跪icul愿tpr陕opos获itio今nOppo父rtun马itie小sex肯ist约toc安hang杯eel浸igib汪ilit酒y,d矩esig鬼n,飘etc.槐for魔fut腊ure引reti侮reesIfw刊edo严n’t俊take杀cos疫tou幻玉tof脑thesys平tem,ei坊ther污the照emp袋loye珍ror痒the拜emp舍loye委es/r留etir帝ees相will嘱pay奏the冒inc须reas丈es23Agen古daThe睬Envi使ronm蛮entThe肠Catc凶h-22Pat惰hs扇Awa顺yf挂rom药Tr磨adi页tio史nal买De济liv哀ery梨:T布wo箱Cam固psOpp珍ort模uni嫂tie棒sA居lon球gP讯ath结2The盯An杆swe县rAdd座iti从ona脉lT走opi唤cs24Path容sAw扇ayf患rom曾Trad挥itio反nal后Deli猜very镜:Tw产oCa炊mpsEmpl觉oyer恋sth怨atb傍ecom指emo采rei遍nvol盾ved插inCha格ngi况ng弓emp燥loy妖ee丢beh涌avi艺orCha附ngi因ng皮pro谁vid披er脱beh壮avi爹orChan迈ging状pro碧vide掩rst尽hat蝇they弄wor氧kwi牌thCha方ngi乔ng叮the饱la栽wsEmpl扣oyer动sth昂atr队educ迟eth点eir胶invo炭lvem深ent锋byInc替rea变sin竟ge骆mpl潜oye险er概esp匪ons劣ibi搜lit轻yLim壮iti灾ng那emp趋loy姐er破cos袜tLimi刷ting葱emp搅loye抹rri群sk25Empl屈oyer它sBe丘comi团ngM脂ore钻Invo劳lvedColl无ecti叠veP零urch恳asin扰gHig严hP婶erf压orm茶anc因eN隆etw赖ork躁sDire扰ctC案ontr爬acti付ngCon郑sum堆er园Acc组oun执tab败ili塞tyLea曲pF万rogLob今byi败ngDis卡eas狮eM休ana乘gem愿ent洋/Pr脂eve尽nti声ve收Car而eWha借tt番hes督ea仗ppr掌oac磁hes疯sh乏are耽is主an氧ey依et浮owa挪rd着red迁uci旗ng泛cos并tf旱rom笑th结ee冲mpl楚oye柏r’s固sy他ste稼m,屠and潮in脖so疗me阻cas圈es,弹th它ee艰nti状re称hea柄lth骆ca够re异sys使tem弯.26Coll燥ecti尝veP瓦urch描asin腔gUse足em昼plo侦yer政an居dp非lan趴ma奔nag厚er亲clo渔ut矩to旦neg宝oti蛾ate度fa兰vor肿abl素ep益aym岭ent瓦ar寇ran竭gem防ent护sBack模grou谁ndTra启dit引ion勤al笑net咏wor旬kn沃ego喊tia好tio盏ns局are钉vo捎lum掌ed房诚riv男enAppr额oach尖est舱oac民hiev椒elo编wer爽cost欠sin蝇clud俘eAgg纳reg终ate杠dp挂urc跪has踏ing抽to按im穴pro见ve役neg租oti征ati睛ng疗str谷eng链thCoa方lit拢ion验sFor删mal遍al爸lia遥nce锦sInf根orm巴al艘all丹ian汤cesDir兆ect荣ing夜ca龟re天to螺mos似tc咐ost还-ef屑fec乒tiv秤es串our黄ce峡of伯qua踪蝶lit贼yc魄areRev封iew漆ing薪ef邻fec欣tiv喊ene蒜ss,揪ef件fic仇ien番cy席and盖“f帜it”遣of腹cu枣rre掌nt受ven粮dor序re镇lat旺ion遇shi娘ps;遇ch滩ang乖ing桌as每ap窃pro够pri俯ate27What邮is幼aHP鹊N?High恩Per抽form退ance绒Net饰work裂:Ahe箩alth邮pla回npe古rfor性manc出eim传prov挠emen倍tme予thod棚tha撒tst旁eers荡car惕eto休pro势vide啄rst闸hat轿meet巩spe生cifi掀cef朽fici他ency蹦and蝇qua旦lity桑cri馆teri欢a28Rati暴onal馋efo婚rHP声NsNew府mana阿geme杂nta灰ppro云ache资sar食ene坏eded乖in茧this竭era碧of污cost优acc鸟eler偷atio锁nPati黄ents倡and装phy马sici模ans损are巧the肯key常driv绞ers镜ofh危ealt联hca摊rec豪ostsBut犁th慨ey轻hav赖el典imi卫ted券or般no漂in撤cen播tiv金et斧oc纳are纲ab捞out狠co援stsThe熟hear惯tof哀the尘Hig虫hPe麻rfor顽manc爱eNe聋twor泊kco暖ncep势tis至to演chan旋get巴hep瓦rovi删der阿sele颈ctio题nbe筹havi申oro毁fpa膊tien摘tsa棵nd/o凝rph淋ysic骑ians29Hig艳hP薯erf咽orm要anc飘eN漂etw撇ork获sNet怜wor巡寿km猴ode台lsLim腿ite拾dN爆etw畜orkAs乌ubs祸et睡of影an商exi摆sti卵ng饼pro框vid怨er解net裙wor名kc披omp同ris娃ed爽of登hig观hp度erf杰orm壤ing哀pr肠ovi眼der腔sTier公edN闸etwo迁rkEmpl既oyee刚cop眼ay/c拔oins投uran请ced庭iffe族rent多ials防to呼enco鼠urag端eus祸eof室hig越hpe消rfor舟ming新pro顾vide拒rsPhys沫icia鹊nPa雄rtne稀ringAna皂rran岂geme吉ntw惨ith组(typ眠ical斯ly)败prim争ary自care佳phy闷sici增ans发toe旨nhan勿cee晨ffic猎ienc亿yCon换sum窜er救Dri佳venDep观loy被men味to配fp全erf少orm堆anc遥ei风nfo扫rma止tio罚nt绿oc齿ons窄ume踢rs低to绒imp贫rov源ep悲rov治ide骨rs挨ele覆cti汇on30Dire触ctC掉ontr延acti映ngLarg摆eem踪蝶ploy拥ers棚with详sig障nifi蒜cant甩mar么ket兆pres喘enceMay窑be忙ab妄le立to剖ach若iev际es眨ign勇ifi悔can窃ts亭avi嫁ngs排by此co们ntr煌act汁ing旁di返rec故tly垦wi贞th是hea跳lth偷ca图re蔬pro坟vid魄ersMay番ne愧ed蔽gro纽奉up忌of翅reg索ion唤al盼emp符loy繁ers首to俭ac扯hie明ve岔cri岔tic扁al缎mas具s31Pro造mot怕eC息ons涌ume恋rA捐cco厘unt停abi若lit证yHel云pp雁ati浊ent点sb必eb桶ett打er盏con驴sum士ers某of械he采alt背hc尖areBac彩kgr球oun咏dIfh宪alf何ofc绑ost信isd貌uet励oli冬fest壤yle泪and摆half索of办chro岔nic昆pati单ents荷do原not床foll召owt丝式reat慈ment境pla糕n,w槐hat然can企wed熄o?Get岸me银mbe王rs’组at锡ten吓tio庸n–积ma是ke择the长ma鹅war骨eo莫fc秩ons域equ萍enc栋esAppr壤oach酷est恶oen郊cour子age材cons砌umer夫inv鸭olve煌ment援inc嚼ludeCoor糖dina立ted省heal家thp霜romo摄tion催,di拉seas牲epr聚even刺tion嫁and节edu伸cati届onal橡pro义gram太sTyin建gem拢ploy亡eec裕ost摄incr解ease啊to壳tren桨d“De终fin建ed葬con粪tri眨but况ion鹿”h纠eal嗓th腿pla搂nsCon若sum鹅er摘dir脾ect脆ed繁hea粮lth束ca么reRe-上int棍rod搁uct描ion骆of扁co素ins乖ura酷nce32Eff抱ort五st此oI当mpr功ove拴Qu茂ali碍ty乎of否Car帆ei今nH税osp很ita这lsLea屿pfr关og威ini诱tia症tiv醋eThe础Leap壶frog风Gro温up:描Back缴grou笛ndForm院edi延nre吴spon惊set炊oIn后stit伴ute疮ofM远edic收ine雪stud屯yof杨err登ors头inh鸟ealt软hca葡reGoa棕l:弓Maj始or汗gai蒜ns佣in班pat薄ien长ts远afe钉ty,纲cu适sto哪mer育se址rvi圾ce桐and当he蜜alt豆hc递are乓af晌for泼dab谈ili闸tySpon阳sore捕dby告Bus滴ines凑sRo细undt转ableEmp沫loy析ers终in回Le笑apf志rog婚Gr知oup燥us原ep忌urc纯has采ing躺po势wer芒to进en府cou倡rag倦eh昨eal文th围car职ep助rov住ide晴rs橡to便ado中pt备pat脚ien落ts含afe拌ty浆sta晋nda轰rdsLeap鹿frog虽sta吓ndar蹦dsi伞nclu贪de:Com槽put迅eri赞zed进sy轧ste页ms浅in菌hos揉pit侵als民to柏im技pro勇ve预the倘ac关cur真acy减of赔ph蜂ysi淘cia摊ns’蛮pr鸦esc耍rip明tio槐ns水and争mi宿nim耗ize速me蔑dic缠ati译on威err咐orsStaf坦fing就of县inte捡nsiv哄eca泳reu耐nits宅by净phys按icia呜nst低rain市edi缎ncr伍itic挽alc楼are欣medi漏cineRef认err汤al祖of忆pat袖ien罩ts捡req樱uir敏ing字ce驻rta饲in香com内ple导xp魄roc兄edu段res黄to妥ho倚spi摔tal碰so河ffe拼rin贫gt畅he芝bes鹊tr苍esu冒lts33Lobb寸yingSome胡emp垫loye脑rsm厉akin索gpr虫esen假cef踪蝶elt迁onC侮apit助olH惠illMan涉yh贺ave奋be脑en蜓act潜ive烟fo拥ry键ear列sa著nd吐are钳re浑cog拾niz怠ed央as发imp填ort龟ant爪vo笨ice伙sSome毁lar啊gea枯ssoc竟iati但ons纺have汉sim号ilar质goa竿lsa芽ndr福epre疼sent扑lar没gev林otin着gpo乐pula般tion微s34Pre反ven害tiv届eC棵are耀an得dD汤ise励ase拥Ma吉nag嫁eme法ntAcr韵oss砖th板e

H批eal稳th净Car冲eC狮ont丘inu滨umPro询gra框ms该sho宏uld揉be霞ta障ilo燃red巾to堤th倦en会eed补sPreventionScreeningsHealthRisk

AssessmentTargetedRiskReductionProgramsRiskModelingNurseAdviceLineWebToolsConsumerDirected

HealthPlanDisease

ManagementIncentiveDesignSelfManagement

TrainingCaseManagementDecisionSupportPredictiveModelingWellNoDiseaseAtRiskObesityHighCholesterolAcuteIllness/

DiscretionaryCareDoctorVisitsEmergencyVisitsChronicIllness

DiabetesCoronaryHeartDiseaseCatastrophicHeadInjuryCancer85%members=15%cost15%members=85%cost35Emp位loy盖ers鹊Be麦com仍ing刮Mo岁re简Inv染olv卵edSumm之aryTypi涝call广yth传ela截rger苹emp淘loye袍rs“Fig递htin骂g”t宾och兽ange莲the卵way裙hea竹lth逗care藏del因iver箱edt彩oow健nem才ploy串eesGoa率li纹st蛋op剪rod颈uce疫be拖tte制ro遍utc氧ome汉s……And针lowe途rco聋st36Emp苏loy脚ers登Be粥com盛ing童Le如ss盖Inv奸olv循ed漠(Ca衬mp胆2)Empl呜oyer伸sde压sire畏to泄“kno锹wth输eir歪cost短”Dol俯lar拐-ba辨sed委pl丝式ans毒(o累fte张na涛cco撤unt绞-ba超sed寨)Reim问burs脂emen漫tpl肉ansAcce透ssO允nly嘉plan谣s“Cap斩ped浇Plan阴s”…t络ypic敬ally城ret点iree抽med躬icalWhat颈the堵sea饰ppro恼ache薄ssh红are甚isa践ney竭eto帽ward捐red仙ucin算gem命ploy偿erc勒ost晶att鼻hee叙xpen董seo男fem绍ploy兵ees/棕reti焰rees37Acco抓unt-假Base灿dAp慎proa捐chesDef嘉ine谎se盆mpl拐oye秤r’s下co握mmi坦tme堆nt鼻as农ad弱efi弟ned柴do觉lla垮rc料ont皱rib锦uti德on他ins苗tea摧do鸦fa卖de统fin仿ed姥med烧ica午lb赴ene罪fitCom循mit膜men予tc淋an苦be钞mon钩thl侨y,傲ann牲ual体,a其ggr混ega子teCom舌mit各men陵tc远an液be怕bas盈ed蚀on震ret迁ire透e-o泼nly仇or漂re哨cog牧niz针ed框epe树nde端ntsAmou陕nts众avai枣labl港efo封rhe煌alth杯car虾eon涌ly;梳empl爆oyer御con已trib煌utio倘nsa阳ret端ax-f遗ree值tot匀her要etir或eea求ndd肠educ罪tibl怪efo抢rem校ploy瞒eru迁nder骑Sec慢tion切s10赢5,1凡06a禽nd1督62o劳fIR锡CCan信bef港unde索dor谈unf跪unde盛dFor罩Medi悦care技-eli声gibl怎e,M券edic狠are+尽Choi腹ce,缩慧Medi遮gap豪and烂trad饿itio瓶nal拾Medi顷care机ava分ilab惠le;妖HIPA领Ama避yev川entu它ally积mak钓eth河isa才via割ble唤opti话onf挑orp给re-M吓edic各are选reti铸rees38Acc现oun沾t-B泪ase拣dA仓ppr抖oac扭hesExa哄mpl励esMont精hly/貌annu图alp呈romi仆seReti立rees遣rec造eive好mon虫thly竖(or棚ann米ual)未cre杯dits第of进asp差ecif毒ied释doll萌ara近moun灿t(e证.g.,纪$10族0/mo乓nthl梳y;$主5/mo吵nth/瞧year浮of雹serv厉ice聋for烤20y俩ears灰of沸serv象ice)Fixe晨dor疲inc废reas牲esa蛛nnua夏lly;脖“fl击at”大ort嗓ied阔tos抓ervi匠ce;敬amou汉ntn凶otu费sed笼can窑bec幻玉arri附edo夜ver刺orn娇otAggr陈egat折e(“帆lump斗sum累”)p夏romi约seEmp拘loy说er昌pro醉mis茂ei筑so充ne-票tim拿ec殿red皇it亚(e.油g.,喉$3启0,0颜00;扬$1旬,00歌0p舱er危yea唉ro别fs煌erv括ice计fo子r3挠0y挽ear阿so烫fs偷erv谈ice诵);男acc舌oun醒ts单ear糊ni国nte史res掀t(常e.g痒.,黑at迁T-b好ill喷ra类te)仰or眼no拦t;煌no徒emp仗loy承er宁pre尾-fu精ndi微ng否req路uir化edPay困men揪to兔pti隙ons“Dra冲w-do匠wn”僚onf亦unds借(re妨tire滥eus柏esf吴unds愿to弯pay耻port荷ion像ofr忌etir延eem教edic李alc跪ost;壶end坊swh柜enf氧und嚷exha尾uste腥d),邪or“烂lump跑sum准”is竖con养vert敢edt溜oan堡ann昼uity宏(mu帆ltip丸leo抬ptio管ns)39Rei侮mbu寺rse驻men葡tP岸lan担sEmp将loy息er松oft父en匙req栽uir格es扁sub雕mis疫sio享no勉fr刻ece子ipt甩sf笼or鸽hea轿lth混ca忧re运exp戏end斥itu走resPre题miu脏msOut饿-of酷-Po养cke策tc观ost检sTypi虾call势yde少fine跃dwi燥tha峡max暴imum驾rei萍mbur捕sabl果eli钞mit怒(e.g促.$7利5/mo慢nth)Mos各tc绢omm牲on普is呀rei隔mbu扶rse脾men瞒t(说or扶pre圆-pa惜yme创nt)赏of淹Me示dic否are吊Pa怕rt爬Bp疗rem遣ium挡fo场rM掏edi忽car见ee盒lig附ibl并er欧eti电ree伴sCur帜ren铜tc苦ost晒$5精8.7迅0p升er上mon坡th烟wit胖hm皇ode仙rat可ey叔ear唱-to歼-ye残ar副tre桨ndsEmp恼loy矛er医mot势iva爬ted珠to券en驱sur悬eP束art从B嘱in窜eff绵ect何fo激rM迷edi兔car萍e-e拿lig万ibl太er毙eti减ree稀sPar铺tD陈re什imb矮urs支eme降nt命may拼be漠com恐ep裙opu赴larEmpl沸oyer罚ach编ievi缘瑞ngEsc而ape汁fr霉om孟pla遮ns乳pon袜sor鼻shi扬p(闷for吗wh燃ich们eve年rs凶egm粪ent塌of乎hi均sp慰opu稿lat氏ion悉th趟ep躺lan郊ap暗pli柏es剪to)Fix浙ed超cos雁ts;觉in烛cre驼ase杂ss怀ubj窑ect弟to补em啄plo柳yer沈di厅scr句eti拣onNot易a恳tax六-ad名van惕tag画ed弱app古roa们ch40Acce稻ssO尾nly罚Plan筑sEmpl暗oyer务“sp菊onso键rs”梨comp溪any妨heal旺thp卡lans粗(st盆ays结“in赚the日busi亭ness裙”)By茄doi字ng释so,授re能tai胡ns粘gro绕up葱und尸erw获rit事ing三,p泰ric洲ing广an昆dr申isk欠pr州ofi莫leEmpl垄oyer音con国temp亡late班sno惰sub拦sidyFull谁cos依tan匪dan权nual背inc周reas池esa还bsor缘瑞bed锄bye瞒mplo愚yees白/ret晕iree瞎sFull胖yin路sure在dpl众ansWor茄ks胜bes君tCost阀skn忌own耐ina体dvan拴cePre藏miu流ms扒fix煮ed辣in傅adv袖anc羽eSelf龟-ins择ured下pla两nsRequ州ires着mor泊ema辨nage溪mentCos刮ts颤not泥kn版own纪in蜜ad澡van详ceBut鸭pr龄emi蚂ums白mu贴st穗be得fix贫ed始in膏adv玻anc诵eCaut备ion辱rega绿rdin辆gac臭tive像/ret粱iree蜘sub贫sidyMay犹im青pac才to裳the释ra扭cco征unt萝ing才(F苹AS掌106请)41Capp送edP李lans“Emp西loye徒rco战stw躁ill山bec轻appe记dat吸2t梅imes灭the再199净3co母st”Impl算icat记ion听ist户hat蛇empl银oyer联sha宴reb雨ecom承esa戏fix脑edd斧olla域rco向mmit狗ment纺at碗some演poi围nti瞧nth喘efu龄tureTyp庭ica芒la塘cti翅on龟tak吉en堂in腰ear殿ly览to屈mid找19浮90s浮fo医rr悼eti仁ree卵pr质ogr中ams文in梳re丢spo管nse移to馆FA恢S1就06;来li敬abi够lit垦ies欲ap苍pro破xim册ate促ly谢½o亦fu草nca鬼ppe担dp膏lan乏sMan我yc沈ave当atsUsua没lly饰appl笔ied距only绒to归thos剪ere攻tiri弦ngp捉ost-击anno固unce摇mentEva伶lua军te鞠sep辟ara固tel细yf季or变pre晌-Me仍dic显are翼el罢igi废ble台vs李.M糊edi固car犹ee挖lig愚ibl伶e,翁or至in悔agg嫁reg财ateEva劳lua乎te或per智re留tir嗓ee仔or嘉in舌agg煌reg货ateDefi非niti仍ons缎of“工prem喷iums肝”an兼d“c妈osts炕”cro撇ss后sub含sid授yo河fa泪cti烂ves响/re扬tir闷ees游ca呈nc缠lou易dc胸alc脖ula秒tio些nsNeed蒸cle店ard悬efin没itio纺nof饰how号cos坛tsa沸ndc赢ontr均ibut辟ions寒are萄cal花cula马tedbef良orecap钳is浊hi扰tEnro子llee奏swi今llu梅nder态stan舰dco是ncep毒t,b枕utl定ikel教ywo先n’t络bep丽repa豪red瞎for易even渴tual淘inc饭reas父es42Emp范loy作ers制Be池com繁ing羞Le软ss阅Inv蓝olv根edSum溪mar句yFocu艳sing丽on结appr灯oach黄est去hat朵allo亡wa浓fixe右dem哑ploy廊erc尚ommi阔tmen蜂tRisk坦tra抛nsfe纺rred漠to卖empl朗oyee收s/re驾tire岸esIn败som萍ev鸡ers薯ion始s(考cap访s),谎no毅im冈med造iat盏ei什mpa教ct残fel悲tb内yp够art朝ici尿pan盐tsCom读mun符ica它tio勒ni仙sc显rit凤ica松lEmpl插oyer裳sco厦ncer罗ned析abou周tpa涉rtic字ipan疫tre北spon义se43The堤Two改Camp型sSu判mmar浇izedFigh忍tor甜Fli蒜ghtThe佳la貌rge肺st款emp耀loy竭ers怎se巩em俗wil帅lin蒙gt诊ot铃ry仙to梦cha磨nge略th穷ew烟orl挖dMid徒si伙zed锐an厚ds产mal选ler险em贡plo石yer里ss泳eem芝to酬wa臂nt低to获“ge竟to煌ut”先of向th但er隶esp违ons铸ibi倦lit扬yNeit掀her闻refl袄ects隐the华tra浆diti款onal王way秤of页prov短idin夜gbe女nefi葬tsFoc活us风on炭emp唐loy滨ers肤re由duc腰ing枣in如vol门vem与ent犁,u榴sin托ga药ge瓜ner广ic朋def著ine水ddol娘lar愁(d真efi变ned朽co刮ntr窗ibu逢tio由n)桨app堂roa平ch44Age羡ndaThe快En丝式vir妨onm滑entThe乏Ca恶tch痰-22Pat踩hs资Awa饼yf凭rom普Tr霜adi禾tio旁nal锯De棍liv橡ery自:T矛wo纳Cam孩psOppo用rtun呢itie观sAl星ong刮Path板2The叔An齐swe动rAddi拉tion舰alT没opic窗s45Whe承re挠can习we今ap葱ply彼“D窜efi修ned晃Co择ntr及ibu策tio零n”湾app嫁roa垃che翻sm值ost急ea挡sil墓y?Act尸ive品em魄plo奔yee雾s/e奏arl乐yr盆eti树ree家sEmp鸣loy医ers垦wi亭ll翻sti观ll悟nee琴dt宇o“劣spo事nso测r”雁ap泥lanCan礼se顶te榨mpl兰oye附ec蜓ont韵rib仿uti尊ons谎to括me就et恶des仗ire姥dc粱ost震sh鸣are锁an晒da象llo冶we械mpl剥oye棒es爸to狱buy街ba倚ck颜int缎oa捐se李lf-拒ins督ure驱dp阶lanEas酷ies戏tc昏alc足ula庄tio煌ni敞fu戚nde晶rly屑ing柜pl符an铲is危ful刻ly葱ins刘ure基dMedi绑care倦Eli盈gibl刘eRe厅tire庄esEmpl谷oyer民sma煌yac粗tual察lyb马eab六let于oge将tal畏lth后ewa和you你tEven凡if慰comp意any西spon联sors债no眼Medi逃care俯eli化gibl雀ere蓬tire锄epl傍an,芒opti谱ons播avai闷labl孩ein舞mar巴ket阀for阅reti族rees孙to妹choo近sef掘romSom债ew挠ith厉li浑ttl阶eo夏rn捕ou杯nde扫rwr掀iti马ng循(re团mov巩es在acc坊ess花pr泽obl扔em)萌bu誓te汤lig壳ibi赤lit晌y/t粒imi村ng猎imp遗ort版ant46DC赠Hea念lth尊Pl播ans昨in昂th伤eS供pec专tru天mo该fE复mpl苏oye旱rC烘ont孔rib泰uti划ons%ofCostEmployerpaysX%

(e.g.,80%)ofcostofhealthplans;employeepaystheremainder.%forBenchmark;DCforOthersEmployerpaysX%ofcostofonespecifiedPlanA(“preferred”or“employer”plan).TheamountofemployercontributionforPlanAbecomesthedefineddollarcontributionforPlansB,C,…;theemployeepaysthebalanceincost.PureDCEmployerpays$Zperemployee.Employeemustpaybalanceforwhateverplanispicked.Theemployercontributionisnottieddirectlytothecostofanyplan.EmployerContributionLevelDCHealthPlans%ofCostNoContribution(wagesonly)%forBenchmarkPlans;DCforOthersPureDCFullCostHighLow47Medi壳care雅+Cho沟iceHeal缓thp孤lan炒take责sri全sk,傻rece狸ives梦“ca斯pita婶ted”辅pay尽mentMedi习care骨“Pa钥rtC笛”(M罚edic叶are捷Adva趴ntag讲e?)Hea必lth斑pl酷an沃off赵ere话db军yp花riv渣ate捷in跃sur民anc档ec励omp沈ani救es,抓us笔ual吓ly顾on否an疫HMO笼-li裹ke蛮bas勇isBen罗efi欢ts言bro闸ade琴rt辞han贵Or喜igi螺nal突Me先dic那areRedu很ced庸out椅ofp巡寿ocke苍tex塔pens佣esf领ord贩educ蜂tibl窗esa豆ndc劈燕opay谋ment页sMay松of锹fer妹pr钓esc虽rip恩tio所nd掘rug达co寄ver摇ageMedi说care百pay辟sa锄set互amou桨nto童fmo啄ney头top陕riva风tei室nsur榴erMay失bea疑ddit省iona显lpr罪emiu汉mco动sto犬ver祝Part位Bp胀remi极um(赵full剑yin甩sure让dto明emp善loye刷r)Avai静labl暖eon押lyi爽nce哭rtai君nar兰easRece导ntp混riva足tei腿nsur消erp侄rofi临tabi讨lity禁poo向ran全din崭sure页rsh