Page 1 GAO-14-524R Range of Health Insurance Premiums in 2013

441 G St. N.W.

Washington, DC 20548

May 28, 2014

The Honorable Orrin G. Hatch

Ranking Member

Committee on Finance

United States Senate

Private Health Insurance: The Range of Average Annual Premiums in the Small Group 

Market by State in Early 2013

Dear Senator Hatch:

About 19 million Americans obtained health coverage through health insurance plans purchased 

in the small group market in 2011.1 These Americans included employees of small employers 

and their dependents. Not all small employers choose to offer health insurance to their 

employees and, while federal and state requirements have helped to ensure small employers 

and their employees have access to health insurance, small employers have consistently cited 

the cost of health insurance as the primary reason for not offering coverage to their employees.2

Insurers have historically set premiums for small group plans using some form of either medical 

underwriting or community rating, both of which were subject to regulation under state law.3

The Patient Protection and Affordable Care Act (PPACA) included a number of provisions that 

changed the requirements for small group health plans and that could affect the cost of 

premiums paid by small employers and their employees for such plans.

In 

general, such regulation included restrictions limiting how insurers could vary premiums for 

different small employers, the factors—such as, age, gender, and health status of employees—

that could be considered when setting premiums rates for the employer group, and the range of 

variation among premiums rates across employers. Even with these restrictions, however, a 

small employer could be subject to significant increases in premiums from one year to the next 

if, for example, a single employee became seriously ill during the previous year.

4

 

1

Centers for Medicare & Medicaid Services, The 80/20 Rule: How Insurers Spend Your Health Insurance Premiums

(Baltimore, Md.: February 15, 2013).

For example, starting 

in January 2014, insurers are no longer able to consider the average health status of a small 

group to set premium rates and will be restricted in the amount they can vary premiums based 

2

The Kaiser Family Foundation, Health Research and Educational Trust, NORC at the University of Chicago, 

Employer Health Benefits: 2013 Annual Survey, (Menlo Park, Calif.; Kaiser Family Foundation, 2013).

3

Medical underwriting is a process through which insurers consider the age, gender, health status, and other factors 

about employees when determining the premium rate for the group and use this information to set the rate for the 

entire group. Community rating is a system through which groups in the same geographic region in a state are 

charged the same premium rate for each health insurance product. Several states allowed adjustments to community 

rating—known as modified community rating—which permitted some variation in group premium rates based on 

factors such as age and gender of employees.

4

Pub. L. No. 111-148, 124 Stat.119 (2010). PPACA defines a small employer as having employed an average of 1 to 

100 employees. Until 2016, a state has the option to define small employers as having employed an average of 1 to 

50 employees during the preceding calendar year. See Pub. L. No. 111-148. § 1304(b), 124 Stat. 172 (codified at 

42 U.S.C. § 18024(b)).
Page 2 GAO-14-524R Range of Health Insurance Premiums in 2013

on the ages and tobacco use of employees within a small group.5 PPACA also established a set 

of minimum essential health benefits for new small group market health plans, and established 

tax credits for eligible small employers that offer health insurance to their employees.6

To examine the range of average premiums in the small group market, we analyzed data 

maintained by the Center for Consumer Information and Insurance Oversight (CCIIO) within the 

Department of Health and Human Services’ (HHS) Centers for Medicare & Medicaid Services 

(CMS) for its online portal—the HealthCare.gov Plan Finder (Plan Finder).

As a 

result, insurers may have changed, and may continue to change, the way premiums are 

calculated for the small group market. You asked us to examine premium amounts for the small 

group market that existed prior to the implementation of PPACA provisions in 2014. This report 

examines the range of average premiums for health insurance in the small group market during 

the first quarter of 2013.

7 This data, which we 

obtained directly from CCIIO, included the total amount of premiums paid and the number of 

covered lives for insurance products available in the first quarter of 2013.8 The premium data 

represent the combined amounts paid by both employers and employees for single as well as 

family coverage and, for each product, combine the data of all employers that purchased that 

product.9

For each product, we calculated an average annual premium per covered life based on the 

premium and enrollment data submitted by the insurers. Actual average premiums per covered

life for each employer may have been higher or lower than our calculated average premiums 

per covered life, because each employer’s premiums would have been determined based on 

the health status of its employees and other factors. We excluded 67 products from our 

analysis. These exclusions include outliers that had annual average premiums at the lowest and 

These data and other supporting product information were self-reported by each 

insurance company, and each company was required to comply with a data validation and 

attestation process.

 

5

See Pub. L. No. 111-148, §§ 1201(4), 10103(a), 124 Stat. 154, 155, 892, (adding § 2701(a) to the Public Health 

Service Act (PHSA), codified at 42 U.S.C. § 300gg(a).

6

Pub. L. No. 111-148, §§ 1201(4), 1421(a), 10105(e)(1), (2), 124 Stat. 154, 161, 237, 906 (adding § 2707 to the 

PHSA, codified at 42 U.S.C. § 300gg-6, and § 45R to the Internal Revenue Code, codified at 26 U.S.C. § 45R) (the 

requirement for minimum health benefits, referred to as an “essential health benefits package,” is contained in 

42 U.S.C. § 300gg-6 and authority for the tax credit for eligible small employers is contained in 26 U.S.C. § 45R). 

PPACA also provided for the establishment of new marketplaces in each state through which small employers may 

purchase health insurance, called the Small Business Health Options Program (or SHOP) exchanges. See Pub. L. 

No. 111-148, §§ 1311(b)(1)(B), 124 Stat. 173 (codified at 42 U.S.C. § 18031(b)(1)(B)). Implementation of certain 

SHOP exchange features has been delayed until 2015.

7

Plan Finder displays a monthly average premium per covered life for small group market health insurance products 

to assist consumers in comparing health insurance coverage options in the small group market. See Plan Finder, 

accessed March 31, 2014, http://finder.healthcare.gov/. 

8

A health insurance product is a package of covered services and network of providers offered by an insurer. An 

insurer may offer multiple products in each state, and multiple health plans may be available for each product. For 

example, a product may include multiple plans with the same covered services and same provider network, but each 

with a discrete combination of cost sharing features, such as deductibles, out-of-pocket maximum payment amounts, 

and coinsurance. The data included information on 1,734 small group market products that insurers reported as in 

effect and covering lives in the first quarter of 2013. According to CCIIO officials, this number of active small group 

market products is consistent with data previously submitted by insurance companies.

9

Employers, including small employers, may choose to tier the amounts they contribute to help their employees cover 

the premium rates set by an insurer based on factors such as tenure and full-time or part-time status.
Page 3 GAO-14-524R Range of Health Insurance Premiums in 2013

the highest extremes of the distribution.10 We developed ranges of average annual premiums 

for each of the 50 states and the District of Columbia by network provider types including 

preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service.11 These ranges could vary widely within a 

particular state for a number of reasons, including significant differences in the services 

covered, cost sharing features selected, and the factors considered when insurers set the 

premium rates for each small employer.

12

To verify the reliability of the data, we reviewed the requirements for the data validation and 

attestation process, reviewed the user manual for the database that houses the information 

submitted to CCIIO, and interviewed key CCIIO officials responsible for overseeing the 

submission and maintenance of the data. We determined that the 2013 data were sufficiently 

reliable for our purposes.

We conducted our work from January 2014 to May 2014 in accordance with all sections of 

GAO’s Quality Assurance Framework that are relevant to our objectives. The framework 

requires that we plan and perform the engagement to obtain sufficient and appropriate evidence 

to meet our stated objectives and to discuss any limitations in our work. We believe that the 

information and data obtained, and the analysis conducted, provide a reasonable basis for any 

findings and conclusions.

The range of average premiums paid in the small group market during the first quarter of 2013 

in each of the 50 states and the District of Columbia is reported in enclosure I.

Agency Comments

The Department of Health and Human Services reviewed a draft of this report and provided 

technical comments, which we incorporated as appropriate.

– – – – – 

As agreed with your office, unless you publicly announce the contents of this report earlier, we 

plan no further distribution until 30 days from the report date. At that time, we will send copies of 

this report to the Secretary of Health and Human Services and other interested parties. In 

addition, the report will be available at no charge on GAO’s website at http://www.gao.gov. 

 

10On the lowest extreme of the distribution, we identified the first product below the median with an average premium 

amount that was more than 5 percent lower than that of the next lowest product. This product and all products below 

it—a total of 54 products—were excluded from the analysis. On the highest extreme of the distribution, we identified 

the first product above the median with an average premium amount that was more than 5 percent higher than that of 

the previous product. This product and all products above it—a total of 13 products—were excluded from the 

analysis. Nearly all of the remaining products had incremental differences of less than 2 percent from the products 

with the next highest and lowest average premiums and an average difference of 0.2 percent.

11A network is a list of doctors, hospitals, and other health care providers that provide medical care to members of a 

specific health plan. In general, preferred provider organization and point of service plans allow members to use 

providers outside their networks, but at a higher cost. Health maintenance organization and exclusive provider 

organization plans limit coverage to providers inside their network. Indemnity plans allow members to use any 

providers they choose.

12Our use of Plan Finder data and our methodology distinguishes our analysis from other information on small group 

premiums reported by The Kaiser Family Foundation and other organizations. For example, The Kaiser Family 

Foundation and Health Research and Educational Trust conduct an annual survey of employer-sponsored health 

benefits, which expands the definition of a small employer to include all employers with less than 200 employees and 

reports premiums per covered worker.
Page 4 GAO-14-524R Range of Health Insurance Premiums in 2013

If you or your staff have any questions about this information, please contact me at (202) 512-

7114 or dickenj@gao.gov. Contact points for our Offices of Congressional Relations and Public 

Affairs may be found on the last page of this report. Major contributors to this report were: 

Gerardine Brennan, Assistant Director; Todd D. Anderson; George Bogart; Aaron Holling; and 

Laurie Pachter.

Sincerely yours,

John E. Dicken

Director, Health Care

Enclosure – 1 
Enclosure I

Page 5 GAO-14-524R Range of Health Insurance Premiums in 2013

Average Annual Premiums per Covered Life in Each State

Table 1: In Alabama, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 20 products available

Average premium (dollars) 2,483 3,995 15,990

Annual deductible options (dollars) 1,500-5,000 350 250-1,000

Co-pay options (dollars) 20-50 35 20

Coinsurance options (percent) 10-50 0-20 10-20

Out-of-pocket maximum options (dollars) 4,500-15,000 1,500 500-1,500

Preferred provider organization 13 products available

Average premium (dollars) 2,483 3,995 15,990

Annual deductible options (dollars) 1,500-5,000 350 250-1,000

Co-pay options (dollars) 20-50 35 20

Coinsurance options (percent) 10-50 0-20 10-20

Out-of-pocket maximum options (dollars) 4,500-15,000 1,500 500-1,500

Health maintenance organization 5 products available

Average premium (dollars) 3,353 4,059 4,886

Annual deductible options (dollars) 250-2,500 600 200

Co-pay options (dollars) 30-35 40 25

Coinsurance options (percent) 0-20 20 20

Out-of-pocket maximum options (dollars) 250-5,000 2,500 600

Other 2 products available

Average premium (dollars) 3,531 N/A 3,764

Annual deductible options (dollars) 250-5,000 N/A 250-5,000

Co-pay options (dollars) 25-35 N/A 20-35

Coinsurance options (percent) 0-30 N/A 0-30

Out-of-pocket maximum options (dollars) 250-7,500 N/A 250-7,500

Legend: N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features. All cost sharing features are for the use of in-network providers.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 6 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 2: In Alaska, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 9 products available

Average premium (dollars) 5,742 7,691 12,200

Annual deductible options (dollars) 500-5,000 1,500-5,950 1,500

Co-pay options (dollars) 20-30 0 25

Coinsurance options (percent) 0-20 0-40 20-30

Out-of-pocket maximum options (dollars) 3,000-5,000 5,000-5,950 6,500

Preferred provider organization 8 products available

Average premium (dollars) 5,742 7,691 12,200

Annual deductible options (dollars) 500-5,000 1,500-5,950 1,500

Co-pay options (dollars) 20-30 0 25

Coinsurance options (percent) 0-20 0-40 20-30

Out-of-pocket maximum options (dollars) 3,000-5,000 5,000-5,950 6,500

Health maintenance organization 0 products available

Average premium (dollars) N/A N/A N/A

Annual deductible options (dollars) N/A N/A N/A

Co-pay options (dollars) N/A N/A N/A

Coinsurance options (percent) N/A N/A N/A

Out-of-pocket maximum options (dollars) N/A N/A N/A

Other 1 product available

Average premium (dollars) N/A 9,995 N/A

Annual deductible options (dollars) N/A 0 N/A

Co-pay options (dollars) N/A * N/A

Coinsurance options (percent) N/A * N/A

Out-of-pocket maximum options (dollars) N/A 5,000 N/A

Legend: N/A = Not applicable. * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 7 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 3: In Arizona, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 20 products available

Average premium (dollars) 754 3,441 13,391

Annual deductible options (dollars) 1,500-4,000 500-5,000 2,000

Co-pay options (dollars) * 20-30 30-50

Coinsurance options (percent) 10-20 0-30 0-30

Out-of-pocket maximum options (dollars) 5,000 3,000-7,500 3,000 a

Preferred provider organization 8 products available

Average premium (dollars) 754 3,378 6,779

Annual deductible options (dollars) 1,500-4,000 250-10,000 5,000

Co-pay options (dollars) * 15-30 0 

Coinsurance options (percent) 10-20 0-50 0 

Out-of-pocket maximum options (dollars) 5,000 2,000-15,000 5,000 a

Health maintenance organization 5 products available

Average premium (dollars) 2,845 4,934 13,391

Annual deductible options (dollars) 0-5,000 500-3,000 2,000

Co-pay options (dollars) 0-45 20-30 30-50

Coinsurance options (percent) 0-100 20-30 0-30

Out-of-pocket maximum options (dollars) 2,000-6,050 2,000-6,000 a 3,000

Other 7 products available

Average premium (dollars) 2,272 3,441 4,299

Annual deductible options (dollars) 2,500-4,000 500-5,000 2,500-4,000

Co-pay options (dollars) * 20-30 *

Coinsurance options (percent) 10-20 0-30 10-20

Out-of-pocket maximum options (dollars) 5,000 3,000-7,500 5,000 a

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 8 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 4: In Arkansas, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 17 products available

Average premium (dollars) 1,651 3,630 7,425

Annual deductible options (dollars) 500-5,000 250-5,000 0-5,000

Co-pay options (dollars) 20-30 20-35 10-35

Coinsurance options (percent) 10 0-20 20-100

Out-of-pocket maximum options (dollars) 1,500-2,000 500-2,000 500-10,000 a

Preferred provider organization

a

10 products available

Average premium (dollars) 1,651 3,630 7,425

Annual deductible options (dollars) 500-5,000 250-5,000 0-5,000

Co-pay options (dollars) 20-30 20-35 10-35

Coinsurance options (percent) 10 0-20 20-100

Out-of-pocket maximum options (dollars) 1,500-2,000 500-2,000 500-10,000 a

Health maintenance organization

a

0 products available

Average premium (dollars) N/A N/A N/A

Annual deductible options (dollars) N/A N/A N/A

Co-pay options (dollars) N/A N/A N/A

Coinsurance options (percent) N/A N/A N/A

Out-of-pocket maximum options (dollars) N/A N/A N/A

Other 7 products available

Average premium (dollars) 3,014 3,634 7,056

Annual deductible options (dollars) 1,250-5,900 500-5,000 250-500

Co-pay options (dollars) * 10-45 10-20

Coinsurance options (percent) 0-20 0-20 0-30

Out-of-pocket maximum options (dollars) 1,000-3,000 1,000-10,000 a 1,000-2,000

Legend: N/A = Not applicable. * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 9 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 5: In California, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 47 products available 

Average premium (dollars) 989 4,379 16,718

Annual deductible options (dollars) 0 2,500 3,000-5,000

Co-pay options (dollars) 0-40 * 0-30

Coinsurance options (percent) 0-50 20 0-50

Out-of-pocket maximum options (dollars) 3,000-6,000 4,000-8,000 4,000-6,000

Preferred provider organization 17 products available

Average premium (dollars) 3,329 4,634 11,284

Annual deductible options (dollars) 300-10,000 1,800-5,000 0-2,500

Co-pay options (dollars) 0-50 * 10-25

Coinsurance options (percent) 20-50 20 80-100

Out-of-pocket maximum options (dollars) 6,000-16,000 3,000-6,000 1,000-5,000

Health maintenance organization 22 products available

Average premium (dollars) 989 4,102 16,718

Annual deductible options (dollars) 0 0-1,500 3,000-5,000

Co-pay options (dollars) 0-40 10-50 0-30

Coinsurance options (percent) 0-50 0-30 0-50

Out-of-pocket maximum options (dollars) 3,000-6,000 1,500-4,000 4,000-6,000

Other 8 products available

Average premium (dollars) 2,319 4,872 9,670

Annual deductible options (dollars) 0 250-7,500 250-500

Co-pay options (dollars) 5 20-50 10-30

Coinsurance options (percent) * 10-50 10-30

Out-of-pocket maximum options (dollars) 1,500 3,000-10,000 1,500-3,500

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 10 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 6: In Colorado, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 19 products available

Average premium (dollars) 586 4,386 14,866

Annual deductible options (dollars) 500-5,950 1,500-4,000 1,500

Co-pay options (dollars) 35-50 * 30

Coinsurance options (percent) 0-30 10-20 20

Out-of-pocket maximum options (dollars) 2,400-5,950 5,000 4,500

Preferred provider organization 7 products available

Average premium (dollars) 2,793 6,621 14,866

Annual deductible options (dollars) 750-2,000 0 1,500

Co-pay options (dollars) * 40-50 30

Coinsurance options (percent) 20-30 0 20

Out-of-pocket maximum options (dollars) 3,000-6,000 5,000-6,000 4,500

Health maintenance organization 6 products available

Average premium (dollars) 586 5,467 8,447

Annual deductible options (dollars) 500-5,950 0-2,000 0 

Co-pay options (dollars) 35-50 10-45 30

Coinsurance options (percent) 0-30 10-40 0 

Out-of-pocket maximum options (dollars) 2,400-5,950 3,000-10,000 4,000

Other 6 products available

Average premium (dollars) 3,180 4,252 4,881

Annual deductible options (dollars) 500-1,000 500-5,000 500-5,000

Co-pay options (dollars) * 20-50 25-30

Coinsurance options (percent) 20 0-30 0-30

Out-of-pocket maximum options (dollars) 1,000-2,000 3,000-7,500 3,500-6,500 a

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 11 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 7: In Connecticut, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Products Sold in the Small Group Market by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 10 products available

Average premium (dollars) 3,351 6,080 8,617

Annual deductible options (dollars) 0 2,500-5,000 0 

Co-pay options (dollars) * 0-30 20-30

Coinsurance options (percent) * * *

Out-of-pocket maximum options (dollars) 1,500-6,000 5,000-6,050 No Limit

Preferred provider organization 4 products available

Average premium (dollars) 4,177 6,080 7,856

Annual deductible options (dollars) 2,000-4,000 2,500-5,000 0-5,000

Co-pay options (dollars) 25-30 0-30 20-30

Coinsurance options (percent) 10-50 * 0-20

Out-of-pocket maximum options (dollars) 2,500-8,000 5,000-6,050 1,500-15,000

Health maintenance organization

a

2 products available

Average premium (dollars) 5,688 N/A 6,359

Annual deductible options (dollars) 0-2,500 N/A 0-5,000

Co-pay options (dollars) 20-30 N/A 10-30

Coinsurance options (percent) * N/A *

Out-of-pocket maximum options (dollars) 1,500-7,500 N/A a 5,000-6,050

Other 4 products available

Average premium (dollars) 3,351 6,544 8,617

Annual deductible options (dollars) 0 0-5,000 0 

Co-pay options (dollars) * 30 20-30

Coinsurance options (percent) * * *

Out-of-pocket maximum options (dollars) 1,500-6,000 No Limit No Limit

Legend: * = Value not reported by the insurer. N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 12 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 8: In Delaware, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Options for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 11 products available

Average premium (dollars) 3,736 5,671 10,464

Annual deductible options (dollars) 0-2,500 0-5,000 0 

Co-pay options (dollars) 10-40 0-30 10-30

Coinsurance options (percent) * * *

Out-of-pocket maximum options (dollars) 1,500-5,000 1,000-7,000 1,000-3,000 a

Preferred provider organization 3 products available

Average premium (dollars) 4,796 4,828 5,064

Annual deductible options (dollars) 0-3,000 1,500-2,500 250-2,000

Co-pay options (dollars) 0-30 30 10-25

Coinsurance options (percent) 0-20 0-20 *

Out-of-pocket maximum options (dollars) 5,600 3,000-5,000 1,000-5,000

Health maintenance organization 3 products available

Average premium (dollars) 5,671 6,296 10,452

Annual deductible options (dollars) 0-5,000 0 250

Co-pay options (dollars) 0-30 10-30 10-20

Coinsurance options (percent) * * 20

Out-of-pocket maximum options (dollars) 1,000-7,000 1,000-3,000 a 1,000-2,500

Other 5 products available

Average premium (dollars) 3,736 7,245 10,464

Annual deductible options (dollars) 0-2,500 0-5,000 0 

Co-pay options (dollars) 10-40 10-40 10-30

Coinsurance options (percent) * 0-20 *

Out-of-pocket maximum options (dollars) 1,500-5,000 500-10,000 1,000-3,000 a

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 13 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 9: In the District of Columbia, the Range of Average Annual Premiums per Covered Life and CostSharing Features for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 21 products available

Average premium (dollars) 800 3,635 6,723

Annual deductible options (dollars) 1,400-2,000 1,000-5,000 0-1,500

Co-pay options (dollars) 0-30 0 10-30

Coinsurance options (percent) 0 0-10 0-30

Out-of-pocket maximum options (dollars) 2,800-4,000 3,500-10,000 1,000-4,000

Preferred provider organization 4 products available

Average premium (dollars) 3,635 4,636 5,732

Annual deductible options (dollars) 1,000-5,000 0-2,500 1,200-2,700

Co-pay options (dollars) 0 20-30 0 

Coinsurance options (percent) 0-10 0-20 0-10

Out-of-pocket maximum options (dollars) 3,500-10,000 1,500-5,000 2,400-5,000

Health maintenance organization 7 products available

Average premium (dollars) 2,650 3,380 5,328

Annual deductible options (dollars) 0-500 1,200-4,000 0-1,500

Co-pay options (dollars) 10-30 0-15 10-30

Coinsurance options (percent) 0 0 0-30

Out-of-pocket maximum options (dollars) 1,300-2,500 2,400-5,250 1,000-4,000

Other 10 products available

Average premium (dollars) 800 2,728 6,723

Annual deductible options (dollars) 1,400-2,000 1,200-4,000 0-1,500

Co-pay options (dollars) 0-30 0-15 10-30

Coinsurance options (percent) 0 0 0-30

Out-of-pocket maximum options (dollars) 2,800-4,000 2,400-5,250 1,000-4,000

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 14 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 10: In Florida, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 170 products available

Average premium (dollars) 1,345 4,863 17,883

Annual deductible options (dollars) 10,000-20,000 500-1,000 1,000-5,000

Co-pay options (dollars) 30 20 20-30

Coinsurance options (percent) 20 20 0-20

Out-of-pocket maximum options (dollars) 20,000-40,000 4,000-8,000 2,000-4,000

Preferred provider organization

a

36 products available

Average premium (dollars) 1,345 4,690 17,883

Annual deductible options (dollars) 10,000-20,000 500-2,000 1,000-5,000

Co-pay options (dollars) 30 30-40 20-30

Coinsurance options (percent) 20 20 0-20

Out-of-pocket maximum options (dollars) 20,000-40,000 2,000-12,000 2,000-4,000

Health maintenance organization

a

85 products available

Average premium (dollars) 1,784 4,863 13,051

Annual deductible options (dollars) 1,000-2,000 500-1,000 0 

Co-pay options (dollars) 35 20 25

Coinsurance options (percent) 50 20 0 

Out-of-pocket maximum options (dollars) 2,000-4,000 4,000-8,000 5,000-10,000

Other 49 products available

Average premium (dollars) 1,473 5,034 13,574

Annual deductible options (dollars) 1,200-2,400 10,000-20,000 0 

Co-pay options (dollars) * * *

Coinsurance options (percent) 20 0 *

Out-of-pocket maximum options (dollars) 3,000-6,000 20,000-40,000 3,000-7,500

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 15 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 11: In Georgia, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 38 products available

Average premium (dollars) 2,397 4,462 14,969

Annual deductible options (dollars) 1,500-4,000 0-10,000 100-2,000

Co-pay options (dollars) * 20-40 5-25

Coinsurance options (percent) 20 0-30 80-90

Out-of-pocket maximum options (dollars) 5,950 500-15,000 500-5,500 a

Preferred provider organization 12 products available

Average premium (dollars) 4,092 6,549 14,969

Annual deductible options (dollars) 1,500-5,000 500-5,000 100-2,000

Co-pay options (dollars) 0-25 20-35 5-25

Coinsurance options (percent) 80-100 0-20 80-90

Out-of-pocket maximum options (dollars) 1,500-5,000 1,000-3,000 500-5,500 a

Health maintenance organization 6 products available

Average premium (dollars) 2,397 4,294 4,871

Annual deductible options (dollars) 1,500-4,000 1,500 500-3,000

Co-pay options (dollars) * 30-40 25-40

Coinsurance options (percent) 20 0-20 0-30

Out-of-pocket maximum options (dollars) 5,950 1,500-5,000 500-7,500

Other

a

20 products available

Average premium (dollars) 2,834 4,136 6,876

Annual deductible options (dollars) 2,500-4,000 2,000-9,000 0 

Co-pay options (dollars) * 20-30 *

Coinsurance options (percent) 0-20 0 *

Out-of-pocket maximum options (dollars) 5,950 N/D 8,000 b

Legend: * = Value not reported by the insurer. N/D = Not able to determine.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.

b

The insurer reported only a value of zero. We could not determine whether this indicated that no out-of-pocket maximum was 

required to be met or that the out-of-pocket maximum was unlimited.
Page 16 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 12: In Hawaii, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 14 products available

Average premium (dollars) 3,054 3,757 11,539

Annual deductible options (dollars) 100 0 100

Co-pay options (dollars) 15 14-20 *

Coinsurance options (percent) 0-20 0-20 10

Out-of-pocket maximum options (dollars) 2,000 2,500 2,500

Preferred provider organization 9 products available

Average premium (dollars) 3,054 3,564 11,539

Annual deductible options (dollars) 100 0 100

Co-pay options (dollars) 15 0-15 *

Coinsurance options (percent) 0-20 0-20 10

Out-of-pocket maximum options (dollars) 2,000 2,500-7,500 2,500

Health maintenance organization 3 products available

Average premium (dollars) 3,713 4,010 4,219

Annual deductible options (dollars) 0 0 0 

Co-pay options (dollars) 0-20 20 0-20

Coinsurance options (percent) 0-50 * 0-50

Out-of-pocket maximum options (dollars) 2,500 2,500 2,500

Other 2 products available

Average premium (dollars) 3,237 N/A 3,757

Annual deductible options (dollars) 300 N/A 0 

Co-pay options (dollars) 17-20 N/A 14-20

Coinsurance options (percent) 0-30 N/A 0-20

Out-of-pocket maximum options (dollars) 3,000 N/A 2,500

Legend: * = Value not reported by the insurer. N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 17 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 13: In Idaho, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 16 products available

Average premium (dollars) 1,799 3,192 15,739

Annual deductible options (dollars) 500-7,500 500-7,500 500-5,000

Co-pay options (dollars) * 20-40 25

Coinsurance options (percent) 0-50 0-30 0-20

Out-of-pocket maximum options (dollars) 2,000-4,000 2,000-4,000 2,500-6,000

Preferred provider organization 10 products available

Average premium (dollars) 1,799 3,023 3,335

Annual deductible options (dollars) 500-7,500 1,500-6,050 250-5,000

Co-pay options (dollars) * * 20-40

Coinsurance options (percent) 0-50 0-20 10-30

Out-of-pocket maximum options (dollars) 2,000-4,000 5,000-6,050 1,500-4,500

Health maintenance organization 0 products available

Average premium (dollars) N/A N/A N/A

Annual deductible options (dollars) N/A N/A N/A

Co-pay options (dollars) N/A N/A N/A

Coinsurance options (percent) N/A N/A N/A

Out-of-pocket maximum options (dollars) N/A N/A N/A

Other 6 products available

Average premium (dollars) 2,573 3,971 15,739

Annual deductible options (dollars) 2,000-5,000 0 500-5,000

Co-pay options (dollars) 0 10-30 25

Coinsurance options (percent) 0-20 0 0-20

Out-of-pocket maximum options (dollars) 4,000-5,000 1,000-5,000 2,500-6,000

Legend: * = Value not reported by the insurer. N/A = Not applicable

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 18 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 14: In Illinois, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 52 products available

Average premium (dollars) 2,406 4,891 12,250

Annual deductible options (dollars) 1,500-5,000 2,500-5,000 100-2,000

Co-pay options (dollars) 35 * 5-25

Coinsurance options (percent) 0-20 0-30 80-90

Out-of-pocket maximum options (dollars) 5,000 2,500-5,000 500-5,500

Preferred provider organization 37 products available

Average premium (dollars) 2,406 4,787 12,250

Annual deductible options (dollars) 1,500-5,000 1,500-5,000 100-2,000

Co-pay options (dollars) 35 * 5-25

Coinsurance options (percent) 0-20 0-30 80-90

Out-of-pocket maximum options (dollars) 5,000 1,500-5,000 500-5,500

Health maintenance organization 10 products available

Average premium (dollars) 4,209 5,741 10,266

Annual deductible options (dollars) 0 0 0 

Co-pay options (dollars) * * 25-35

Coinsurance options (percent) 20 20 0-30

Out-of-pocket maximum options (dollars) 1,000-3,000 1,000-3,000 1,500-3,000

Other 5 products available

Average premium (dollars) 3,876 7,924 11,959

Annual deductible options (dollars) 250-7,500 0 500-1,000

Co-pay options (dollars) 0-50 30 *

Coinsurance options (percent) 0-30 20 20

Out-of-pocket maximum options (dollars) 1,000-10,000 3,000 1,000-2,000

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 19 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 15: In Indiana, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 31 products available

Average premium (dollars) 953 4,435 17,734

Annual deductible options (dollars) 4,000 1,000-3,000 0-3,000

Co-pay options (dollars) 0 25-35 10-20

Coinsurance options (percent) 0 0-20 10-20

Out-of-pocket maximum options (dollars) No Limit 5,000 1,250-8,000

Preferred provider organization

a

22 products available

Average premium (dollars) 953 4,435 16,486

Annual deductible options (dollars) 4,000 1,000-3,000 500-5,000

Co-pay options (dollars) 0 25-35 20

Coinsurance options (percent) 0 0-20 0 

Out-of-pocket maximum options (dollars) No Limit 5,000 2,500

Health maintenance organization 3 products available

Average premium (dollars) 3,218 3,963 17,104

Annual deductible options (dollars) 1,250-5,950 0-5,000 0-3,000

Co-pay options (dollars) * 10-35 10-20

Coinsurance options (percent) 0-20 0-50 0-30

Out-of-pocket maximum options (dollars) 1,500-5,950 500-10,000 1,300-8,000

Other

a

6 products available

Average premium (dollars) 2,859 9,192 17,734

Annual deductible options (dollars) 1,250-5,950 0 0-3,000

Co-pay options (dollars) * * 10-20

Coinsurance options (percent) 0-20 * 10-20

Out-of-pocket maximum options (dollars) 1,500-5,950 3,000 1,250-8,000

Legend: * = Value not reported by the insurer.

a

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 20 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 16: In Iowa, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average

premium

Product with 

maximum average 

premium

All 27 products available

Average premium (dollars) 896 3,828 13,238

Annual deductible options (dollars) 2,000-5,000 250-5,000 500

Co-pay options (dollars) 25 0-30 20

Coinsurance options (percent) 0 0-30 10-20

Out-of-pocket maximum options (dollars) 2,000-5,000 1,000-15,000 2,000

Preferred provider organization 6 products available

Average premium (dollars) 896 2,072 13,238

Annual deductible options (dollars) 2,000-5,000 1,000-1,500 500

Co-pay options (dollars) 25 20 20

Coinsurance options (percent) 0 20-50 10-20

Out-of-pocket maximum options (dollars) 2,000-5,000 2,000-4,000 2,000

Health maintenance organization 10 products available

Average premium (dollars) 3,060 4,224 6,292

Annual deductible options (dollars) 1,500-3,000 500-3,000 0 

Co-pay options (dollars) * 0-25 20-35

Coinsurance options (percent) 0-20 20-30 *

Out-of-pocket maximum options (dollars) 1,500-5,000 1,500-9,000 1,000

Other 11 products available

Average premium (dollars) 1,110 3,075 8,126

Annual deductible options (dollars) 1,500-5,000 1,250-2,500 0 

Co-pay options (dollars) 0 0 10-20

Coinsurance options (percent) 0 20 *

Out-of-pocket maximum options (dollars) 1,500-5,000 2,500-5,000 1,000

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 21 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 17: In Kansas, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 24 products available

Average premium (dollars) 775 3,957 15,522

Annual deductible options (dollars) 0 250-5,000 0 

Co-pay options (dollars) 30 30-40 25

Coinsurance options (percent) * 0-50 20

Out-of-pocket maximum options (dollars) 5,000 1,000-5,000 2,500

Preferred provider organization 17 products available

Average premium (dollars) 775 3,957 5,022

Annual deductible options (dollars) 0 250-5,000 500-10,000

Co-pay options (dollars) 30 30-40 20-40

Coinsurance options (percent) * 0-50 0-50

Out-of-pocket maximum options (dollars) 5,000 1,000-5,000 3,200-30,000

Health maintenance organization 2 products available

Average premium (dollars) 3,073 N/A 4,811

Annual deductible options (dollars) 0-1,499 N/A 0 

Co-pay options (dollars) 20-39 N/A 15-40

Coinsurance options (percent) 0-30 N/A *

Out-of-pocket maximum options (dollars) 1,500-2,999 N/A No Limit

Other 5 products available

Average premium (dollars) 2,292 3,712 15,522

Annual deductible options (dollars) 500-1,000 0-5,000 0 

Co-pay options (dollars) * 15-40 25

Coinsurance options (percent) 20 0-50 20

Out-of-pocket maximum options (dollars) 1,000-2,000 1,000-5,000 2,500 a

Legend: * = Value not reported by the insurer. N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 22 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 18: In Kentucky, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 276 products available

Average premium (dollars) 574 1,311 14,603

Annual deductible options (dollars) 4,000 1,000 750

Co-pay options (dollars) 0 0 25

Coinsurance options (percent) 0 0 0 

Out-of-pocket maximum options (dollars) No Limit No Limit 3,000

Preferred provider organization 246 products available

Average premium (dollars) 574 1,261 4,197

Annual deductible options (dollars) 4,000 2,500 250-5,000

Co-pay options (dollars) 0 0-30 15-40

Coinsurance options (percent) 0 0 0-30

Out-of-pocket maximum options (dollars) No Limit No Limit 1,000-20,000

Health maintenance organization 21 products available

Average premium (dollars) 1,658 3,117 14,603

Annual deductible options (dollars) 0 2,000 750

Co-pay options (dollars) 0-20 25 25

Coinsurance options (percent) 0 0-20 0 

Out-of-pocket maximum options (dollars) No Limit 2,500 3,000

Other 9 products available

Average premium (dollars) 2,288 3,083 5,260

Annual deductible options (dollars) 2,500-4,000 1,500-4,000 500-5,000

Co-pay options (dollars) 30 * 25-30

Coinsurance options (percent) 0 10-20 0-20

Out-of-pocket maximum options (dollars) 5,000 5,000 3,000-10,000

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 23 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 19: In Louisiana, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 47 products available

Average premium (dollars) 992 3,773 9,882

Annual deductible options (dollars) 1,000-3,000 0 0-10,000

Co-pay options (dollars) 20-30 40-50 0-40

Coinsurance options (percent) 10 0 0-50

Out-of-pocket maximum options (dollars) 2,000 5,000-6,000 500-10,000

Preferred provider organization

a

19 products available

Average premium (dollars) 992 3,780 9,882

Annual deductible options (dollars) 1,000-3,000 2,500-4,000 0-10,000

Co-pay options (dollars) 20-30 30 0-40

Coinsurance options (percent) 10 0 0-50

Out-of-pocket maximum options (dollars) 2,000 5,950 500-10,000

Health maintenance organization

a

8 products available

Average premium (dollars) 1,171 3,775 5,017

Annual deductible options (dollars) 1,500-5,000 0 0 

Co-pay options (dollars) 15 40-50 15-30

Coinsurance options (percent) 30 0 20-60

Out-of-pocket maximum options (dollars) 3,500 5,000-6,000 2,000-4,000

Other 20 products available

Average premium (dollars) 1,203 3,773 6,833

Annual deductible options (dollars) 1,500-5,000 0 1,000

Co-pay options (dollars) 25-50 40-50 40

Coinsurance options (percent) 0 0 20

Out-of-pocket maximum options (dollars) No Limit 5,000-6,000 1,500

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 24 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 20: In Maine, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 12 products available

Average premium (dollars) 3,028 4,407 6,348

Annual deductible options (dollars) 2,500-10,000 1,500-5,000 500-2,850

Co-pay options (dollars) * 30 20-30

Coinsurance options (percent) 20 20 0-20

Out-of-pocket maximum options (dollars) 5,000-12,000 4,000-7,000 1,000-4,850

Preferred provider organization 6 products available

Average premium (dollars) 3,276 4,752 4,881

Annual deductible options (dollars) 2,500-6,000 500-10,000 2,500-5,000

Co-pay options (dollars) * 25 35

Coinsurance options (percent) 20 10-20 20-40

Out-of-pocket maximum options (dollars) 2,500-10,000 1,500-14,000 4,000-8,000

Health maintenance organization 4 products available

Average premium (dollars) 3,028 4,150 5,057

Annual deductible options (dollars) 2,500-10,000 500-2,000 2,000-3,500

Co-pay options (dollars) * 25 25

Coinsurance options (percent) 20 20-30 20-30

Out-of-pocket maximum options (dollars) 5,000-12,000 2,000-7,000 4,500-5,500

Other 2 products available

Average premium (dollars) 4,308 N/A 6,348

Annual deductible options (dollars) 0 N/A 500-2,850

Co-pay options (dollars) * N/A 20-30

Coinsurance options (percent) * N/A 0-20

Out-of-pocket maximum options (dollars) 4,500 N/A 1,000-4,850

Legend: * = Value not reported by the insurer. N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 25 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 21: In Maryland, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 36 products available

Average premium (dollars) 1,025 4,564 8,957

Annual deductible options (dollars) 1,500 1,200-2,700 0-1,500

Co-pay options (dollars) 0 10-30 25-30

Coinsurance options (percent) 0 * *

Out-of-pocket maximum options (dollars) 3,000 1,000-5,250 2,500-6,000

Preferred provider organization 13 products available

Average premium (dollars) 2,708 5,310 6,255

Annual deductible options (dollars) 250-2,500 500-2,500 0-2,750

Co-pay options (dollars) 20-40 0-30 10-40

Coinsurance options (percent) 20 * 0-20

Out-of-pocket maximum options (dollars) 2,500-4,900 2,000-5,000 1,000-5,250

Health maintenance organization 11 products available

Average premium (dollars) 1,386 4,104 5,033

Annual deductible options (dollars) 1,500-2,500 0 0 

Co-pay options (dollars) 20-30 5-30 10-30

Coinsurance options (percent) 0 0 *

Out-of-pocket maximum options (dollars) 3,000-4,900 3,300 2,900

Other 12 products available

Average premium (dollars) 1,025 5,805 8,957

Annual deductible options (dollars) 1,500 0 0-1,500

Co-pay options (dollars) 0 10-30 25-30

Coinsurance options (percent) 0 * *

Out-of-pocket maximum options (dollars) 3,000 2,900 2,500-6,000

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.” 
Page 26 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 22: In Massachusetts, the Range of Average Annual Premiums per Covered Life and Cost-Sharing 

Features for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 52 products available

Average premium (dollars) 2,254 4,470 7,541

Annual deductible options (dollars) 1,500-6,000 1,000 3,000-4,500

Co-pay options (dollars) 25 0-20 15-25

Coinsurance options (percent) 20 * *

Out-of-pocket maximum options (dollars) 3,000-10,000 2,000-4,000 5,000

Preferred provider organization 15 products available

Average premium (dollars) 2,254 4,789 7,541

Annual deductible options (dollars) 1,500-6,000 2,000 3,000-4,500

Co-pay options (dollars) 25 0-20 15-25

Coinsurance options (percent) 20 * *

Out-of-pocket maximum options (dollars) 3,000-10,000 4,000-8,000 5,000

Health maintenance organization 36 products available

Average premium (dollars) 2,293 4,367 6,337

Annual deductible options (dollars) 2,000-4,000 1,500-3,000 0-1,000

Co-pay options (dollars) 30 15-60 15-25

Coinsurance options (percent) 20 20-35 20-50

Out-of-pocket maximum options (dollars) 5,000-10,000 5,000-5,800 2,000-5,000

Other

a

1 product available

Average premium (dollars) N/A 5,738 N/A

Annual deductible options (dollars) N/A 0-5,000 N/A

Co-pay options (dollars) N/A 20-30 N/A

Coinsurance options (percent) N/A 0-50 N/A

Out-of-pocket maximum options (dollars) N/A 1,000-6,000 N/A

Legend: * = Value not reported by the insurer. N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 27 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 23: In Michigan, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 44 products available

Average premium (dollars) 1,147 3,910 10,391

Annual deductible options (dollars) 500-5,000 1,500-8,000 500-2,500

Co-pay options (dollars) 20-30 * 20-40

Coinsurance options (percent) 0-30 0-30 20

Out-of-pocket maximum options (dollars) 1,500-10,000 3,000-5,000 2,500 a

Preferred provider organization 29 products available

Average premium (dollars) 1,203 4,019 10,391

Annual deductible options (dollars) 0-5,000 1,000-8,000 500-2,500

Co-pay options (dollars) 10-30 20-40 20-40

Coinsurance options (percent) 0-50 0-30 20

Out-of-pocket maximum options (dollars) 500-10,000 2,000-5,000 a 2,500 a

Health maintenance organization 10 products available

Average premium (dollars) 1,147 3,221 4,727

Annual deductible options (dollars) 500-5,000 1,000-3,000 0 

Co-pay options (dollars) 20-30 20-30 20

Coinsurance options (percent) 0-30 20-50 0-50

Out-of-pocket maximum options (dollars) 1,500-10,000 1,500-2,500 No Limit

Other 5 products available

Average premium (dollars) 2,368 4,484 6,796

Annual deductible options (dollars) 250-3,000 0-3,000 500-1,000

Co-pay options (dollars) 0-40 15-30 *

Coinsurance options (percent) 0-40 0-20 20

Out-of-pocket maximum options (dollars) 1,000-5,000 250-4,000 1,000-2,000 a

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 28 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 24: In Minnesota, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 16 products available

Average premium (dollars) 2,887 4,114 8,152

Annual deductible options (dollars) 1,500-4,500 0-4,500 0 

Co-pay options (dollars) * 25-50 25

Coinsurance options (percent) 75-100 75-100 0-20

Out-of-pocket maximum options (dollars) 1,500-5,950 2,000-9,500 1,500

Preferred provider organization 10 products available

Average premium (dollars) 2,887 4,428 8,152

Annual deductible options (dollars) 1,500-4,500 300-6,250 0 

Co-pay options (dollars) * 25-50 25

Coinsurance options (percent) 75-100 0-30 0-20

Out-of-pocket maximum options (dollars) 1,500-5,950 1,750-6,250 1,500

Health maintenance organization 1 product available

Average premium (dollars) N/A 3,139 N/A

Annual deductible options (dollars) N/A 0-3,000 N/A

Co-pay options (dollars) N/A 0-45 N/A

Coinsurance options (percent) N/A 20 N/A

Out-of-pocket maximum options (dollars) N/A 2,500-4,500 N/A

Other 5 products available

Average premium (dollars) 2,953 4,069 4,416

Annual deductible options (dollars) 1,500-4,500 1,200-6,000 0-4,500

Co-pay options (dollars) * 0 25-50

Coinsurance options (percent) 75-100 0-20 75-100

Out-of-pocket maximum options (dollars) 1,500-5,950 1,200-6,050 2,000-9,500

Legend: * = Value not reported by the insurer. N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 29 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 25: In Mississippi, the Range of Average Annual Premiums per Covered Life and Cost-Sharing 

Features for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 12 products available 

Average premium (dollars) 1,006 2,586 5,373

Annual deductible options (dollars) 250-5,000 1,500-5,000 0 

Co-pay options (dollars) 15-35 20-50 40-50

Coinsurance options (percent) 20 10-50 0 

Out-of-pocket maximum options (dollars) 1,500-3,000 4,500-15,000 5,000-6,000

Preferred provider organization 9 products available

Average premium (dollars) 1,006 1,995 5,373

Annual deductible options (dollars) 250-5,000 2,500-4,000 0 

Co-pay options (dollars) 15-35 30 40-50

Coinsurance options (percent) 20 0 0 

Out-of-pocket maximum options (dollars) 1,500-3,000 5,000 5,000-6,000

Health maintenance organization 1 product available

Average premium (dollars) N/A 3,430 N/A

Annual deductible options (dollars) N/A 1,000-7,500 N/A

Co-pay options (dollars) N/A 30 N/A

Coinsurance options (percent) N/A 20 N/A

Out-of-pocket maximum options (dollars) N/A 3,500-10,000 N/A

Other 2 products available

Average premium (dollars) 3,756 N/A 4,445

Annual deductible options (dollars) 250-10,000 N/A 500-7,500

Co-pay options (dollars) 20-50 N/A 25-40

Coinsurance options (percent) 0-20 N/A 0-50

Out-of-pocket maximum options (dollars) 1,000-15,000 N/A 2,000-9,000

Legend: N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 30 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 26: In Missouri, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 32 products available

Average premium (dollars) 706 3,608 9,416

Annual deductible options (dollars) 1,000-10,000 2,000-5,000 0 

Co-pay options (dollars) 20-40 25 *

Coinsurance options (percent) 30 0-20 *

Out-of-pocket maximum options (dollars) 3,000-5,000 2,500-10,000 No Limit

Preferred provider organization 23 products available

Average premium (dollars) 706 3,534 5,227

Annual deductible options (dollars) 1,000-10,000 1,500-4,000 2,500-5,000

Co-pay options (dollars) 20-40 * *

Coinsurance options (percent) 30 10-20 0-30

Out-of-pocket maximum options (dollars) 3,000-5,000 5,000 1,000-4,000

Health maintenance organization 5 products available

Average premium (dollars) 1,886 3,699 5,142

Annual deductible options (dollars) 0 0-1,499 0 

Co-pay options (dollars) * 15-30 20

Coinsurance options (percent) 20 0-50 *

Out-of-pocket maximum options (dollars) 2,000-6,000 1,000-3,000 3,000

Other 4 products available

Average premium (dollars) 3,115 4,625 9,416

Annual deductible options (dollars) 0-1,499 0-5,000 0 

Co-pay options (dollars) 15-30 10-35 *

Coinsurance options (percent) 0-50 0-50 *

Out-of-pocket maximum options (dollars) 1,000-1,500 250-10,000 No Limit

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 31 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 27: In Montana, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 5 products available

Average premium (dollars) 3,201 5,152 14,045

Annual deductible options (dollars) 3,000-6,050 0-10,000 250-500

Co-pay options (dollars) * 0-40 20-25

Coinsurance options (percent) * 0-50 10-20

Out-of-pocket maximum options (dollars) 3,000-6,050 500-10,000 2,000-3,000 a

Preferred provider organization 4 products available

Average premium (dollars) 3,201 5,152 14,045

Annual deductible options (dollars) 3,000-6,050 0-10,000 250-500

Co-pay options (dollars) * 0-40 20-25

Coinsurance options (percent) * 0-50 10-20

Out-of-pocket maximum options (dollars) 3,000-6,050 500-10,000 2,000-3,000 a

Health maintenance organization 0 products available

Average premium (dollars) N/A N/A N/A

Annual deductible options (dollars) N/A N/A N/A

Co-pay options (dollars) N/A N/A N/A

Coinsurance options (percent) N/A N/A N/A

Out-of-pocket maximum options (dollars) N/A N/A N/A

Other 1 product available

Average premium (dollars) N/A 12,556 N/A

Annual deductible options (dollars) N/A 250-5,000 N/A

Co-pay options (dollars) N/A 20-25 N/A

Coinsurance options (percent) N/A 10-20 N/A

Out-of-pocket maximum options (dollars) N/A 1,500-7,500 N/A

Legend: * = Value not reported by the insurer. N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 32 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 28: In Nebraska, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 15 products available

Average premium (dollars) 626 2,271 14,946

Annual deductible options (dollars) 3,000-5,000 2,000-5,000 250-2,500

Co-pay options (dollars) 20 25 10-30

Coinsurance options (percent) 0 0 10-20

Out-of-pocket maximum options (dollars) 3,000-5,000 2,000-5,000 500-2,000

Preferred provider organization 8 products available

Average premium (dollars) 626 2,842 14,946

Annual deductible options (dollars) 3,000-5,000 1,000-5,000 250-2,500

Co-pay options (dollars) 20 20-40 10-30

Coinsurance options (percent) 0 0-20 10-20

Out-of-pocket maximum options (dollars) 3,000-5,000 750-4,000 500-2,000

Health maintenance organization 0 products available

Average premium (dollars) N/A N/A N/A

Annual deductible options (dollars) N/A N/A N/A

Co-pay options (dollars) N/A N/A N/A

Coinsurance options (percent) N/A N/A N/A

Out-of-pocket maximum options (dollars) N/A N/A N/A

Other 7 products available

Average premium (dollars) 1,580 2,044 5,003

Annual deductible options (dollars) 2,000-5,000 500-5,000 500-6,000

Co-pay options (dollars) 0 30 25-40

Coinsurance options (percent) 0 20-50 0-50

Out-of-pocket maximum options (dollars) 2,000-5,000 2,000-10,000 2,000-10,000

Legend: N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 33 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 29: In Nevada, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 26 products available

Average premium (dollars) 2,299 3,643 5,084

Annual deductible options (dollars) 0 250-10,000 250-7,500

Co-pay options (dollars) 30 0-40 20-35

Coinsurance options (percent) 0 0-50 0-30

Out-of-pocket maximum options (dollars) 5,000 1,000-12,000 4,250-11,500

Preferred provider organization 11 products available

Average premium (dollars) 2,881 3,941 4,202

Annual deductible options (dollars) 0 500-5,000 1,500-4,000

Co-pay options (dollars) 30-40 20-50 *

Coinsurance options (percent) 0 0-30 10-20

Out-of-pocket maximum options (dollars) 5,000 3,000-7,500 5,000 a

Health maintenance organization 9 products available

Average premium (dollars) 2,299 3,302 4,318

Annual deductible options (dollars) 0 0 0 

Co-pay options (dollars) 30 15 15-30

Coinsurance options (percent) 0 0 10-25

Out-of-pocket maximum options (dollars) 5,000 3,000 2,000-6,000

Other 6 products available

Average premium (dollars) 2,549 3,767 5,084

Annual deductible options (dollars) 2,500-4,000 500-2,500 250-7,500

Co-pay options (dollars) 30 25-30 20-35

Coinsurance options (percent) 0 20-30 0-30

Out-of-pocket maximum options (dollars) 5,000 3,000-5,000 4,250-11,500

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 34 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 30: In New Hampshire, the Range of Average Annual Premiums per Covered Life and Cost-Sharing 

Features for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 17 products available

Average premium (dollars) 3,627 5,559 6,538

Annual deductible options (dollars) 1,500-10,000 1,000-7,000 2,500-4,000

Co-pay options (dollars) * 25-50 20

Coinsurance options (percent) 20 0-20 0 

Out-of-pocket maximum options (dollars) 2,000-12,000 2,000-10,000 5,000

Preferred provider organization 6 products available

Average premium (dollars) 3,627 5,837 6,428

Annual deductible options (dollars) 1,500-10,000 1,500-5,000 1,000-5,000

Co-pay options (dollars) * * 25-50

Coinsurance options (percent) 20 0-20 0-20

Out-of-pocket maximum options (dollars) 2,000-12,000 2,500-6,000 2,000-6,000

Health maintenance organization 6 products available

Average premium (dollars) 3,651 5,559 6,426

Annual deductible options (dollars) 1,500-7,500 1,000-7,000 2,500-4,000

Co-pay options (dollars) 40 25-50 20

Coinsurance options (percent) 20 0-20 *

Out-of-pocket maximum options (dollars) 3,000-10,000 2,000-10,000 5,000

Other 5 products available

Average premium (dollars) 5,275 5,409 6,538

Annual deductible options (dollars) 2,000-5,000 1,000-9,500 2,500-4,000

Co-pay options (dollars) * 0-35 20

Coinsurance options (percent) 0-20 0-30 0 

Out-of-pocket maximum options (dollars) 4,000-6,250 2,000-21,000 5,000 a

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 35 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 31: In New Jersey, the Range of Average Annual Premiums per Covered Life and Cost-Sharing 

Features for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 17 products available

Average premium (dollars) 2,819 5,942 14,852

Annual deductible options (dollars) 1,250-2,500 1,000-2,500 0 

Co-pay options (dollars) 30 20-50 40

Coinsurance options (percent) 20-50 0-50 0 

Out-of-pocket maximum options (dollars) 2,500-5,950 3,000-7,500 4,000

Preferred provider organization 3 products available

Average premium (dollars) 5,507 6,471 11,872

Annual deductible options (dollars) 1,500-2,000 2,000 0-2,500

Co-pay options (dollars) 30 0 20-30

Coinsurance options (percent) 20 20 0-10

Out-of-pocket maximum options (dollars) 4,000-5,000 4,000 1,000-5,000

Health maintenance organization 5 products available

Average premium (dollars) 3,454 4,413 14,852

Annual deductible options (dollars) 0-2,500 1,000-2,500 0 

Co-pay options (dollars) 20-50 15-40 40

Coinsurance options (percent) 0-50 20-50 0 

Out-of-pocket maximum options (dollars) 3,500-7,500 3,000-7,500 4,000

Other 9 products available

Average premium (dollars) 2,819 5,954 11,838

Annual deductible options (dollars) 1,250-2,500 0-2,500 0 

Co-pay options (dollars) 30 15-30 *

Coinsurance options (percent) 20-50 0-20 *

Out-of-pocket maximum options (dollars) 2,500-5,950 1,500-5,000 2,500-7,750

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 36 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 32: In New Mexico, the Range of Average Annual Premiums per Covered Life and Cost-Sharing 

Features for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 15 products available

Average premium (dollars) 1,242 3,685 7,043

Annual deductible options (dollars) 1,250-5,000 500-5,000 0 

Co-pay options (dollars) * 30 10-30

Coinsurance options (percent) 0-50 0-50 0 

Out-of-pocket maximum options (dollars) 2,500-5,000 2,000-4,500 1,000-2,500

Preferred provider organization 7 products available

Average premium (dollars) 1,242 3,106 7,043

Annual deductible options (dollars) 1,250-5,000 500-10,000 0 

Co-pay options (dollars) * 10-20 10-30

Coinsurance options (percent) 0-50 0-30 0 

Out-of-pocket maximum options (dollars) 2,500-5,000 2,000-10,000 1,000-2,500

Health maintenance organization 6 products available

Average premium (dollars) 1,296 3,685 5,982

Annual deductible options (dollars) 500-1,000 500-5,000 0 

Co-pay options (dollars) 40 30 15-40

Coinsurance options (percent) 30-50 0-50 0-50

Out-of-pocket maximum options (dollars) 7,500 2,000-4,500 5,040

Other 2 products available

Average premium (dollars) 4,701 N/A 4,924

Annual deductible options (dollars) 250-5,000 N/A 500-5,000

Co-pay options (dollars) 10-45 N/A 30

Coinsurance options (percent) 20-30 N/A 0-30

Out-of-pocket maximum options (dollars) 2,000-10,000 N/A 2,500-6,500

Legend: * = Value not reported by the insurer. N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 37 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 33: In New York, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 66 products available

Average premium (dollars) 1,856 4,765 12,657

Annual deductible options (dollars) 1,500-5,000 0 0 

Co-pay options (dollars) * 20-30 15-20

Coinsurance options (percent) 0-20 0 0 

Out-of-pocket maximum options (dollars) 3,000-6,000 No Limit No Limit

Preferred provider organization 13 products available

Average premium (dollars) 2,254 5,729 8,633

Annual deductible options (dollars) 3,000 0-2,000 0 

Co-pay options (dollars) 20 25-40 15-50

Coinsurance options (percent) 30 0-20 *

Out-of-pocket maximum options (dollars) 5,000 3,000 No Limit

Health maintenance organization 26 products available

Average premium (dollars) 1,890 4,418 12,657

Annual deductible options (dollars) 1,250 1,200 0 

Co-pay options (dollars) 20 20 15-20

Coinsurance options (percent) * * 0 

Out-of-pocket maximum options (dollars) 6,250 5,250 No Limit

Other 27 products available

Average premium (dollars) 1,856 5,021 11,496

Annual deductible options (dollars) 1,500-5,000 0-7,000 0 

Co-pay options (dollars) * 0-40 0-45

Coinsurance options (percent) 0-20 0-30 0 

Out-of-pocket maximum options (dollars) 3,000-6,000 3,000-21,000 No Limit a

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 38 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 34: In North Carolina, the Range of Average Annual Premiums per Covered Life and Cost-Sharing 

Features for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 17 products available

Average premium (dollars) 2,836 4,236 13,651

Annual deductible options (dollars) 1,500-5,000 1,500-5,000 0 

Co-pay options (dollars) * 25-30 *

Coinsurance options (percent) 0-20 0-30 *

Out-of-pocket maximum options (dollars) 1,500-5,000 3,500-10,000 2,000-3,000

Preferred provider organization 8 products available

Average premium (dollars) 2,836 4,275 7,470

Annual deductible options (dollars) 1,500-5,000 500-10,000 250-5,000

Co-pay options (dollars) * 25-35 20-30

Coinsurance options (percent) 0-20 0-30 0-30

Out-of-pocket maximum options (dollars) 1,500-5,000 2,000-10,000 1,000-4,000

Health maintenance organization

a

2 products available

Average premium (dollars) 4,947 N/A 6,711

Annual deductible options (dollars) 250-5,000 N/A 1,000-2,500

Co-pay options (dollars) 15-35 N/A 20-30

Coinsurance options (percent) 0-50 N/A 25-50

Out-of-pocket maximum options (dollars) 2,000-10,000 N/A 3,000-7,000

Other 7 products available

Average premium (dollars) 3,444 4,026 13,651

Annual deductible options (dollars) 500-10,000 0-10,000 0 

Co-pay options (dollars) 25-50 0-30 *

Coinsurance options (percent) 0-30 0-40 *

Out-of-pocket maximum options (dollars) 2,000-20,000 1,000-10,000 2,000-3,000

Legend: * = Value not reported by the insurer. N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 39 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 35: In North Dakota, the Range of Average Annual Premiums per Covered Life and Cost-Sharing 

Features for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 20 products available

Average premium (dollars) 2,129 3,817 5,903

Annual deductible options (dollars) 1,000-7,500 100-5,000 100-1,000

Co-pay options (dollars) 30 25 25

Coinsurance options (percent) 0-30 0-20 0-20

Out-of-pocket maximum options (dollars) 3,500-10,000 1,100-7,000 1,100-2,500

Preferred provider organization 14 products available

Average premium (dollars) 2,129 3,797 5,903

Annual deductible options (dollars) 1,000-7,500 100-5,000 100-1,000

Co-pay options (dollars) 30 25 25

Coinsurance options (percent) 0-30 0-20 0-20

Out-of-pocket maximum options (dollars) 3,500-10,000 1,100-7,000 1,100-2,500

Health maintenance organization 0 products available

Average premium (dollars) N/A N/A N/A

Annual deductible options (dollars) N/A N/A N/A

Co-pay options (dollars) N/A N/A N/A

Coinsurance options (percent) N/A N/A N/A

Out-of-pocket maximum options (dollars) N/A N/A N/A

Other 6 products available

Average premium (dollars) 3,520 3,916 4,794

Annual deductible options (dollars) 1,500-3,000 0 250-5,000

Co-pay options (dollars) * 30 25

Coinsurance options (percent) 80-100 0-20 0-40

Out-of-pocket maximum options (dollars) 1,500-5,950 1,000 3,250-11,000

Legend: N/A = Not applicable. * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 40 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 36: In Ohio, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 46 products available

Average premium (dollars) 1,223 4,775 10,624

Annual deductible options (dollars) 500-10,000 250-5,000 0 

Co-pay options (dollars) 30-40 20-30 0-20

Coinsurance options (percent) 10-30 0-40 0 

Out-of-pocket maximum options (dollars) 1,000-3,000 1,250-10,000 No Limit

Preferred provider organization 26 products available

Average premium (dollars) 1,223 4,775 9,192

Annual deductible options (dollars) 500-10,000 250-5,000 1,500-4,000

Co-pay options (dollars) 30-40 20-30 *

Coinsurance options (percent) 10-30 0-40 10-20

Out-of-pocket maximum options (dollars) 1,000-3,000 1,250-10,000 5,000

Health maintenance organization 9 products available

Average premium (dollars) 3,589 6,336 10,624

Annual deductible options (dollars) 500-5,000 0-2,500 0 

Co-pay options (dollars) 15-25 0-5 0-20

Coinsurance options (percent) 0-20 20-30 0 

Out-of-pocket maximum options (dollars) 1,000-5,000 3,500-10,000 No Limit

Other 11 products available

Average premium (dollars) 2,859 3,887 5,728

Annual deductible options (dollars) 2,500-4,000 0 250-5,000

Co-pay options (dollars) * 0-15 20-30

Coinsurance options (percent) 10-20 20-30 0-50

Out-of-pocket maximum options (dollars) 5,000 1,500-3,000 1,000-9,000

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 41 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 37: In Oklahoma, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 18 products available

Average premium (dollars) 3,214 4,462 17,707

Annual deductible options (dollars) 1,500-5,000 1,500-5,950 0 

Co-pay options (dollars) 0 30-35 *

Coinsurance options (percent) 0-20 0-30 *

Out-of-pocket maximum options (dollars) 3,000-5,000 3,000-10,000 4,000

Preferred provider organization 8 products available

Average premium (dollars) 3,214 4,198 15,490

Annual deductible options (dollars) 1,500-5,000 500-5,000 250-2,500

Co-pay options (dollars) 0 20-30 15-35

Coinsurance options (percent) 0-20 20 10-30

Out-of-pocket maximum options (dollars) 3,000-5,000 1,000-2,000 500-3,000

Health maintenance organization 5 products available

Average premium (dollars) 3,975 5,220 6,080

Annual deductible options (dollars) 500-4,000 0 0 

Co-pay options (dollars) 25-35 10 15-20

Coinsurance options (percent) 20-50 20-50 20-50

Out-of-pocket maximum options (dollars) 1,000 750 1,500-2,000

Other 5 products available

Average premium (dollars) 3,755 4,462 17,707

Annual deductible options (dollars) 500-3,000 1,500-5,950 0 

Co-pay options (dollars) 25-30 30-35 *

Coinsurance options (percent) 20-30 0-30 *

Out-of-pocket maximum options (dollars) 3,000-5,000 3,000-10,000 4,000

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 42 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 38: In Oregon, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 20 products available

Average premium (dollars) 2,936 4,226 14,256

Annual deductible options (dollars) 750-5,500 300-3,000 0 

Co-pay options (dollars) 30 15-35 15-25

Coinsurance options (percent) 25-50 0-30 0-50

Out-of-pocket maximum options (dollars) 4,250-11,500 2,000-5,000 2,000

Preferred provider organization 10 products available

Average premium (dollars) 2,936 3,749 7,142

Annual deductible options (dollars) 750-5,500 500-5,000 0 

Co-pay options (dollars) 30 10-35 15-25

Coinsurance options (percent) 25-50 20-30 0-50

Out-of-pocket maximum options (dollars) 4,250-11,500 3,000-4,000 2,000

Health maintenance organization 1 product available

Average premium (dollars) N/A 6,674 N/A

Annual deductible options (dollars) N/A 0-1,000 N/A

Co-pay options (dollars) N/A 15-35 N/A

Coinsurance options (percent) N/A 0-50 N/A

Out-of-pocket maximum options (dollars) N/A 2,000-3,000 N/A

Other 9 products available

Average premium (dollars) 3,287 4,696 14,256

Annual deductible options (dollars) 1,500-3,500 0-2,000 0 

Co-pay options (dollars) 20-50 10-25 15-25

Coinsurance options (percent) 20 20-50 0-50

Out-of-pocket maximum options (dollars) 5,500 1,200-3,000 2,000

Legend: N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: A single insurer may have offered several products within a state, and these products may have varied in the premium paid 

or in the plan details, such as network provide type and cost-sharing features.

The number of products available state-wide may not reflect the total number of products that were available to all small employers 

in the state, because insurers may have offered some plans only in specific regions of a state.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 43 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 39: In Pennsylvania, the Range of Average Annual Premiums per Covered Life and Cost-Sharing 

Features for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 32 products available

Average premium (dollars) 600 4,390 17,309

Annual deductible options (dollars) 1,250-5,500 0-5,000 0 

Co-pay options (dollars) 5-35 5-35 5-35

Coinsurance options (percent) 0-20 0-20 0 

Out-of-pocket maximum options (dollars) 2,500-5,500 500-3,000 No Limit a

Preferred provider organization 17 products available

Average premium (dollars) 600 4,182 6,053

Annual deductible options (dollars) 1,250-5,500 0-10,000 0-3,000

Co-pay options (dollars) 5-35 0-25 0-40

Coinsurance options (percent) 0-20 0-20 0-20

Out-of-pocket maximum options (dollars) 2,500-5,500 500-4,000 3,000-5,600 a

Health maintenance organization

a

5 products available

Average premium (dollars) 2,694 8,948 17,309

Annual deductible options (dollars) 0-1,000 0 0 

Co-pay options (dollars) 5-35 5-35 5-35

Coinsurance options (percent) 0-30 0 0 

Out-of-pocket maximum options (dollars) 10,000 No Limit No Limit

Other 10 products available

Average premium (dollars) 3,678 4,587 6,149

Annual deductible options (dollars) 2,000-4,000 250-10,000 100-500

Co-pay options (dollars) 0 20 *

Coinsurance options (percent) 10-25 0-30 20

Out-of-pocket maximum options (dollars) 4,000-5,250 2,500-15,000 500-1,000 a

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 44 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 40: In Rhode Island, the Range of Average Annual Premiums per Covered Life and Cost-Sharing 

Features for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 9 products available

Average premium (dollars) 4,193 4,483 6,109

Annual deductible options (dollars) 250-2,000 0-5,000 0-2,000

Co-pay options (dollars) 20-30 20-30 10-30

Coinsurance options (percent) 0-20 0-20 0-20

Out-of-pocket maximum options (dollars) 2,250-4,500 800-6,000 300-5,000

Preferred provider organization

a

3 products available

Average premium (dollars) 4,346 5,077 5,584

Annual deductible options (dollars) 1,000-3,500 2,000 250-2,000

Co-pay options (dollars) 0-25 0 5-25

Coinsurance options (percent) 0-20 0 0-20

Out-of-pocket maximum options (dollars) 3,000-10,500 2,000-4,000 750-6,000

Health maintenance organization 1 product available

Average premium (dollars) N/A 4,319 N/A

Annual deductible options (dollars) N/A 750-5,000 N/A

Co-pay options (dollars) N/A 10-30 N/A

Coinsurance options (percent) N/A 0-50 N/A

Out-of-pocket maximum options (dollars) N/A 2,000-10,000 N/A

Other 5 products available

Average premium (dollars) 4,193 4,483 6,109

Annual deductible options (dollars) 250-2,000 0-5,000 0-2,000

Co-pay options (dollars) 20-30 20-30 10-30

Coinsurance options (percent) 0-20 0-20 0-20

Out-of-pocket maximum options (dollars) 2,250-4,500 800-6,000 300-5,000

Legend: N/A = Not applicable.

a

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 45 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 41: In South Carolina, the Range of Average Annual Premiums per Covered Life and Cost-Sharing 

Features for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 13 products available 

Average premium (dollars) 3,457 4,647 7,123

Annual deductible options (dollars) 500-10,000 1,500-5,000 250-8,000

Co-pay options (dollars) 30-45 0 20-40

Coinsurance options (percent) 0-30 70-100 0-30

Out-of-pocket maximum options (dollars) 2,000-10,000 1,500-5,500 1,000-5,000

Preferred provider organization 10 products available

Average premium (dollars) 4,060 4,899 7,123

Annual deductible options (dollars) 1,500-5,000 0 250-8,000

Co-pay options (dollars) 0-25 20-25 20-40

Coinsurance options (percent) 80-100 10-20 0-30

Out-of-pocket maximum options (dollars) 1,500-5,000 2,000-3,000 1,000-5,000

Health maintenance organization 0 products available

Average premium (dollars) N/A N/A N/A

Annual deductible options (dollars) N/A N/A N/A

Co-pay options (dollars) N/A N/A N/A

Coinsurance options (percent) N/A N/A N/A

Out-of-pocket maximum options (dollars) N/A N/A N/A

Other 3 products available

Average premium (dollars) 3,457 4,073 4,918

Annual deductible options (dollars) 500-10,000 500-10,000 250-10,000

Co-pay options (dollars) 30-45 20-30 20-35

Coinsurance options (percent) 0-30 0-40 0-50

Out-of-pocket maximum options (dollars) 2,000-10,000 2,500-10,000 2,000-20,000

Legend: N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 46 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 42: In South Dakota, the Range of Average Annual Premiums per Covered Life and Cost-Sharing 

Features for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 8 products available

Average premium (dollars) 1,074 4,442 6,376

Annual deductible options (dollars) 2,000-5,000 1,500-4,500 0 

Co-pay options (dollars) 0 * *

Coinsurance options (percent) 0 80-100 20

Out-of-pocket maximum options (dollars) 2,000-5,000 1,500-5,750 750-10,000

Preferred provider organization 7 products available

Average premium (dollars) 1,074 4,378 5,340

Annual deductible options (dollars) 2,000-5,000 250-5,000 300-5,000

Co-pay options (dollars) 0 0-30 25-40

Coinsurance options (percent) 0 0-30 70-80

Out-of-pocket maximum options (dollars) 2,000-5,000 1,000-15,000 1,500-10,000

Health maintenance organization 0 products available

Average premium (dollars) N/A N/A N/A

Annual deductible options (dollars) N/A N/A N/A

Co-pay options (dollars) N/A N/A N/A

Coinsurance options (percent) N/A N/A N/A

Out-of-pocket maximum options (dollars) N/A N/A N/A

Other 1 product available

Average premium (dollars) N/A 6,376 N/A

Annual deductible options (dollars) N/A 0 N/A

Co-pay options (dollars) N/A * N/A

Coinsurance options (percent) N/A 20 N/A

Out-of-pocket maximum options (dollars) N/A 750-10,000 N/A

Legend: * = Value not reported by the insurer. N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower. 

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 47 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 43: In Tennessee, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 25 products available

Average premium (dollars) 1,129 3,515 13,310

Annual deductible options (dollars) 2,500-5,000 0-10,000 500-1,000

Co-pay options (dollars) 0 10-35 *

Coinsurance options (percent) 0 0-30 20

Out-of-pocket maximum options (dollars) N/D 1,000-15,000 a 1,000-2,000

Preferred provider organization 16 products available

Average premium (dollars) 1,129 3,504 5,358

Annual deductible options (dollars) 2,500-5,000 0 1,500-5,000

Co-pay options (dollars) 0 40-50 0-25

Coinsurance options (percent) 0 0 80-100

Out-of-pocket maximum options (dollars) N/D 5,000-6,000 a 1,500-5,000

Health maintenance organization 1 product available

Average premium (dollars) N/A 5,284 N/A

Annual deductible options (dollars) N/A 250-5,000 N/A

Co-pay options (dollars) N/A 10-30 N/A

Coinsurance options (percent) N/A 0-20 N/A

Out-of-pocket maximum options (dollars) N/A 1,000-10,000 N/A

Other 8 products available

Average premium (dollars) 2,915 4,186 13,310

Annual deductible options (dollars) 0 250-5,000 500-1,000

Co-pay options (dollars) 40-50 10-30 *

Coinsurance options (percent) 0 0-20 20

Out-of-pocket maximum options (dollars) 5,000-6,000 1,000-10,000 1,000-2,000

Legend: * = Value not reported by the insurer. N/D = Not able to determine. N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

The insurer reported only a value of zero. We could not determine whether this indicated that no out-of-pocket maximum was 

required to be met or that the out-of-pocket maximum was unlimited.
Page 48 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 44: In Texas, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 26 products available

Average premium (dollars) 2,715 4,440 9,640

Annual deductible options (dollars) 2,500-4,000 1,500-4,000 500-1,000

Co-pay options (dollars) * * *

Coinsurance options (percent) 10-20 10-20 20

Out-of-pocket maximum options (dollars) 5,000 5,000 1,000-2,000

Preferred provider organization 12 products available

Average premium (dollars) 3,565 4,293 5,272

Annual deductible options (dollars) 2,500-4,000 500-5,000 1,500-5,000

Co-pay options (dollars) 30 20-50 0-25

Coinsurance options (percent) 0 0-30 80-100

Out-of-pocket maximum options (dollars) 5,000 3,000-7,500 1,500-5,000 a

Health maintenance organization 3 products available

Average premium (dollars) 6,781 6,876 9,389

Annual deductible options (dollars) 0-1,000 0 0 

Co-pay options (dollars) 20-25 10-40 25

Coinsurance options (percent) 0-30 0 0 

Out-of-pocket maximum options (dollars) 2,000-6,000 1,500-4,000 5,000

Other 11 products available

Average premium (dollars) 2,715 4,128 9,640

Annual deductible options (dollars) 2,500-4,000 2,500-4,000 500-1,000

Co-pay options (dollars) * 30 *

Coinsurance options (percent) 10-20 0 20

Out-of-pocket maximum options (dollars) 5,000 5,000 1,000-2,000

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 49 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 45: In Utah, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 14 products available 

Average premium (dollars) 1,493 2,841 15,978

Annual deductible options (dollars) 1,250-2,500 500-5,000 2,000-4,000

Co-pay options (dollars) 0 25-30 25

Coinsurance options (percent) 0-20 15-20 30

Out-of-pocket maximum options (dollars) 1,250-5,000 2,500 5,000-10,000

Preferred provider organization 9 products available

Average premium (dollars) 1,945 2,927 15,978

Annual deductible options (dollars) 2,500-4,000 500-5,000 2,000-4,000

Co-pay options (dollars) 30 20-50 25

Coinsurance options (percent) 0 0-30 30

Out-of-pocket maximum options (dollars) 5,000 2,000-7,500 5,000-10,000 a

Health maintenance organization 3 products available

Average premium (dollars) 1,493 2,383 2,841

Annual deductible options (dollars) 1,250-2,500 2,000-4,000 500-5,000

Co-pay options (dollars) 0 25 25-30

Coinsurance options (percent) 0-20 30 15-20

Out-of-pocket maximum options (dollars) 1,250-5,000 5,000-10,000 2,500

Other 2 products available

Average premium (dollars) 2,335 N/A 3,295

Annual deductible options (dollars) 1,200-5,000 N/A 500-5,000

Co-pay options (dollars) 0 N/A 20-30

Coinsurance options (percent) 0-20 N/A 10-30

Out-of-pocket maximum options (dollars) 1,500-5,000 N/A 2,500-4,000

Legend: N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 50 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 46: In Vermont, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 5 products available

Average premium (dollars) 3,958 5,232 8,509

Annual deductible options (dollars) 1,500-5,000 500-3,000 0 

Co-pay options (dollars) 0 25-30 15

Coinsurance options (percent) 0-20 20 0 

Out-of-pocket maximum options (dollars) 3,000-8,000 1,000-6,000 No Limit

Preferred provider organization 2 products available

Average premium (dollars) 3,958 N/A 5,232

Annual deductible options (dollars) 1,500-5,000 N/A 500-3,000

Co-pay options (dollars) 0 N/A 25-30

Coinsurance options (percent) 0-20 N/A 20

Out-of-pocket maximum options (dollars) 3,000-8,000 N/A 1,000-6,000

Health maintenance organization 1 product available

Average premium (dollars) N/A 8,509 N/A

Annual deductible options (dollars) N/A 0 N/A

Co-pay options (dollars) N/A 15 N/A

Coinsurance options (percent) N/A 0 N/A

Out-of-pocket maximum options (dollars) N/A No Limit N/A

Other 2 products available

Average premium (dollars) 4,196 N/A 5,636

Annual deductible options (dollars) 1,500-5,500 N/A 0-9,500

Co-pay options (dollars) 30-35 N/A 0-50

Coinsurance options (percent) 0-20 N/A 0-20

Out-of-pocket maximum options (dollars) 2,500-10,000 N/A 1,500-21,000

Legend: N/A = Not applicable.

a

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 51 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 47: In Virginia, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features for 

Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 43 products available

Average premium (dollars) 573 4,120 14,955

Annual deductible options (dollars) 300-2,500 1,200-4,000 500-5,000

Co-pay options (dollars) 0 0-25 20-50

Coinsurance options (percent) 0 0 0-30

Out-of-pocket maximum options (dollars) 4,000 2,400-5,250 1,000-7,500

Preferred provider organization

a

9 products available

Average premium (dollars) 3,773 4,565 14,955

Annual deductible options (dollars) 0-5,000 1,200-2,700 500-5,000

Co-pay options (dollars) 0-30 0 20-50

Coinsurance options (percent) 0-30 0-10 0-30

Out-of-pocket maximum options (dollars) 2,000-8,000 2,400-5,000 1,000-7,500

Health maintenance organization

a

11 products available

Average premium (dollars) 2,897 4,246 8,094

Annual deductible options (dollars) 0-500 1,200-4,000 0 

Co-pay options (dollars) 10-30 0-25 20

Coinsurance options (percent) 0 0 *

Out-of-pocket maximum options (dollars) 500-2,500 2,400-5,250 5,000

Other 23 products available

Average premium (dollars) 573 3,641 9,491

Annual deductible options (dollars) 300-2,500 1,500-5,000 0 

Co-pay options (dollars) 0 * *

Coinsurance options (percent) 0 0-20 *

Out-of-pocket maximum options (dollars) 4,000 3,500-8,000 No Limit

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

a

In addition to the range noted, the insurer also reported a value of zero. We could not determine whether this indicated that no outof-pocket maximum was required to be met or that the out-of-pocket maximum was unlimited.
Page 52 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 48: In Washington, the Range of Average Annual Premiums per Covered Life and Cost-Sharing 

Features for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 43 products available

Average premium (dollars) 839 1,753 7,397

Annual deductible options (dollars) 7,000 1,000 0 

Co-pay options (dollars) * 20 20-25

Coinsurance options (percent) 20 20 20-30

Out-of-pocket maximum options (dollars) 10,200 4,000 4,000-4,500

Preferred provider organization 6 products available

Average premium (dollars) 2,858 4,351 5,521

Annual deductible options (dollars) 1,500-5,000 250-7,500 1,500-5,000

Co-pay options (dollars) 0 20-45 0 

Coinsurance options (percent) 60-100 50-90 60-100

Out-of-pocket maximum options (dollars) 5,000 2,000-6,000 5,000

Health maintenance organization 18 products available

Average premium (dollars) 839 1,545 7,397

Annual deductible options (dollars) 7,000 1,000 0 

Co-pay options (dollars) * 20 20-25

Coinsurance options (percent) 20 20 20-30

Out-of-pocket maximum options (dollars) 10,200 5,000 4,000-4,500

Other 19 products available

Average premium (dollars) 1,216 1,975 4,707

Annual deductible options (dollars) 7,000 1,000 250-5,000

Co-pay options (dollars) * 20 10-25

Coinsurance options (percent) 20 20 10-30

Out-of-pocket maximum options (dollars) 10,200 5,000 1,200-4,000

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 53 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 49: In West Virginia, the Range of Average Annual Premiums per Covered Life and Cost-Sharing 

Features for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 21 products available

Average premium (dollars) 3,196 5,925 10,374

Annual deductible options (dollars) 3,000-5,000 0-2,500 0-2,500

Co-pay options (dollars) * 0-20 0-10

Coinsurance options (percent) * 20-30 20-30

Out-of-pocket maximum options (dollars) 3,000-5,000 3,500-10,000 3,500-10,000

Preferred provider organization 12 products available

Average premium (dollars) 3,196 4,922 7,696

Annual deductible options (dollars) 3,000-5,000 100-2,500 250-500

Co-pay options (dollars) * 10-25 0-15

Coinsurance options (percent) * 0-20 20-30

Out-of-pocket maximum options (dollars) 3,000-5,000 1,100-5,000 2,000-4,000

Health maintenance organization 7 products available

Average premium (dollars) 5,925 8,092 10,374

Annual deductible options (dollars) 0-2,500 0-2,500 0-2,500

Co-pay options (dollars) 0-20 10-20 0-10

Coinsurance options (percent) 20-30 20-30 20-30

Out-of-pocket maximum options (dollars) 3,500-10,000 2,000-6,000 3,500-10,000

Other 2 products available

Average premium (dollars) 4,548 N/A 6,989

Annual deductible options (dollars) 500-5,000 N/A 0-3,000

Co-pay options (dollars) 25 N/A 10-30

Coinsurance options (percent) 0-20 N/A 0-30

Out-of-pocket maximum options (dollars) 3,000 N/A 500-6,000

Legend: * = Value not reported by the insurer. N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage.

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 54 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 50: In Wisconsin, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 68 products available

Average premium (dollars) 720 4,514 17,575

Annual deductible options (dollars) 0-2,000 250-5,000 0 

Co-pay options (dollars) 15-30 0-30 10-20

Coinsurance options (percent) 0-30 0-30 *

Out-of-pocket maximum options (dollars) 500-5,000 750-7,000 1,000

Preferred provider organization 23 products available

Average premium (dollars) 1,214 5,226 8,383

Annual deductible options (dollars) 0-5,000 0 500-10,000

Co-pay options (dollars) 20-30 40-50 *

Coinsurance options (percent) 0-30 0 40

Out-of-pocket maximum options (dollars) 500-10,000 5,000-6,000 No Limit

Health maintenance organization 19 products available

Average premium (dollars) 720 4,123 17,575

Annual deductible options (dollars) 0-2,000 250-5,000 0 

Co-pay options (dollars) 15-30 30-40 10-20

Coinsurance options (percent) 0-30 0-20 *

Out-of-pocket maximum options (dollars) 500-5,000 1,000-8,000 1,000

Other 26 products available

Average premium (dollars) 1,300 4,433 14,905

Annual deductible options (dollars) 0-2,000 1,250-5,000 500-1,000

Co-pay options (dollars) 0-20 * *

Coinsurance options (percent) 0-20 * 20

Out-of-pocket maximum options (dollars) 500-4,000 1,250-5,000 1,000-2,000

Legend: * = Value not reported by the insurer.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”
Page 55 GAO-14-524R Range of Health Insurance Premiums in 2013

Table 51: In Wyoming, the Range of Average Annual Premiums per Covered Life and Cost-Sharing Features 

for Small Group Market Products by Network Provider Type, First Quarter 2013

Network provider type

Product with 

minimum average 

premium

Product with 

median average 

premium

Product with 

maximum average 

premium

All 5 products available

Average premium (dollars) 3,746 4,383 5,839

Annual deductible options (dollars) 1,050-5,000 500-5,000 0-5,000

Co-pay options (dollars) 0 0-25 10-40

Coinsurance options (percent) 0-20 20-50 10-20

Out-of-pocket maximum options (dollars) 2,650-5,000 1,500-7,500 2,000

Preferred provider organization 1 product available

Average premium (dollars) N/A 4,383 N/A

Annual deductible options (dollars) N/A 500-5,000 N/A

Co-pay options (dollars) N/A 0-25 N/A

Coinsurance options (percent) N/A 20-50 N/A

Out-of-pocket maximum options (dollars) N/A 1,500-7,500 N/A

Health maintenance organization 0 products available

Average premium (dollars) N/A N/A N/A

Annual deductible options (dollars) N/A N/A N/A

Co-pay options (dollars) N/A N/A N/A

Coinsurance options (percent) N/A N/A N/A

Out-of-pocket maximum options (dollars) N/A N/A N/A

Other 4 products available

Average premium (dollars) 3,746 5,037 5,839

Annual deductible options (dollars) 1,050-5,000 500-20,000 0-5,000

Co-pay options (dollars) 0 0-25 10-40

Coinsurance options (percent) 0-20 0-50 10-20

Out-of-pocket maximum options (dollars) 2,650-5,000 1,500-20,000 2,000

Legend: N/A = Not applicable.

Source: GAO analysis of data from the Center for Consumer Information and Insurance Oversight.

Notes: The number of products available state-wide may not reflect the total number of products that were available to all small 

employers in the state, because insurers may have offered some plans only in specific regions of a state. In addition, a single 

insurer may have offered several products within a state, and these products may have varied in the premium paid or in the plan 

details, such as network provider type and cost-sharing features.

The calculation for average annual premiums per covered life included premium amounts paid for individual and family coverage. 

Because insurers could have imposed different premiums on small employers on the basis of a variety of factors, actual average 

premiums per covered life for each employer may have been higher or lower.

Network provider types include preferred provider organizations, health maintenance organizations, exclusive provider 

organizations, indemnity, and point of service. Products for exclusive provider organizations, indemnity, and point of service network 

provider types are reported under the category “Other.”

(291187)
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