By Lauren Bikoff, MLS
An annual report mandated by the Patient Protection and Affordable Care Act (ACA) revealed that self-insured group health plans covered about 34 million participants in 2016.
The Department of Labor (DOL) has released to Congress its ninth annual report on self-insured group health plans with data from Form 5500, Annual Return/Report of Employee Benefit Plan, as well as data from certain financial filings of self-insured employers. Approximately 56,200 health plans filed a Form 5500 for 2016 (the most recent complete data available), an increase of 3 percent from the health plans that filed a Form 5500 for 2015. Of health plans filing a 2016 Form 5500, about 23,100 were self-insured and approximately 4,100 mixed self-insurance with insurance (mixed-insured).
The IRS and the DOL developed Form 5500 for employee benefit plans to satisfy annual reporting requirements under ERISA and the Tax Code. The Patient Protection and Affordable Care Act (ACA) generally requires the DOL to prepare an annual report about self-insured group health plans filing Form 5500. Generally, sponsors of self-insured plans pay their plans’ covered health expenses directly, as the plans incur claims.
Plan type. The DOL report states that approximately 22,700 of the self-insured group health plans filing a 2016 Form 5500 were sponsored by a single employer while 1,000 plans were multiemployer plans. About 3,500 of the mixed-insured group health plans filing a 2016 Form 5500 were sponsored by a single employer; approximately 600 plans were multiemployer plans.
On average, about 49,900 group health plans filed a Form 5500 in the years 2007–2016. While the number of health plans filing a Form 5500 has increased over this period, the fraction of group health plans that are self-insured or mixed-insured has been relatively stable, slipping from 51 percent in 2007 to 48 percent in 2013, and rebounding to 50 percent in 2016.
Number of participants. Overall, the 23,700 self-insured group health plans filing a 2016 Form 5500 covered approximately 34 million participants, 31 million of whom were active participants. The 4,100 mixed-insured group health plans filing a 2016 Form 5500 covered approximately 28 million participants, 23 million of whom were active participants.
In general, plans covering a larger number of participants are more likely to be self-insured than plans with fewer participants. While 51 percent of plans are fully-insured, only 18 percent of participants in plans that file the Form 5500 are covered by these plans.
Benefits offered. The report also notes that of the 23,700 self-insured group health plans in 2016, 5,100 offered only health benefits and approximately 18,600 offered other benefits in addition to health benefits. Of the 4,100 mixed-insured group health plans, approximately 200 offered only health benefits and about 3,900 offered other benefits in addition to health benefits.
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