CALIFORNIA Health Care Almanac APRIL 2023 California Employer Health Benefits Cost Burden on Workers Varies California Employer Health Benefits California Employer Health Benefits Survey, 2022 Executive Summary In 2022, 64% of firms in California offered health benefits to at least some of their employees. Sixty CONTENTS percent of workers at those firms were covered by their firm's health benefits. Premium costs are typically shared between employers and workers. Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 California Health Benefits: Cost Burden on Workers Varies presents data compiled from the 2022 KFF Coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Employer Health Benefits Survey. Cost of Health Insurance. . . . . . . . . . . . . . . . . . . . . . . . . 12 KEY FINDINGS FROM THE 2022 SURVEY: Benefits and Cost Sharing . . . . . . . . . . . . . . . . . . . . . . . 20 • Annual premiums for covered workers in California averaged $8,083 for single coverage and $22,818 for family coverage. Employer Views and Practices. . . . . . . . . . . . . . . . . . . . 31 • On average, workers paid 15% of the cost for single coverage ($1,167 annually) and 30% for family Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 coverage ($6,680 annually). • One in five covered workers with family coverage paid more than half of the premium. Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 • The average deductible for covered workers with single coverage and a deductible was $1,464. Single coverage deductibles were higher at firms with fewer than 200 workers than at larger firms ($1,850 vs. $1,354). • Fewer covered workers in California had a deductible of $1,000 or more than workers nationally (42% vs. 61%) in 2022. However, nearly one in four covered workers at small firms in California had a deductible of $2,000 or more. Note: See the current and past editions of California Employer Health Benefits at www.chcf.org/collection/california-employer-health-benefits-almanac. CALIFORNIA HEALTH CARE FOUNDATION 2 California Employer Health Benefits Employers, Workers, and Covered Workers, by Firm Size Overview California vs. United States, 2022 In 2022, California firms with three NUMBER OF WORKERS to nine workers accounted for 59% ■ 3–9 ■ 10–49 ■ 50–199 ■ 200–999 ■ 1,000+ of all employers. However, only 8% Employers of workers and 5% of workers with CA 59% 32% 6% health coverage were employed by 2% 1% those firms. US 59% 33% 6% 1%<1% Workers CA 8% 16% 13% 13% 50% US 7% 16% 13% 14% 50% Covered Workers CA 5% 13% 12% 15% 55% US 3% 11% 12% 16% 57% Note: Figures may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 3 California Employer Health Benefits Employers Offering Health Benefits, by Firm Size Coverage California vs. United States, 2022 In 2022, 64% of all California PERCENTAGE OF FIRMS OFFERING HEALTH BENEFITS employers offered health benefits to at ■ California ■ United States 99% 99% 100% 99% least some of their employees, higher 92% 91% than the national average. Virtually all firms with 200 or more employees 76% offered health benefits to at least 72% 73% some of their workers. 64% 58% 55% 51% 39% All Firms* 3–9* 10–24* 25–49 50–199 200–999 1,000+ Number of Workers * Estimate is statistically different between firms with workers in California and all firms nationwide within group (p < .05). Note: Estimates are based on both the sample of firms that completed the entire survey and those that answered just one question about whether they offer health benefits. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 4 California Employer Health Benefits Worker Coverage Rates, by Firm Size Coverage California vs. United States, 2022 At firms that offer health benefits, PERCENTAGE OF WORKERS COVERED AT FIRMS OFFERING HEALTH BENEFITS 60% of workers were covered by their ■ California ■ United States firm's health benefits, in California and nationally. The 40% of workers at these firms who were not covered by their firm's benefits may not have 61% 61% been eligible, declined coverage, or 60% 60% 60% 58% were covered on another plan. All Firms All Small Firms All Large Firms (3–199 workers) (200+ workers) Note: Worker coverage rate is the share of workers covered by their firm's health benefits. Tests found no statistical difference between firms with workers in California and all firms nationwide within group (p < .05). Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 5 California Employer Health Benefits Worker Coverage Rates, by Firm Characteristics Coverage California, 2022 Workers in firms with many workers PERCENTAGE OF WORKERS COVERED AT FIRMS OFFERING HEALTH BENEFITS with higher wages were more likely All Firms 60% to be covered by their firm's health Public 67% benefits than those in firms with Private Nonprofit 62% fewer workers with higher wages. Private For-Profit 58% Workers in firms with union workers Many Older Workers 62% were more likely to be covered than Fewer Older Workers 59% those in firms without union workers. Many Younger Workers 41% * Fewer Younger Workers 63%* No Union Workers 56%* Some Union Workers 67%* Many Workers with Higher Wages 70%* Fewer Workers with Higher Wages 50%* Many Workers with Lower Wages 42%* Fewer Workers with Lower Wages 62%* 0.0 12.5 25.0 37.5 50.0 * Estimates are statistically different from each other within category (p < .05). Notes: Worker coverage rate is the share of workers covered by their own firm's health benefits. Firms with many workers with lower wages are those with 35% or more of workers earning $30,000 or less per year. Firms with fewer workers with lower wages are those with less than 35% of workers earning that amount. Firms with many workers with higher wages are those with 35% or more of workers earning $70,000 or more per year. Firms with fewer workers with higher wages are those with less than 35% of workers earning that amount. Firms with many older workers are those with at least 35% of workers age 50 or older. Firms with many younger workers are those with at least 35% of workers age 26 or younger. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 6 California Employer Health Benefits Enrollment of Covered Workers, by Plan Type Coverage California vs. United States, 2022 Compared to their national DISTRIBUTION OF COVERED WORKERS counterparts, covered workers in ■ Conventional ■ HMO ■ PPO ■ POS ■ HDHP/SO California were more likely to enroll in All Firms HMO plans and less likely to enroll in a CA 32%* 37%* 12% 17%* PPO plan or an HDHP/SO plan. 1% US 12%* 49%* 9% 29%* 1% All Small Firms (3–199 workers) CA 39%* 34%* 18% 8%* 1% US 11%* 44%* 18% 26%* 2% All Large Firms (200+ workers) CA 29%* 39%* 9% 22% <1% US 12%* 51%* 6% 30% 1% * Estimate is statistically different between firms with workers in California and all firms nationwide within coverage type (p < .05). Notes: HMO is health maintenance organization. PPO is preferred provider organization. POS is point-of-service plan. HDHP/SO is high-deductible health plan with a savings option, such as a health reimbursement arrangement or health savings account. Figures may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 7 California Employer Health Benefits Firms Offering a High-Deductible Health Plan with a Savings Coverage Option, by Firm Size, California, 2022 Compared to other plan types, PERCENTAGE AMONG FIRMS THAT OFFER HEALTH BENEFITS HDHP/SOs have higher deductibles on average but typically have lower ■ All Firms ■ All Small Firms ■ All Large Firms (3–199 workers) (200+ workers) premiums and a savings option. Over half of large firms (55%) offering health benefits offered a high- deductible health plan (HDHP) with 55%* 52%* a health reimbursement arrangement (HRA), a health savings account (HSA), or both. 2% 2%* 7%* 7% 9% 6%* 5%* HDHP/HRA HDHP/HSA-Qualified HDHP/SO * Estimate is statistically different between small and large firms (p < .05). Notes: An HDHP/SO is a high-deductible health plan with a savings option, and is defined as (1) a health plan with a deductible of at least $1,000 for single coverage and $2,000 for family coverage and offered with a health reimbursement arrangement (HDHP/HRA), or (2) a high-deductible health plan that meets the federal legal requirements to permit an enrollee to establish and contribute to a health savings account (HDHP/HSA-qualified). Adding the percentage of firms offering HDHP/HRAs and HDHP/HSA-qualified plans may not sum to the percentage of firms offering HDHP/SOs because some firms offer both. Among all firms that offer health benefits, 0.9% offered both an HDHP/HRA and an HDHP/HSA- qualified plan. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 8 California Employer Health Benefits Offer Rates, by Plan Type Coverage California vs. United States, 2022 Covered workers in California were more PERCENTAGE AMONG COVERED WORKERS AT A FIRM THAT OFFERS HEALTH BENEFITS likely to work at a firm that offered an ■ California ■ United States HMO and less likely to work at a firm that offered an HDHP/SO, compared to 68% 68% covered workers nationally. 61% 59% 59% 48% 38% 19% 14% 10% HMO* PPO POS HDHP/SO* * Estimate is statistically different between firms with workers in California and all firms nationwide within coverage type (p < .05). Notes: HMO is health maintenance organization. PPO is preferred provider organization. POS is point-of-service plan. HDHP/SO is high-deductible health plan with a savings option, such as a health reimbursement arrangement or health savings account. Firms may offer different types of plans to different workers; for example, different plan options at different locations or to different classes of workers. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 9 California Employer Health Benefits Covered Workers ■ California in Self-Insured Plans, by Firm Size ■ United States Coverage California vs. United States, 2022 Many firms, particularly larger firms, PERCENTAGE OF COVERED WORKERS choose to pay for some or all of their ■ California ■ United States workers' health services directly 91% * from their own funds rather than 82%* by purchasing health insurance. In 74%* California, about three-quarters of 65% covered workers in firms with 5,000 59% or more workers were in self-insured 48% 49% plans. 34%* 30% * 25% * 13%* 11%* All Firms 3–49 50–199 200–999 1,000–4,999 5,000+ Number of Workers * Estimate is statistically different from estimate for all other firms not in the indicated size category (p < .05). Notes: Self-insured plans are plans in which the employer assumes direct financial responsibility for the costs of enrollees' medical claims. Employers with self-insured plans typically contract with a third-party administrator or insurer to provide administrative services. Self-insured employers may buy stop-loss coverage from an insurer to protect themselves against very large claims. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 10 California Employer Health Benefits Covered Workers in Self-Insured Plans, by Plan Type Coverage California vs. United States, 2022 Both in California and nationally, PERCENTAGE OF COVERED WORKERS covered workers enrolled in HMOs ■ California ■ United States were less likely to be in self-insured plans than workers in other plan types. Overall, self-insured plans were less common in California, with 48% 71% 74% of covered workers covered by such 65% 63% an arrangement, compared to 65% 64% nationally. 48% 49% 27% All Plans* HMO* PPO HDHP/SO * Estimate is statistically different between firms with workers in California and all firms nationwide within group (p < .05). Notes: HMO is health maintenance organization. PPO is preferred provider organization. HDHP/SO is high-deductible health plan with a savings option, such as a health reimbursement arrangement or health savings account. Includes covered workers enrolled in self-insured plans in which the firm's liability is limited through stop-loss coverage. POS (point-of-service) plans not reported due to small sample size. All-plan average includes POS plans. Self-insured plans are plans in which the employer assumes direct financial responsibility for the costs of enrollees' medical claims. Employers with self-insured plans typically contract with a third-party administrator or insurer to provide administrative services. Self-insured employers may buy stop-loss coverage from an insurer to protect themselves against very large claims. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 11 California Employer Health Benefits Average Annual Premiums, by Plan Type Cost of Health Insurance California vs. United States, 2022 In 2022, the average premiums for Single Coverage covered workers in California were All Plans $8,083 $7,911 ■ California $8,083 for single coverage and $7,792 ■ United States HMO $22,818 for family coverage, similar to $7,954 $9,112 the averages nationally. The average PPO* $8,272 premiums for single and family POS $8,006 $7,810 coverage in PPO plans in California HDHP/SO $7,216 were higher than those in PPO plans $7,288 nationally. Family Coverage All Plans $22,818 $22,463 HMO $21,898 $22,891 PPO* $25,726 $23,426 POS $20,952 $20,691 HDHP/SO $21,429 $21,136 * Estimate is statistically different between firms with workers in California and all firms nationwide within coverage type (p < .05). Notes: HMO is health maintenance organization. PPO is preferred provider organization. POS is point of service plan. HDHP/SO is high-deductible plan with savings option, such as a health reimbursement arrangement or health savings account.. HDHPs have a deductible of at least $1,000 for single coverage and at least $2,000 for family coverage. Family is a family of four. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 12 California Employer Health Benefits Annual Premiums for Covered Workers, Family Coverage Cost of Health Insurance California, 2022 Premiums for family coverage varied significantly. Ten percent of workers with family coverage in California had a premium of $29,000 or more. Eight 26% percent had premiums of less than $14,000. 18% 15% 10% 8% 8% 4% 4% 4% 2% ,9 99 ,4 99 ,9 99 ,4 99 ,9 99 ,4 99 ,9 99 ,499 3,999 ,000+ $13 $16 $18 $21 $23 $26 $28 $31 00–$3 $34 $0– 00 0– 50 0– 00 0– 50 0– 00 0– 500– 00 0– ,5 $ 14, $16, $ 19, $21, $ 24, $ 26, $29, $31 Note: Annual premiums are for a family of four. Includes both the worker and employer contributions. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 13 California Employer Health Benefits Annual Worker and Employer Premium Contributions Cost of Health Insurance California vs. United States, 2022 The average worker contributions for covered workers in California in 2022 were $1,167 for single coverage and ■ Worker ■ Employer $6,680 for family coverage. Employer Single Coverage contributions for single coverage CA $1,167 $6,916* $8,083 were higher for covered workers in California than for covered workers US $1,327 $6,584* $7,911 nationally. Family Coverage CA $6,680 $16,138 $22,818 US $6,106 $16,357 $22,463 * Estimate is statistically different between firms with workers in California and all firms nationwide within group (p < .05). Note: Family is a family of four. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 14 California Employer Health Benefits Average Workers' Share of Premium, by Firm Size Cost of Health Insurance California vs. United States, 2022 Covered workers in California on average paid 15% of the premium ■ All Firms for single coverage and 30% of the ■ All Small Firms (3–199 workers) premium for family coverage, similar ■ All Large Firms (200+ workers) to the national average. Covered 40% * workers in small firms paid a higher 36%* share of the family premium than 30% those in larger firms (40% vs. 26%). 28% 26%* 26%* 17% 16% 18% 15% 15% 15% California United States California United States Single Coverage Family Coverage * Estimate is statistically different between small and large firms within coverage type (p < .05). Note: Family is a family of four. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 15 California Employer Health Benefits Workers' Share of Premium Cost of Health Insurance California vs. United States, 2022 Almost a quarter of covered workers DISTRIBUTION OF COVERED WORKERS in California paid no premium for their single coverage in 2022. One ■ No Contribution ■ >0% to ≤25% ■ >25% to ≤50% ■ >50% in five covered workers in California Single Coverage contributed more than half the CA 23% 60% 16% premium for family coverage. 2% US 13% 66% 19% 2% Family Coverage CA 7% 48% 25% 20% US 5% 49% 33% 13% Notes: Family is a family of four. Segments may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 16 California Employer Health Benefits Workers' Share of Premium, by Firm Size Cost of Health Insurance California, 2022 Forty-two percent of covered workers DISTRIBUTION OF COVERED WORKERS in small firms that had single ■ No Contribution ■ >0% to ≤25% ■ >25% to ≤50% ■ >50% coverage were enrolled in a plan with Single Coverage no worker premium contribution, compared to 14% of covered workers All Firms 23% 60% 16% 2% in large firms. Thirty-nine percent of All Small Firms* covered workers in small firms with (3–199 workers) 42% 35% 19% 4% family coverage were enrolled in a All Large Firms * (200+ workers) 14% 70% 15% plan where they contribute more than <1% half of the premium. Family Coverage All Firms 7% 48% 25% 20% All Small Firms* (3–199 workers) 15% 20% 26% 39% All Large Firms* (200+ workers) 4% 59% 24% 12% * Distributions are statistically different between small and large firms within coverage type (p < .05). Notes: Figures may not sum due to rounding. Family is a family of four. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 17 California Employer Health Benefits Workers' Share of Premium, Single Coverage Cost of Health Insurance by Firm Characteristics, California, 2022 On average, covered workers in firms AMONG COVERED WORKERS with many workers with higher wages were asked to pay a smaller share of All Firms 15% Public 12% the premium for single coverage than Private Nonprofit 8%* those in firms with fewer workers Private For-Profit 18%* with higher wages. Many Older Workers 15% Fewer Older Workers 15% Many Younger Workers 15% Fewer Younger Workers 15% No Union Workers 16% Some Union Workers 14% Many Workers with Higher Wages 12%* Fewer Workers with Higher Wages 19%* Many Workers with Lower Wages 11% Fewer Workers with Lower Wages 15% 0.0 * Estimates are statistically different from each other within category (p < .05). 12.5 25.0 Notes: Average percentage of single premium paid by covered workers. Firms with many workers with lower wages are those with 35% or more of workers earning $30,000 or less per year. Firms with fewer workers with lower wages are those with less than 35% of workers earning that amount. Firms with many workers with higher wages are those with 35% or more of workers earning $70,000 or more per year. Firms with fewer workers with higher wages are those with less than 35% of workers earning that amount. Firms with many older workers are those with at least 35% of workers age 50 or older. Firms with many younger workers are those with at least 35% of workers age 26 or younger. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 18 California Employer Health Benefits Workers' Share of Premium, Family Coverage Cost of Health Insurance by Firm Characteristics, California, 2022 Covered workers in firms with many AMONG COVERED WORKERS workers with higher wages paid a smaller share of the premium for All Firms 30% 19% Public 19%* family coverage than those in firms 25% Private Nonprofit 25% with fewer workers with higher 37% Private For-Profit 37%* wages. Covered workers in firms 28% Many Older Workers 28% with union workers and in public 32% Fewer Older Workers 32% organizations paid a smaller share of 36% Many Younger Workers 36% the premium than those in firms with 30% Fewer Younger Workers 30% no union workers and in private, for- 5%* No Union Workers 35%* profit firms, respectively. 26% Some Union Workers 26%* 26% Many Workers with Higher Wages 26%* 38% Fewer Workers with Higher Wages 38%* 26% Many Workers with Lower Wages 26% 31% Fewer Workers with Lower Wages 31% 0.0 12.5 * Estimates are statistically different from each other within category (p < .05). 25.0 37.5 Notes: Average percentage of family premium paid by covered workers. Family is a family of four. Firms with many workers with lower wages are those with 35% or more of workers earning $30,000 or less per year. Firms with fewer workers with lower wages are those with less than 35% of workers earning that amount. Firms with many workers with higher wages are those with 35% or more of workers earning $70,000 or more per year. Firms with fewer workers with higher wages are those with less than 35% of workers earning that amount. Firms with many older workers are those with at least 35% of workers age 50 or older. Firms with many younger workers are those with at least 35% of workers age 26 or younger. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 19 California Employer Health Benefits Workers with Annual Deductible, Single Coverage Benefits and Cost Sharing by Plan Type, California vs. United States, 2022 In 2022, 62% of covered workers in PERCENTAGE OF COVERED WORKERS AND AVERAGE ANNUAL DEDUCTIBLE California with single coverage had a ■ California ■ United States general annual deductible, compared $2,212 $2,539 * * to 88% nationwide. Those enrolled 100% 100% $1,763* $981 $1,160 $1,592 * in HMO and POS plans in California 88%* 86% 88% were less likely to have a deductible 83% * than enrollees nationwide. Among $1,464* covered workers with a deductible, $860* $822* 62%* 59%* 59%* the average deductible was lower in California ($1,464 vs. $1,763). $530* 29%* All Plans HMO PPO POS HDHP/SO * Estimate is statistically different between firms with workers in California and all firms nationwide within coverage type (p < .05). Notes: HMO is health maintenance organization. PPO is preferred provider organization. POS is point-of-service plan. HDHP/SO is high-deductible health plan with a savings option, such as a health reimbursement arrangement or health savings account. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 20 California Employer Health Benefits Workers with Annual Deductible, Single Coverage Benefits and Cost Sharing by Plan Type and Firm Size, ■ AllCalifornia, Large Firms2022 In 2022, the average deductible for AMONG COVERED WORKERS WITH A GENERAL ANNUAL DEDUCTIBLE covered workers with single coverage ■ All Firms ■ All Small Firms ■ All Large Firms and a deductible was $1,464. Covered (3–199 workers) (200+ workers) $2,212 workers with a deductible at small $2,085 $2,099 firms had higher annual deductibles $1,850 * $1,825 than those at larger firms. $1,569* $1,527 $1,464 $1,372 $1,393 $1,345* $1,137 $998* All Plans HMO PPO POS HDHP/SO * Estimate is statistically different between small and large firms within plan type (p < .05). Notes: Data based on workers with a deductible. HMO is health maintenance organization. PPO is preferred provider organization. POS is point-of-service plan. HDHP/SO is high- deductible health plan with a savings option, such as a health reimbursement arrangement or health savings account. Average general annual deductibles are for in-network providers. POS and HDHP/SO estimates for small firms are not reported due to small sample size. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 21 California Employer Health Benefits Workers with Annual Deductible, Single Coverage Benefits and Cost Sharing by Plan Type, California, 2022 Among covered workers with an annual deductible for single coverage, 10% ■ $1–$499 ■ $500–$999 ■ $1,000–$1,999 ■ $2,000–$2,999 ■ $3,000+ had a deductible of $3,000 or more. All Plans 8% 28% 43% 12% 10% HMO 15% 19% 35% 14% 17% PPO 11% 37% 38% 7% 7% POS 11% 29% 35% 10% 15% HDHP/SO 50% 28% 22% Notes: Data based on workers with a deductible. HMO is health maintenance organization. PPO is preferred provider organization. POS is point-of-service plan. HDHP/SO is high- deductible health plan with a savings option, such as a health reimbursement arrangement or health savings account. Average general annual deductibles are for in-network providers. Segments may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 22 California Employer Health Benefits Workers with a Large Deductible ($1,000+), Single Coverage Benefits and Cost Sharing by■ Firm Has a Size, California■ vs. Deductible United $1,000+ States, 2022 Deductible ■$2,000+ Deductible ■ $3,000+ Deductible In California, covered workers at small PERCENTAGE OF COVERED WORKERS firms were slightly more likely to ■ Has a Deductible ■ $1,000+ Deductible have a deductible of $1,000 or more ■ $2,000+ Deductible ■ $3,000+ Deductible 88%* 88%* than those at large firms. On average, 87%* workers in both small and large firms 74%* in California were less likely to have 62%* 64%* 62%* 61%* a deductible than their counterparts 56%* nationally. 49% * 45% * 42%* 40%* 32%* 31%* 23%* 25%* 17%* 15%* 15%* 11% * 10% 8%* 6% All Firms All Small Firms All Large Firms All Firms All Small Firms All Large Firms (3–199 workers) (200+ workers) (3–199 workers) (200+ workers) California United States * Estimate is statistically different between firms with workers in California and all firms nationwide within group (p < .05). Notes: Percentages are based on all covered workers and include workers enrolled in high-deductible health plans with a savings option (HDHP/SO) and other plan types. Average general annual health plan deductibles for PPOs, POS plans, and HDHP/SOs are for in-network services. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 23 California Employer Health Benefits Aggregate Family Deductibles, Family Coverage Benefits and Cost Sharing BROKEN GRAPH DATA by Plan Type, California, 2022 COVERED WORKERS WITH AN AGGREGATE DEDUCTIBLE FOR FAMILY COVERAGE Among covered workers with an aggregate family deductible, about 20% of those enrolled in an HDHP/SO ■ $1–$999 ■ $1,000–$1,999 ■ $2,000–$2,999 ■ $3,000–$3,999 ■ $4,000–$5,999 ■ $6,000+ or POS plan had a deductible of $6,000 or more. HMO 13% 19% 15% 26% 13% 14% PPO 14% 32% 21% 21% 4% 8% POS 13% 21% 14% 15% 15% 23% HDHP/SO 49% 29% 20% 3% Notes: HMO is health maintenance organization. PPO is preferred provider organization. POS is point-of-service plan. HDHP/SO is high-deductible health plan with a savings option, such as a health reimbursement arrangement or health savings account. Family is a family of four. Average general annual deductibles are for in-network providers. The survey distinguishes between plans that have an aggregate family deductible and plans that have per person deductibles, typically with a limit on the number of family members required to reach that amount. Segments may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 24 California Employer Health Benefits Cost Sharing for Physician Office Visits, by Plan Type NOT THIS ONE Benefits and Cost Sharing California, 2022 Most covered workers enrolled in AMONG COVERED WORKERS an HMO had a copay for a physician ■ Copayment ■ Coinsurance ■ No Cost Sharing ■ None of the Above office visits. Covered workers enrolled Primary Care Office Visit All Plans 81% 14% in HDHP/SO plans were more likely 3% 2% to have a coinsurance requirement in HMO 97% * <1% 1% 1% addition to any annual deductible. PPO 88% 7% 4% 1% POS 93% * 4% 3% HDHP/SO 15% * 70% * 12% 3% Specialty Care Office Visit All Plans 78% 16% 4% 2% HMO 93%* 4% 2% <1% PPO 81% 15% 4% POS 92%* 4% 1% * 3% HDHP/SO 15% * 70% * 7% 8% * Estimate is statistically different from all plans estimate (p < .05). Notes: Copayment is a fixed dollar amount per visit. Coinsurance is a fixed percentage of the cost of the visit. HMO is health maintenance organization. PPO is preferred provider organization. POS is point-of-service plan. HDHP/SO is high-deductible health plan with a savings option, such as a health reimbursement arrangement or health savings account. Cost sharing amounts are for in-network providers. Segments may not sum due to rounding. Cost sharing may be in addition to any general annual deductible required under the plan. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 25 California Employer Health Benefits Workers with Office Visit Copayments Benefits and Cost Sharing California vs. United States, 2022 Among California workers with a primary or specialty care office visit Primary Care Office Visit copay, 7% faced a primary care ■ $5–$10 ■ >$10–$20 ■ >$20–$30 ■ >$30–$40 ■ $40+ copayment of $40 or more per visit, CA 6% 34% 38% 15% 7% and 9% faced a copayment for a specialist office visit of $60 or more. US 6% 26% 46% 17% 4% Specialty Care Office Visit ■ $5–$15 ■ >$15–$30 ■ >$30–$45 ■ >$45–$60 ■ $60+ CA 10% 41% 21% 19% 9% US 5% 20% 32% 33% 10% Notes: Averages are for covered workers with an office visit copayment. Copayment amounts are for in-network providers and may be in addition to any general annual deductible required under the plan. Segments may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 26 California Employer Health Benefits Primary Care Office Visit Average Copayments, by Plan Type Benefits and Cost Sharing California, 2022 Overall, 81% of covered workers had a COVERED WORKERS WITH A COPAYMENT FOR A PRIMARY CARE OFFICE VISIT copayment for primary care office visits. ■ $5–$10 ■ >$10–$20 ■ >$20–$30 ■ >$30–$40 ■ $40+ Workers in HDHP/SOs were less likely PERCENTAGE WITH COPAYMENTS to have a primary visit copayment All Plans 6% 34% 38% 15% 7% 81% than those in other plan types. Among covered workers with an office visit copayment for in-network providers, HMO 5% 36% 37% 12% 10% 97% the average copayment for a primary care office visits was $27 (not shown). PPO 27% 41% 24% 6% 88% 2% POS 20% 32% 28% 11% 9% 93% HDHP/SO 4% 7% 24% 37% 28% 15% Notes: Copayment is a fixed dollar amount per visit. HMO is health maintenance organization. PPO is preferred provider organization. POS is point-of-service plan. HDHP/SO is high- deductible health plan with a savings option, such as a health reimbursement arrangement or health savings account. Copayments are for in-network providers and may be in addition to any general annual deductible required under the plan. Segments may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 27 California Employer Health Benefits Cost-Sharing for Prescription Drugs Benefits and Cost Sharing California vs. United States, 2022 In 2022, 71% of covered workers with prescription drug coverage in ■ Four or More Tiers ■ Three Tiers ■ Two Tiers ■ One Tier California were in a plan with three ■ No Cost Sharing After Deductible Is Met ■ Other or more tiers of cost sharing for California prescription drugs, compared to about 78% nationally. 22% 49% 16% 6% 5% 2% United States 23% 56% 9% 7% 6% 1% Notes: A tier is a grouping on the formulary list (list of drugs with preferred cost sharing), which describes what cost sharing is applied to particular drugs and excludes tiers covering only specialty drugs. For example, one payment for generic drugs, another for preferred drugs, a third for nonpreferred drugs, and additional tiers for specialty, lifestyle, or other expensive drugs. Figures may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 28 California Employer Health Benefits Average Prescription Drug Copayments, by Drug Type Benefits and Cost Sharing California, 2022 Among covered workers with four or AMONG COVERED WORKERS WITH A FOUR OR MORE TIER FORMULARY FOR PRESCRIPTION DRUG COST SHARING more tiers of prescription drug cost sharing, the average copayment for First Tier generic drugs was one-fifth the cost $14 of fourth-tier drugs. Second Tier $37 Third Tier $62 Fourth Tier $78 Notes: Data are shown for workers with four or more tiers and excludes tiers covering only specialty drugs. Averages are among covered workers who have a copayment requirement. First-tier drugs are often called generic drugs. Second-tier drugs are often called preferred drugs. Third-tier drugs are often called nonpreferred drugs. Fourth-tier drugs include specialty, lifestyle, or other expensive drugs. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 29 California Employer Health Benefits Annual Out-of-Pocket Limits, Single Coverage Benefits and Cost Sharing by Plan Type, California, 2022 Out-of-pocket limits varied COVERED WORKERS WITH AN OUT-OF-POCKET LIMIT FOR SINGLE COVERAGE considerably across plan types. About ■ <$2,000 ■ $2,000–$2,999 ■ $3,000–$3,999 one in four covered workers with ■ $4,000–$4,999 ■ $5,000–$5,999 ■ $6,000+ single coverage and an out-of-pocket limit had an out-of-pocket limit of All Plans $6,000 or more in 2022. 22% 15% 24% 11% 5% 23% HMO 30% 18% 21% 5% 25% PPO* 1%* 7%* 14% 23% 14% 6% 36% POS 21% 17% 19% 4% 36% HDHP/SO* 3% 6%* 6%* 39% 27% 11% 11%* * Estimate is statistically different from all plans estimate (p < .05). Notes: Out-of-pocket limits are for in-network services. HMO is health maintenance organization. PPO is preferred provider organization. POS is point-of-service plan. HDHP/SO is high- deductible health plan with a savings option, such as a health reimbursement arrangement or health savings account. Segments may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 30 California Employer Health Benefits Firms Offering Various Wellness and Health Promotion Programs Employer Views and Practices Large Firms, California, 2022 Most large firms offered specific wellness programs (86%), and 33% Incentive for Participating In or Completing Wellness Programs offered employees incentives to 33% participate in or to complete wellness Offers Specific Wellness Programs activities. Six percent of firms offered 86% workers incentives to meet biometric Incentive for Meeting Biometric Outcomes outcomes, such as maintaining a 6% certain cholesterol level or body Incentive for Completing Biometric Screening weight. 21% Offers Biometric Screening 49% Incentive for Completing Health Risk Assessment 23% Offers Health Risk Assessment 52% Notes: Specific wellness programs include programs to help workers stop smoking or lose weight, or other lifestyle or behavioral coaching. Large firms have 200 or more workers. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 31 California Employer Health Benefits Employer Satisfaction with Firm's Health Plans, Large Firms Employer Views and Practices California, 2022 Overall, the majority of large employers reported being satisfied ■ Very Satisfied ■ Satisfied ■ Dissatisfied ■ Very Dissatisfied ■ Don't Know with key aspects of their health plans, Employee Engagement with Plan and Providers including the cost of care and quality 13% 66% 11% 8% of in-network providers. 1% Ability to Get Information About Cost and Quality of Options Beforehand 20% 63% 10% 5% 2% Access to Behavioral Health Care 22% 55% 13% 8% 2% Timely Access to Services 30% 58% 6% 3% 4% Quality of In-Network Providers 38% 54% 4% 2%2% Overall Cost of Care 21% 59% 13% 5% 3% Notes: Includes large firms (200 or more workers) offering health benefits. Segments may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 32 California Employer Health Benefits Importance of Telemedicine in Providing Access Employer Views and Practices by Type of Care and Firm Size, California, 2022 In 2022, the vast majority of employers (93%) covered services ■ Very Important ■ Important ■ Slightly Important ■ Not Important ■ Don't Know delivered through telehealth (not All Small Firms (50–199 Workers) shown). In addition to playing a Enrollees in Remote Settings 45% 26% 9% 10% 10% critical role in care delivery during the ongoing COVID-19 pandemic, the Specialty Care 30% 39% 16% 9% 6% majority of large employers responded Primary Care 45% 32% 13% 4% 6% that telehealth will continue to be important in providing access to Behavioral Health 34% 36% 13% 4% 13% enrollees in remote settings and those All Large Firms (200+ workers) seeking behavioral health services. Enrollees in Remote Settings 61% 26% 6% 5% 2% Specialty Care 28% 40% 22% 7% 3% Primary Care 39% 43% 15% 1% 2% Behavioral Health 56% 31% 9% 1% 3% Note: Segments may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 33 California Employer Health Benefits Firms That Offered a Narrow Network Plan, by Firm Size Employer Views and Practices California vs. United States, 2022 Narrow network plans limit the number of providers that can ■ All Firms ■ All Small Firms (3–199 workers) ■ All Large Firms (200+ workers) participate, often to reduce costs, and generally are more restrictive than standard HMO networks. Large firms 17%* offering health benefits in California were more likely to offer at least one 13% 13% plan with a narrow network than 11%* large firms offering health benefits nationally. 9% 9% California United States * Estimate is statistically different between firms with workers in California and all firms nationwide within group (p < .05). Notes: Based on firms offering health benefits. A narrow network limits the number of providers who can participate in the plan's provider network, or limits services to certain facilities. The networks in these plans are more restrictive than a standard HMO network. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 34 California Employer Health Benefits Employer Satisfaction with Provider Networks Available from Employer Views and Practices Insurer or Third-Party Administrator, by Firm Size, California, 2022 Overall, employers reported being satisfied with the choice of provider ■ Very Satisfied ■ Satisfied ■ Neither ■ Dissatisfied ■ Very Dissatisfied networks made available to them by Cost of Provider Networks Available their insurer or plan administrator. Small firms were less likely to be All Firms 13% 47% 14% 20% 5% satisfied with the cost of provider All Small Firms networks available than large firms. (3–199 workers) 13% 46%* 14% 21%* 6% All Large Firms (200+ workers) 17% 62%* 13% 8%* 1% Choice of Provider Networks Available All Firms 40% 47% 9% 2% 2% All Small Firms (3–199 workers) 41% 46% 9% 2% 2% All Large Firms (200+ workers) 33% 55% 9% 2% <1% * Estimates are statistically different from estimate for all other firms not in the indicated category within each firm size (p < .05). Note: Segments may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 35 California Employer Health Benefits Breadth of Provider Network, Plan with Largest Enrollment Employer Views and Practices by Firm Size, California, 2022 Forty percent of firms said that the network in the plan with the largest ■ Very Broad ■ Somewhat Broad ■ Somewhat Narrow ■ Very Narrow enrollment was "very broad," and 46% said it was "somewhat broad." Breadth of Provider Network By contrast, only about one in five All Firms 40% 46% 11% 4% firms indicated that their largest plan's All Small Firms network for mental health services (3–199 workers) 39%* 46%* 11% 4% was "very broad." All Large Firms (200+ workers) 59%* 33%* 7% 2% Breadth of Network for Mental Health Services All Firms 19% 49% 21% 11% All Small Firms (3–199 workers) 18% 49% 21% 11%* All Large Firms (200+ workers) 27% 49% 19% 5%* * Estimates are statistically different from estimate for all other firms not in the indicated category within each firm size (p < .05). Notes: A broad provider network includes most doctors and hospitals in the area; a narrow network is limited to a small number of providers. Segments may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 36 BROKEN GRAPH - BEWARE GAPS California Employer Health Benefits Provider Network is Sufficient to Provide Timely Access, Employer Views and Practices by Firm Size, California, 2022 Just over half of large firms offering FIRMS OFFERING HEALTH BENEFITS health benefits responded that their ■ Yes ■ No ■ Don't Know plan with the largest enrollment had a Primary Care Providers sufficient number of behavioral health providers to ensure timely access, All Firms 76% 10% 14% compared to 37% of small firms. All Small Firms Overall, firms were twice as likely to (3–199 workers) 76%* 10% 14% indicate their plan had a sufficient All Large Firms (200+ workers) 86%* 7% 7% number of primary care providers compared to behavioral health Behavioral Health Providers providers. All Firms 38% 19% 43% All Small Firms (3–199 workers) 37%* 19%* 45%* All Large Firms (200+ workers) 52%* 27%* 20%* * Estimates are statistically different from estimate for all other firms not in the indicated category within each firm size (p < .05). Notes: Firms with multiple plans were asked about their plan with the largest enrollment. Segments may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 37 California Employer Health Benefits Firms That Expanded the Availability of Mental Health Providers Employer Views and Practices by Firm Size, California, 2022 In 2022, relatively small percentages OFFERING FIRMS (50 OR MORE WORKERS) of employers offering health benefits ■ Yes ■ No ■ Don't Know added new mental health providers or facilities. Six percent added new Added New Providers or Facilities for In-Person Mental Health Care All Firms 6% 77% 17% in-person providers or facilities and 12% added new virtual providers. 50–199 Workers 4%* 82% * 14% Larger firms were more likely to add 200–999 Workers 10% 68%* 22% new providers. 1,000+ Workers 11%* 63%* 25% Added New Virtual Mental Health Providers All Firms 12% 74% 14% 50–199 Workers 5%* 82%* 13% 200–999 Workers 22%* 64%* 14% 1,000+ Workers 35%* 46%* 19% * Estimates are statistically different from estimate for all other firms not in the indicated category within each firm size (p < .05). Notes: Segments may not sum due to rounding. Includes firms with 50 or more workers. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 38 California Employer Health Benefits Awareness of Any All-Payer Claims Databases Employer Views and Practices Large Firms, California, 2022 All-payer claims databases (APCD) FIRMS OFFERING HEALTH BENEFITS combine medical claims and eligibility ■ Yes ■ No ■ Don't Know information from public and private health plans. California is currently All Large Firms implementing an APCD called the 11% 76% 13% Health Payments Data Program. 500–999 Workers About 1 in 10 firms with 500 or more workers offering health benefits 5%* 81% 13% indicated that they were aware of all- 1,000–4,999 Workers payer claims database efforts. 10% 79% 10% 5,000+ Workers 23%* 60%* 17% * Estimates are statistically different from estimate for all other firms not in the indicated category within each firm size (p < .05). Notes: Large firms have 500 or more workers. All-payer claims databases combine information on medical claims and eligibility from private and public payers. These data sets are run by state governments, with data submitted from insurers and third-party administrators. Segments may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 39 California Employer Health Benefits Assessment of Value of All-Payer Claims Databases to Employer Views and Practices Employers, the Public, and Policymakers, Large Firms, California, 2022 Many states build all-payer claims Live data graph, FIRMS OFFERING HEALTH BENEFITS databases to study health care ■ A Great Deal ■ Somewhat ■ Very Little ■ Not at All ■ Don't Know markets and to compare the cost and performance of providers and All Large Firms payers. Thirteen percent of firms with 13% 43% 9% 6% 29% 500 or more workers indicated that 500–999 Workers these data sets offer "a great deal" of value to employers, the public, and 16% 39% 7% 9% 29% policymakers. 1,000–4,999 Workers 14% 44% 10% 4% 28% 5,000+ Workers 4%* 48% 14% 4% 31% * Estimates are statistically different from estimate for all other firms not in the indicated category within each firm size (p < .05). Notes: Large firms have 500 or more workers. All-payer claims databases combine information on medical claims and eligibility from private and public payers. These data sets are run by state governments, with data submitted from insurers and third-party administrators. Segments may not sum due to rounding. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 40 California Employer Health Benefits Large Firms Offering Retiree Health Benefits Employer Views and Practices by Firm Characteristics, California, 2022 Retiree benefits can be a crucial source PERCENTAGE OF LARGE FIRMS OFFERING RETIREE HEALTH BENEFITS of coverage for people retiring before All Firms 31% Medicare eligibility. For retirees with Public 86%* Medicare coverage, these benefits can Private Nonprofit 19%* provide an important supplement to Private For-Profit 14%* Medicare, helping them pay for cost Many Older Workers 37%* sharing and benefits not otherwise Fewer Older Workers 24% * covered. About one third of firms Many Younger Workers 20% in California offered retirees health Fewer Younger Workers 32% benefits. No Union Workers 11%* Some Union Workers 56%* Many Workers with Higher Wages 37%* Fewer Workers with Higher Wages 24%* Many Workers with Lower Wages 41% Fewer Workers with Lower Wages 30% 0.0 12.5 25.0 37.5 50.0 * Estimates are statistically different from each other within category (p < .05). Notes: Large firms have 200 or more workers. Many workers with lower wages firms are those with 35% or more of workers earning $30,000 or less per year. Fewer workers with lower wages firms are those with less than 35% of workers earning that amount. Many workers with higher wages firms are those with 35% or more of workers earning $70,000 or more per year. Fewer workers with higher wages firms are those with less than 35% of workers earning that amount. Firms with many older workers are those where at least 35% of workers are age 50 or older. Firms with many younger workers are those where at least 35% of workers are age 26 or younger. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 41 California Employer Health Benefits Methods The KFF Employer Health Benefits Survey was designed and analyzed by researchers at KFF and NORC at the University of Chicago, ABOUT THIS SERIES and administered by Davis Research (Davis). The findings are based on a random sample of 742 interviews with employee benefit The California Health Care Almanac is an online managers in firms in or having employees in California. In addition, 943 firms answered just one question on whether their firm clearinghouse for data and analysis examining offered health benefits. Davis conducted interviews from February to July 2022. Responses reflect employers' plans at the time of the the state's health care system. It focuses on issues interview. of quality, affordability, insurance coverage and The 2022 sample included panel and nonpanel firms. The panel firms included California-based employers with 10 or more employees the uninsured, and the financial health of the who responded to either the 2018 California Health Benefits Survey (CHBS), the 2020 CHBS, or KFF's 2021 or 2020 Employer Health system with the goal of supporting thoughtful Benefits Survey (EHBS), who were invited to participate in the 2022 survey. The sample of nonpanel firms was drawn from a Dynata list planning and effective decisionmaking. Learn (based on a census assembled by Dun & Bradstreet) of private employers with three or more workers. Firms were sampled within size and industry categories. In 2022, 16% of firms responded to the survey, including 41% of firms that had completed one of the surveys more at www.chcf.org/almanac. listed above. AU T H O R S The 2022 EHBS includes several major methodological revisions from earlier CHBS surveys, which limit comparison to past years. First, in 2022, KFF integrated the CHBS sample into its nationwide survey by adding multiple questions to the nationwide survey about the Gary Claxton, Senior Vice President and Director of firms' presence and employment in California. As of 2022, information was collected on all plans with California enrollment, regardless the Program on the Health Care Marketplace, KFF of where the employer was headquartered. This chart pack was calibrated to estimate California's firm-level and employment-level Matthew Rae, Associate Director of the Program statistics within the state, rather than the share of covered workers working in firms headquartered within the state. The CHBS and on the Health Care Marketplace, KFF EHBS surveys used similar methods and asked similar questions in earlier years, which limited the disruption from integrating California Anthony Damico, Independent Consultant into the national survey. This change fully aligned the methods used in the California and national estimates. Second, the sampling population for the CHBS was expanded to include nonfederal public employers. Third, averages reported were weighted by California workers and by firms with workers in the state; however, firm characteristics and sizes reflect their national characteristics. Fourth, respondents were given the option to complete the survey either online or through computer-assisted telephone interviewing. Forty- one percent of survey responses were completed via telephone, and the rest were completed online. In 2022, 56% of the covered worker weight and 89% of the employer weight was represented by firms with workers only in California. Sixty-six percent of the covered worker weight comprised firms with 200 or more workers. Conversely, firms with fewer than 50 F O R M O R E I N F O R M AT I O N workers made up 92% of the employer weight. To control for item nonresponse, missing data were imputed using a hot deck California Health Care Foundation approach, which replaces missing information with observed values from a similar firm. Calculation of the weights followed a common 1438 Webster Street, Suite 400 approach. To produce nationally representative estimates, weights specific to employers, workers, covered workers, and workers within each of the four specified health plan types were developed. Weights were calibrated to the Census Bureau's 2019 Statistics Oakland, CA 94612 of US Businesses and the 2017 Census of Governments within size and industry categories. The weights were trimmed to reduce the 510.238.1040 influence of weight outliers. For more information on weighting, imputation, and sampling, please see "2022 Employer Health Benefits www.chcf.org Survey: Survey Design and Methods." CALIFORNIA HEALTH CARE FOUNDATION 42 Appendix A. Average Annual Premiums, by Firm Size, California, 2022 AV E R A G E A N N UA L S I N G L E CO V E R A G E P R E M I U M S A M O N G CO V E R E D W O R K E R S WEIGHTED STANDARD UNWEIGHTED WEIGHTED STATISTICAL FIRM SIZE AVERAGE ERROR COUNTS COUNTS SIGNIFICANCE 3–24 Workers $8,190 $426.12 79 1,113,083 25–49 Workers $8,788 $745.66 39 473,544 50–199 Workers $8,211 $312.31 86 1,068,592 200–999 Workers $8,584 $197.29 192 1,310,678 * 1,000–4,999 Workers $8,328 $269.65 134 1,184,233 5,000 or More Workers $7,657 $198.95 82 3,604,480 * All Small Firms (3–199 Workers) $8,305 $254.25 204 2,655,219 All Large Firms (200+ Workers) $7,987 $135.48 408 6,099,391 ALL FIRMS $8,083 $122.91 612 8,754,610 AV E R A G E A N N UA L FA M I LY CO V E R A G E P R E M I U M S A M O N G CO V E R E D W O R K E R S WEIGHTED STANDARD UNWEIGHTED WEIGHTED STATISTICAL FIRM SIZE AVERAGE ERROR COUNTS COUNTS SIGNIFICANCE 3–24 Workers $20,033 $784.27 71 995,692 * 25–49 Workers $23,143 $1,155.84 37 444,379 50–199 Workers $23,224 $1,118.16 86 1,068,592 200–999 Workers $23,641 $569.74 192 1,310,678 1,000–4,999 Workers $23,582 $878.91 134 1,184,233 5,000 or More Workers $22,876 $720.42 82 3,604,480 All Small Firms (3–199 Workers) $21,943 $620.42 194 2,508,663 All Large Firms (200+ Workers) $23,178 $467.18 408 6,099,391 ALL FIRMS $22,818 $382.85 602 8,608,054 * Estimates are statistically different from each other within category (p < .05). Notes: Unweighted counts are the firm unweighted sample size. Weighted counts are the weighted count of covered workers. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 43 Appendix B. Average Annual Premiums, by Plan Type, California, 2022 AV E R A G E A N N UA L S I N G L E CO V E R A G E P R E M I U M S A M O N G CO V E R E D W O R K E R S WEIGHTED STANDARD UNWEIGHTED WEIGHTED STATISTICAL PLAN TYPE AVERAGE ERROR COUNTS COUNTS SIGNIFICANCE HMO $7,792 $185.07 250 2,832,717 PPO $9,112 $256.20 332 3,305,888 * POS $8,006 $469.66 80 1,022,036 HDHP/SO $7,216 $275.86 215 1,519,461 * ALL FIRMS $8,083 $122.91 612 8,754,610 AV E R A G E A N N UA L FA M I LY CO V E R A G E P R E M I U M S A M O N G CO V E R E D W O R K E R S WEIGHTED STANDARD UNWEIGHTED WEIGHTED STATISTICAL PLAN TYPE AVERAGE ERROR COUNTS COUNTS SIGNIFICANCE HMO $21,898 $463.24 247 2,787,803 PPO $25,726 $674.17 327 3,215,058 * POS $20,952 $1,274.22 78 1,012,471 HDHP/SO $21,429 $1,231.74 215 1,519,461 ALL FIRMS $22,818 $382.85 602 8,608,054 * Estimate is statistically different from all firms (p < .05). Notes: Unweighted counts are the firm unweighted sample size. Weighted counts are the weighted count of covered workers. Source: KFF Employer Health Benefits Survey (2022), KFF. CALIFORNIA HEALTH CARE FOUNDATION 44