Medical Expenditure Panel Survey
Insurance Component

2023 HEALTH INSURANCE
COST STUDY


OMB No. 0935-0110: Approval Expires 01/31/2026


U.S. DEPARTMENT OF COMMERCE
U.S. CENSUS BUREAU
ACTING AS COLLECTING AGENT FOR
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
AGENCY FOR HEALTHCARE RESEARCH AND QUALITY



TO COMPLETE THIS SURVEY ONLINE

Visit https://portal.census.gov

Authentication Code:



If completing paper form, please RETURN TO:

U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

OR

Fax to 1-800-447-4613



PLEASE RETURN ENTIRE CONTENTS OF THIS PACKAGE WITHIN


PLEASE DO NOT REMOVE THIS COVER SHEET



INSTRUCTIONS

  1. Please report for the location identified on the cover sheet, unless otherwise specified.

  2. Please report data for the year 2023.

  3. Estimates are acceptable.

  4. For an explanation of unfamiliar terms, refer to the MEPS-20(D) Health Insurance Cost Study definition sheet included with this package.

  5. Unless otherwise specified, respond for ACTIVE employees.

  6. Please retain a completed copy of this form for your records.

  7. For assistance completing this survey, please log-in to your Census Bureau account at https://portal.census.gov and send us a secure message OR call            at      , Monday through Friday, 8:30 a.m. to 5:00 p.m. Eastern Time.



Collection of this information is authorized under Section 913 of the Public Health Service Act (Title 42 United States Code, Section 299b-2). Section 9 of Title 13, United State Code (the U.S. Census Bureau Statute), ensures that the information you report to us will be strictly confidential. It may be seen only by individuals sworn to uphold U.S. Census Bureau confidentiality and may be used only for statistical purposes.



Paperwork Reduction Act and Burden Statements

We estimate this survey will take 45 minutes, on average, to complete, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you offered more than two plans, we estimate an extra 11 minutes per additional plan. Factors such as company size, complexity, and activity will affect your actual time to complete the survey. You may email comments regarding this burden estimate or any other aspect of the collection of information, including suggestions for reducing burden, to the following address: MEPSPROJECTDIRECTOR@ahrq.hhs.gov. If the enclosed mailing envelope has been misplaced, please send questionnaire to the address printed on the front page of this form.


NUMBER OF PLANS


Respond for ACTIVE employees only.

  1. In 2023, did your organization offer any health insurance plans to its ACTIVE employees at this location?

    For this survey, a health insurance plan is defined as a plan where hospital and/or physician coverage is made available to employees.

    1 ▢ Yes - Continue with 2

    2 ▢ No - SKIP to 3


  2. During the 2023 plan year, how many different health insurance plan choices did your organization offer to its ACTIVE employees at this location?
    • Single, employee-plus-one, and family coverage providing the same level of benefits from the same insurance company count as ONE plan.
    • High and standard options count as TWO plans.
    • An HMO and a PPO from the same insurance company count as TWO plans.
    • Do not count single service plans (optional plans) such as dental or vision.

    ____ Health insurance plan choices at this location

PRIOR YEAR


  1. In 2022, did your organization offer any health insurance plans to its ACTIVE employees at this location?

    1 ▢ Yes - Offered

    2 ▢ No - Not offered

    3 ▢ Don't know


EMPLOYMENT CHARACTERISTICS


Estimates are acceptable for all employment, eligibility, and enrollment figures.

For Questions 4 through 11b, if the answer is NONE, please enter "0".

Include:

Exclude:



  1. In 2023, what was the total number of employees your organization had at ALL locations for a typical pay period?

    _________ Employees at all locations

Complete Questions 5a through 21 for the location listed on the cover sheet.

  1. a. How many employees were on your organization's payroll AT THIS LOCATION for a typical pay period?

    _________ All employees at this location

    If your organization did not offer health insurance in 2023, SKIP to 6a.

    b. How many of these employees were ELIGIBLE for at least one health plan through your organization?

    _________ Eligible employees

    c. How many of these employees were ENROLLED in any health plan through your organization?

    _________ Enrolled employees


  2. a. For the same TYPICAL pay period, how many employees reported in Question 5a worked part-time?

    _________ Part-time employees

    If your organization did not offer health insurance in 2023, SKIP to 7.

    b. How many of these part-time employees were ELIGIBLE for at least one health plan through your organization?

    _________ Eligible part-time employees

    c. How many of these part-time employees were ENROLLED in any health plan through your organization?

    _________ Enrolled part-time employees


  3. How many of the employees reported in Question 5a worked fewer than 30 hours per week?

    _____ Employees worked fewer than 30 hours

    ▢ No employees worked fewer than 30 hours.



  4. Is the information you provided in Questions 5 through 7 for the location listed on the cover sheet OR did you provide information for multiple locations?

    1 ▢ Information for specified location

    2 ▢ Information for multiple locations

    If your organization did not offer health insurance in 2023, SKIP to 10a.



  5. What was the minimum number of hours per week that an employee had to work in order to be eligible for health insurance?

    _____ Minimum hours worked per week to be eligible

    ▢ No minimum number of hours required.


Provide information for a TYPICAL pay period in 2023.
Estimates are acceptable.

  1. a. Approximately what percentage of the employees at this location were union members?

    _____% Union members

    ▢ No union members

    b. Approximately what percentage of the employees at this location were women?

    _____% Women employees

    c. Approximately what percentage of the employees at this location were 50 years old or older?

    _____% Employees 50 years old or older

    d. For the employees at this organization, approximately what percentage earned:

    Less than $15.50 per hour?
    Approximately $32,240 a year or less       ____% Earned less than $15.50 per hour

    Between $15.50 and $34.00 per hour?
    Approximately $32,240 to $70,720 a year    ____% Earned between $15.50 and $34.00 per hour

    More than $34.00 per hour?
    Approximately $70,120 a year or more     ____% Earned more than $34.00 per hour

    ________
      100%

    e. For the employees at this location, how many earned more than $53.50 per hour?
    Approximately $111,280 a year or more

    _____ Number of employees that earned more than $53.50 per hour


  2. a. For the employees at this location, what percentage are able to do their jobs by teleworking if necessary?
    Necessary - Due to pandemic, inclement weather or other circumstances that make it difficult or inadvisable to work in the office.
    Estimates are acceptable. Include all position types.

    _____% Employees able to do their jobs by teleworking if necessary

    b. For the employees at this location, what percentage telework on a regular basis?
    For example, once a week, once a pay period, monthly, etc.
    Estimates are acceptable. Include all position types.

    _____% Employees teleworking on a regular basis


FRINGE BENEFITS CHARACTERISTICS


  1. Did your organization offer the following fringe benefits to its employees at this location?

    If Paid Time Off (PTO) is offered, mark (X) Yes for paid vacation AND paid sick leave.
    Paid vacation 1 ▢ Yes 2 ▢ No 3 ▢ Don't know
    Paid sick leave 1 ▢ Yes 2 ▢ No 3 ▢ Don't know
    Life insurance 1 ▢ Yes 2 ▢ No 3 ▢ Don't know
    Disability insurance 1 ▢ Yes 2 ▢ No 3 ▢ Don't know
    Critical illness insurance is a special form of insurance that pays the policyholder a lump-sum, tax-free payment if they suffer from serious illnesses, including but not limited to cancer, heart attack, kidney failure and stroke.
    Critical illness insurance 1 ▢ Yes 2 ▢ No 3 ▢ Don't know
    Retirement/pension plans 1 ▢ Yes 2 ▢ No 3 ▢ Don't know

TAX-ADVANTAGED BENEFITS


  1. Did your organization offer any of these tax-advantaged benefits to its employees?

    See the definition sheet MEPS-20(D) included with this package for an explanation of these benefits.
    Employee contributions to health insurance made on a pre-tax basis 1 ▢ Yes 2 ▢ No 3 ▢ Don't know
    Flexible Spending Accounts (FSA) for healthcare 1 ▢ Yes 2 ▢ No 3 ▢ Don't know
    Flexible Benefits Plans
    Full cafeteria plans that offer employees a set of benefits from which to choose.     		1 ▢ Yes 2 ▢ No 3 ▢ Don't know

If your organization offered health insurance, continue with 14.

If your organization DID NOT offer health insurance, SKIP to 21.


HEALTH INSURANCE EXCHANGES AND INSURANCE BROKERS


  1. Did your organization offer health insurance to active employees through a private exchange (also known as a corporate exchange)?

    A private exchange is created by a consulting company, insurance carrier, or other private organization and not by either a federal or state government. Private exchanges often allow employees to choose from several health insurance options offered on the exchange.

    1 ▢ Yes

    2 ▢ No

    3 ▢ Don't know

    If your organization has more than 100 employees at all locations, SKIP to 16a. Otherwise, continue with 15.



  2. Did your organization use a third party, such as an insurance broker or agent, to help purchase the insurance plan(s)?

    1 ▢ Yes

    2 ▢ No

    3 ▢ Don't know

GENERAL HEALTH COVERAGE CHARACTERISTICS


  1. a. Did your organization offer any of the listed optional coverage services at a premium SEPARATE from the comprehensive health plan to its active employees at this location?
    Report for single service insurance plans only.
    Do not include services covered under a comprehensive health plan.
    Long-term care insurance helps cover the cost of institutional and home care required by the chronically ill or disabled.
    Dental 1 ▢ Yes 2 ▢ No 3 ▢ Don't know
    Vision 1 ▢ Yes 2 ▢ No 3 ▢ Don't know
    Prescription drugs 1 ▢ Yes 2 ▢ No 3 ▢ Don't know
    Long-term care 1 ▢ Yes 2 ▢ No 3 ▢ Don't know
    ▢ No optional coverage - SKIP to 17

    b. What was the total amount paid for optional coverage for all active employees during a TYPICAL MONTH at this location?
    Include both employer and employee contributions.

    $__________.00 Monthly total optional coverage cost


  2. Did your organization impose a waiting period before new employees could be covered by health insurance?

    1 ▢ Yes

    2 ▢ No

    3 ▢ Don't know


  3. Did your organization provide any financial compensation or incentives to employees if they did not elect to receive health insurance coverage through your organization?

    1 ▢ Yes

    2 ▢ No

    3 ▢ Don't know


  4. Were employees' SPOUSES eligible for health insurance coverage through your organization?

    5 ▢ All spouses eligible, HIGHER employee contribution paid if spouse eligible through own employer.

    6 ▢ All spouses eligible, SAME employee contribution.

    7 ▢ All spouses eligible, don't know employee contribution.

    2 ▢ Limited spouses eligible, only if not offered by own employer.

    3 ▢ No spouses eligible.

    4 ▢ Don't know


  5. Did your organization offer health insurance coverage to UNMARRIED domestic partners?
    Same sex domestic partners 1 ▢ Yes 2 ▢ No 3 ▢ Don't know
    Opposite sex domestic partners 1 ▢ Yes 2 ▢ No 3 ▢ Don't know


  6. Did your organization offer an Individual Coverage Health Reimbursement Arrangement (ICHRA) or Qualified Small Employer Health Reimbursement Arrangement (QSEHRA)?

    1 ▢ Yes, offered ICHRA

    2 ▢ Yes, offered QSEHRA

    3 ▢ No, did not offer either arrangement

    4 ▢ Don't know


RETIREE HEALTH COVERAGE CHARACTERISTICS


Please complete Questions 22 through 24g for ALL LOCATIONS. If the answer is NONE, please enter "0".

Exclude any retirees that have coverage through COBRA or state continuation-of-benefits laws. See the definition sheet MEPS-20(D) included with this package for an explanation of these terms.

  1. Did your organization provide health insurance coverage to any person who retired in 2023 OR BEFORE, or to any of their survivors?

    If COBRA was the only coverage offered, mark “No.”

    1 ▢ Yes - Continue with 23

    2 ▢ No - SKIP to the section after "REMARKS" to complete form

    3 ▢ Don't know - SKIP to the section after "REMARKS" to complete form



  2. In a typical month, how many retirees were enrolled in health insurance through your organization at all locations?

    _______ Number of retirees enrolled


If this was a self-insured plan, report the premium equivalent.

  1. a. Were any of the enrolled retirees reported in Question 23, under 65 years of age or age 65 or older?

    UNDER 65 YEARS OF AGE AGE 65 OR OLDER

    1 ▢ Yes

    2 ▢ No
        (SKIP to next column)

    3 ▢ Don't know
        (SKIP to next column)

    1 ▢ Yes

    2 ▢ No
        (SKIP to 25a)

    3 ▢ Don't know
        (SKIP to 25a)
    b. In a typical month, what was the TOTAL number of retirees, by age category, enrolled in health insurance through your organization at all locations?

    _____ Total under 65 _____ Total 65 or older

    c. What percentage of these retirees, by age category, were ENROLLED in SINGLE coverage?

    _____% Percent of under 65 enrolled in single _____% Percent of 65 or older enrolled in single

    d. For a typical plan, how much did the EMPLOYER contribute, by age category, toward the monthly plan premium for one typical retiree with SINGLE coverage?

    $_______.00 Under 65 $_______.00 65 or older

    e. For this same plan, what was the TOTAL monthly premium, by age category, for this typical retiree with SINGLE coverage?

    $_______.00 Under 65 $_______.00 65 or older

    f. For a typical plan, how much did the EMPLOYER contribute, by age category, toward the monthly plan premium for one typical retiree with FAMILY coverage?

    If premium varied by family size, report for a family of two.

    $_______.00 Under 65 $_______.00 65 or older

    g. For this same plan, what was the TOTAL monthly premium, by age category, for this typical retiree with FAMILY coverage?

    $_______.00 Under 65 $_______.00 65 or older


NEW RETIREES

For Questions 25a through 25c, NEW RETIREES refers only to persons who retired from your organization in 2023.

Exclude any retirees that have coverage through COBRA or state continuation-of-benefits laws.

  1. a. Did your organization offer health insurance to any NEW RETIREES?

    1 ▢ Yes - Continue with 25b

    2 ▢ No - SKIP to the section after "REMARKS" to complete form.

    3 ▢ Don't know - SKIP to the section after "REMARKS" to complete form.

    b. Were NEW RETIREES under 65 years of age eligible for health insurance?

    1 ▢ Yes

    2 ▢ No

    3 ▢ Don't know

    c. Were NEW RETIREES age 65 or older eligible for health insurance?

    1 ▢ Yes

    2 ▢ No

    3 ▢ Don't know


Remarks

 

 



PERSON COMPLETING THIS QUESTIONNAIRE


Name (Please print) _________________________________________________

Title (Please print) _________________________________________________

Phone (Area code/Number/Extension)  _____ - ____________ - ___

Date (MM/DD/YYYY)  ____ - ____ - ________

Email _________________________________



*** PLEASE NOTE ***

If your organization offered health insurance, please complete the MEPS-10(S), Plan Information Questionnaire, for each plan offered (up to four plans).
If your organization DID NOT offer health insurance, you have completed the survey.



PLEASE RETAIN A COPY OF THIS FORM FOR YOUR RECORDS