National Compensation Survey: 

Health Plan Provisions for Private Industry Workers in the 

United States, 2018 

U.S. Department of Labor

R. Alexander Acosta, Secretary

U.S. Bureau of Labor Statistics 

William W. Beach, Commissioner 

April 2019 

Bulletin 2790

Contents

Overview 

Health benefit tables 

Appendix table 1: Survey establishment response 

Appendix table 2: Number of workers represented

Technical note

Glossary
Overview

The National Compensation Survey (NCS) provides comprehensive measures of compensation cost trends and the 

coverage, costs, and provisions of employer-sponsored benefits in the United States. This bulletin presents 2018

estimates of the detailed benefit provisions of employer-sponsored health plans in private industry by worker and 

establishment characteristics. 

These estimates are also accessible from the National Compensation Survey – Benefits database, available at 

www.bls.gov/ncs/ebs/data.htm. 

Health benefits detailed provisions

• Annual individual and family deductibles, coinsurance percentages, annual individual and family out-ofpocket maximums;

• Annual individual deductible for high and nonhigh deductible health plans;

• Coverage and limits for hospital room and board benefits as well as physician office visits; and

• Outpatient prescription drug benefits: types of coverage and limits for generic and brand-name drugs.

Estimates for prior years and other benefits publications are available from the benefits homepage at 

www.bls.gov/ebs. 

U. S. Bureau of Labor Statistics (BLS) staff designed the survey, collected and reviewed the survey data, and 

prepared survey estimates for publication. The survey could not have been conducted without the cooperation of 

the many private businesses that provided benefits data. BLS thanks these respondents for their cooperation.

Information for respondents is available at www.bls.gov/respondents/ncs/home.htm. 

For more information on benefits estimates, contact NCS staff by phone at (202) 691–6199 or by email at 

ncsinfo@bls.gov. Information is made available to sensory-impaired individuals upon request (Voice phone: (202) 

691–5200; Federal Relay Service: 1 (800) 877–8339). Data requests also may be sent to U.S. Bureau of Labor 

Statistics, National Compensation Survey - Benefits, 2 Massachusetts Avenue NE, Room 4160, Washington, DC 

20212. 

Material in this publication is in the public domain and, with appropriate credit, may be reproduced without 

permission, see www.bls.gov/opub/#copyright.

2
Table 1. Medical care benefits: Plan characteristics, private industry workers, 2018

(All workers participating in medical care plans = 100 percent)

Characteristics

Plan network Allow nonemergency services outside

network

Yes No Not

determinable Yes No Notdeterminable

Worker characteristics

All workers ............................................................... 98 2 – 82 18 –

Management, professional, and related .................. 99 1 – 85 15 –

Management, business, and financial ................. 99 – – 87 13 –

Professional and related ...................................... 98 – – 83 17 –

Sales and office ....................................................... 99 – – 80 20 –

Sales and related ................................................. 98 – – 86 14 –

Office and administrative support ........................ 99 – – 77 23 –

Full time ................................................................... 98 2 – 82 18 –

Part time .................................................................. 97 – – 81 19 –

Establishment characteristics

Service-providing industries ..................................... 98 2 – 80 20 –

Trade, transportation, and utilities ....................... 99 – – 85 15 –

Information ........................................................... 98 – – 82 18 –

Financial activities ................................................ 100 – – 89 11 –

Education and health services ............................. 95 – – 69 31 –

Educational services ........................................ 95 5 – 68 32 –

Health care and social assistance ................... 95 – – 69 31 –

Geographic areas

Northeast ................................................................. 97 – – 86 14 –

New England ....................................................... 95 – – 86 14 –

Middle Atlantic ..................................................... 97 – – 85 15 –

South ....................................................................... 98 – – 85 15 –

South Atlantic ....................................................... 98 – – 83 17 –

West South Central .............................................. 98 – – 87 13 –

Midwest .................................................................... 98 – – 85 15 –

East North Central ............................................... 98 – – 84 16 –

West North Central .............................................. 98 – – 86 – –

West:

Mountain ............................................................ 99 – – 71 – –

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data do not meet publication criteria. For

definitions of major plans, key provisions, and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

3
Table 1. Standard errors for medical care benefits: Plan characteristics, private industry workers, 2018

Characteristics

Plan network Allow nonemergency services outside

network

Yes No Not

determinable Yes No Notdeterminable

Worker characteristics

All workers ............................................................... 0.4 0.4 0.0 1.2 1.2 0.0

Management, professional, and related .................. 0.3 0.3 0.0 1.4 1.4 0.0

Management, business, and financial ................. 0.3 – 0.0 1.6 1.6 0.0

Professional and related ...................................... 0.5 – 0.0 1.9 1.9 0.0

Sales and office ....................................................... 0.4 – 0.0 2.8 2.8 0.0

Sales and related ................................................. 0.7 – 0.0 2.6 2.6 0.0

Office and administrative support ........................ 0.5 – 0.0 3.5 3.5 0.0

Full time ................................................................... 0.4 0.4 0.0 1.2 1.2 0.0

Part time .................................................................. 1.9 – 0.0 4.5 4.5 0.0

Establishment characteristics

Service-providing industries ..................................... 0.5 0.5 0.0 1.4 1.4 0.0

Trade, transportation, and utilities ....................... 0.4 – 0.0 1.5 1.5 0.0

Information ........................................................... 1.3 – 0.0 4.9 4.9 0.0

Financial activities ................................................ 0.2 – 0.0 2.2 2.2 0.0

Education and health services ............................. 1.8 – 0.0 4.3 4.3 0.0

Educational services ........................................ 1.4 1.4 0.0 3.6 3.6 0.0

Health care and social assistance ................... 2.1 – 0.0 5.0 5.0 0.0

Geographic areas

Northeast ................................................................. 1.3 – 0.0 2.1 2.1 0.0

New England ....................................................... 3.0 – 0.0 3.1 3.1 0.0

Middle Atlantic ..................................................... 1.4 – 0.0 2.7 2.7 0.0

South ....................................................................... 0.8 – 0.0 1.6 1.6 0.0

South Atlantic ....................................................... 1.3 – 0.0 2.3 2.3 0.0

West South Central .............................................. 1.1 – 0.0 2.3 2.3 0.0

Midwest .................................................................... 1.1 – 0.0 1.9 1.9 0.0

East North Central ............................................... 1.3 – 0.0 2.0 2.0 0.0

West North Central .............................................. 1.9 – 0.0 4.4 – 0.0

West:

Mountain ............................................................ 0.5 – 0.0 10.5 – 0.0

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the

"Glossary of Employee Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

4
Table 2. Medical care benefits: Number of plan networks, private industry

workers, 2018

(All workers participating in medical care plans = 100 percent)

Characteristics No network One network Two

networks

More than 2

networks

Worker characteristics

All workers ............................................................... 2 16 77 5

Management, professional, and related .................. 1 14 79 6

Management, business, and financial ................. – 12 85 –

Professional and related ...................................... – 15 75 –

Sales and office ....................................................... – 19 77 –

Sales and related ................................................. – 12 85 –

Office and administrative support ........................ – 22 74 –

Full time ................................................................... 2 16 77 5

Part time .................................................................. – 16 76 –

Establishment characteristics

Service-providing industries ..................................... 2 18 75 5

Trade, transportation, and utilities ....................... – 14 84 –

Information ........................................................... – – 80 –

Financial activities ................................................ – 11 86 –

Education and health services ............................. – 26 54 –

Educational services ........................................ 5 27 59 10

Health care and social assistance ................... – 26 53 –

Geographic areas

Northeast ................................................................. – 11 77 –

New England ....................................................... – 9 78 –

Middle Atlantic ..................................................... – – 77 –

South ....................................................................... – 13 81 –

South Atlantic ....................................................... – 15 79 –

West South Central .............................................. – 11 83 –

Midwest .................................................................... – 13 81 –

East North Central ............................................... – 14 81 –

West North Central .............................................. – – 82 –

West:

Mountain ............................................................ – – 63 8

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data

do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee

Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

5
Table 2. Standard errors for medical care benefits: Number of plan networks,

private industry workers, 2018

Characteristics No network One network Two

networks

More than 2

networks

Worker characteristics

All workers ............................................................... 0.4 1.2 1.3 0.6

Management, professional, and related .................. 0.3 1.3 1.7 0.9

Management, business, and financial ................. – 1.5 1.8 –

Professional and related ...................................... – 1.7 2.7 –

Sales and office ....................................................... – 2.8 2.8 –

Sales and related ................................................. – 2.4 2.7 –

Office and administrative support ........................ – 3.6 3.5 –

Full time ................................................................... 0.4 1.2 1.3 0.6

Part time .................................................................. – 4.1 4.9 –

Establishment characteristics

Service-providing industries ..................................... 0.5 1.5 1.5 0.6

Trade, transportation, and utilities ....................... – 1.4 1.6 –

Information ........................................................... – – 4.9 –

Financial activities ................................................ – 2.2 2.3 –

Education and health services ............................. – 4.8 4.4 –

Educational services ........................................ 1.4 3.6 4.2 1.8

Health care and social assistance ................... – 5.6 5.1 –

Geographic areas

Northeast ................................................................. – 2.7 3.1 –

New England ....................................................... – 2.0 4.7 –

Middle Atlantic ..................................................... – – 4.4 –

South ....................................................................... – 1.5 1.7 –

South Atlantic ....................................................... – 2.2 2.3 –

West South Central .............................................. – 2.0 2.5 –

Midwest .................................................................... – 1.8 2.7 –

East North Central ............................................... – 1.9 2.3 –

West North Central .............................................. – – 7.2 –

West:

Mountain ............................................................ – – 8.7 2.4

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key

provisions, and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

6
Table 3. Medical care benefits: Summary of plan features, private industry workers, 2018

(All workers participating in medical care plans = 100 percent)

Characteristics

Annual deductible Coinsurance Annual out-of-pocket maximum

Yes No Not

determinable Yes No Notdeterminable Yes No Notdeterminable

Worker characteristics

All workers ............................................................... 91 9 1 ( ) 77 23 – 97 2 1 ( )

Management, professional, and related .................. 92 8 1 ( ) 76 24 – 98 1 1 ( )

Management, business, and financial ................. 94 6 – 80 20 – 98 1 1 ( )

Professional and related ...................................... 91 9 1 ( ) 74 26 – 99 – –

Sales and office ....................................................... 91 – – 78 22 – 98 – –

Sales and related ................................................. 98 – – 86 14 – 100 – –

Office and administrative support ........................ 88 – – 75 25 – 97 – –

Full time ................................................................... 92 8 1 ( ) 78 22 – 98 2 1 ( )

Part time .................................................................. 84 – – 70 30 – 96 – –

Establishment characteristics

Service-providing industries ..................................... 91 9 1 ( ) 77 23 – 98 – –

Trade, transportation, and utilities ....................... 96 4 1 ( ) 86 14 – 100 – –

Information ........................................................... 91 – – 84 – – 100 – –

Financial activities ................................................ 96 – – 87 13 – 96 – –

Education and health services ............................. 83 17 1 ( ) 64 36 – 99 1 1

Educational services ........................................ 90 10 1 ( ) 57 43 – 95 4 1 ( )

Health care and social assistance ................... 82 18 – 65 35 – 99 – –

Geographic areas

Northeast ................................................................. 89 11 1 ( ) 69 31 – 96 – –

New England ....................................................... 94 – – 67 33 – 94 – –

Middle Atlantic ..................................................... 87 13 1 ( ) 69 31 – 96 – –

South ....................................................................... 95 4 1 ( ) 78 22 – 98 – –

South Atlantic ....................................................... 95 4 1 ( ) 81 19 – 98 – –

West South Central .............................................. 95 – – 75 25 – 99 – –

Midwest .................................................................... 96 4 1 ( ) 82 18 – 98 2 1 ( )

East North Central ............................................... 95 5 1 ( ) 82 18 – 97 3 1 ( )

West North Central .............................................. 98 – – 84 16 – 99 – –

West:

Mountain ............................................................ 95 – – 87 – – 98 – –

1 Less than 0.5.

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key

provisions, and related terms, see the "Glossary of Employee Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

7
Table 3. Standard errors for medical care benefits: Summary of plan features, private industry workers, 2018

Characteristics

Annual deductible Coinsurance Annual out-of-pocket maximum

Yes No Not

determinable Yes No Notdeterminable Yes No Notdeterminable

Worker characteristics

All workers ............................................................... 0.9 0.9 0.1 1.2 1.2 0.0 0.4 0.4 0.1

Management, professional, and related .................. 0.9 0.9 1 ( ) 1.9 1.9 0.0 0.4 0.3 0.2

Management, business, and financial ................. 0.9 0.9 0.0 1.9 1.9 0.0 0.4 0.4 0.1

Professional and related ...................................... 1.2 1.2 0.1 3.0 3.0 0.0 0.5 – –

Sales and office ....................................................... 2.8 – – 3.0 3.0 0.0 0.7 – –

Sales and related ................................................. 0.6 – – 3.0 3.0 0.0 0.2 – 0.0

Office and administrative support ........................ 3.9 – – 3.9 3.9 0.0 1.0 – –

Full time ................................................................... 0.8 0.8 0.1 1.2 1.2 0.0 0.5 0.4 0.1

Part time .................................................................. 8.4 – – 7.1 7.1 0.0 3.1 – 0.0

Establishment characteristics

Service-providing industries ..................................... 1.1 1.0 1 ( ) 1.5 1.5 0.0 0.5 – –

Trade, transportation, and utilities ....................... 0.6 0.6 1 ( ) 1.4 1.4 0.0 0.1 – 0.0

Information ........................................................... 4.6 – – 4.9 – 0.0 0.1 – 0.0

Financial activities ................................................ 1.8 – 0.0 2.8 2.8 0.0 1.7 – –

Education and health services ............................. 3.2 3.2 1 ( ) 4.2 4.2 0.0 0.6 0.2 0.5

Educational services ........................................ 1.7 1.7 0.1 4.4 4.4 0.0 1.2 1.2 0.2

Health care and social assistance ................... 3.7 3.7 0.0 4.8 4.8 0.0 0.6 – –

Geographic areas

Northeast ................................................................. 2.9 2.9 0.1 3.0 3.0 0.0 1.2 – –

New England ....................................................... 3.1 – – 3.1 3.1 0.0 2.6 – –

Middle Atlantic ..................................................... 3.9 3.9 0.1 4.2 4.2 0.0 1.2 – –

South ....................................................................... 0.9 0.9 0.2 2.0 2.0 0.0 0.6 – –

South Atlantic ....................................................... 1.3 1.3 0.1 2.3 2.3 0.0 0.9 – –

West South Central .............................................. 1.6 – – 4.7 4.7 0.0 0.4 – –

Midwest .................................................................... 0.8 0.7 0.3 2.0 2.0 0.0 0.6 0.6 0.1

East North Central ............................................... 1.1 0.9 0.4 2.6 2.6 0.0 0.9 0.8 0.1

West North Central .............................................. 0.7 – – 3.1 3.1 0.0 0.2 – 0.0

West:

Mountain ............................................................ 1.8 – 0.0 4.6 – 0.0 1.0 – –

1 Less than 0.05.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee Benefit

Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

8
Table 4. Medical care benefits: Amount of annual individual deductible, private industry workers, 2018

(All workers participating in medical care plans = 100 percent)

Characteristics With

deductible

Amount of annual deductible

With no

deductible

Not

10th determinable

percentile

25th

percentile

50th

percentile

(median)

75th

percentile

90th

percentile

Worker characteristics

All workers ............................................................... 91 $300 $500 $1,500 $2,000 $3,500 9 1 ( )

Management, professional, and related .................. 92 350 550 1,500 2,000 – 8 1 ( )

Management, business, and financial ................. 93 400 500 1,500 2,000 3,000 7 –

Professional and related ...................................... 91 300 600 1,500 2,000 – 9 1 ( )

Sales and office ....................................................... 91 350 750 1,500 2,600 3,000 – –

Sales and related ................................................. 97 500 – 1,750 2,750 3,500 – –

Office and administrative support ........................ 88 300 – 1,500 2,000 3,000 – –

Full time ................................................................... 91 300 500 1,500 2,100 – 9 1 ( )

Part time .................................................................. 84 300 500 1,250 – 3,000 – –

Establishment characteristics

Service-providing industries ..................................... 91 300 500 1,500 2,000 – 9 1 ( )

Trade, transportation, and utilities ....................... 94 300 750 1,500 2,500 3,000 5 1 ( )

Information ........................................................... 91 500 500 1,300 1,500 2,000 – –

Financial activities ................................................ 96 500 750 1,500 2,000 3,000 – –

Education and health services ............................. 83 250 500 1,250 – 5,000 17 1 ( )

Educational services ........................................ 90 – 500 – 2,500 3,500 10 1 ( )

Health care and social assistance ................... 82 250 500 1,250 – 6,000 18 –

Geographic areas

Northeast ................................................................. 88 250 500 1,250 2,000 3,000 12 1 ( )

New England ....................................................... 94 400 500 – 2,000 3,000 – –

Middle Atlantic ..................................................... 86 250 500 1,250 1,750 3,000 14 1 ( )

South ....................................................................... 95 350 600 1,500 2,500 4,500 4 1 ( )

South Atlantic ....................................................... 95 350 500 1,500 2,500 5,000 5 1 ( )

West South Central .............................................. 95 – 850 1,500 2,500 – – –

Midwest .................................................................... 95 350 750 1,500 2,500 3,000 5 1 ( )

East North Central ............................................... 94 350 750 1,500 2,500 3,000 6 1 ( )

West North Central .............................................. 97 – 700 1,500 2,000 3,000 – –

West:

Mountain ............................................................ 94 – – 1,500 – – 6 –

1 Less than 0.5.

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key

provisions, and related terms, see the "Glossary of Employee Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

9
Table 4. Standard errors for medical care benefits: Amount of annual individual deductible, private industry workers, 2018

Characteristics With

deductible

Amount of annual deductible

With no

deductible

Not

10th determinable

percentile

25th

percentile

50th

percentile

(median)

75th

percentile

90th

percentile

Worker characteristics

All workers ............................................................... 0.9 $0 $76 $84 $523 $756 0.9 0.1

Management, professional, and related .................. 1.0 63 97 49 0 – 1.0 1 ( )

Management, business, and financial ................. 1.2 33 77 108 242 122 1.2 0.0

Professional and related ...................................... 1.3 43 147 65 18 – 1.3 0.1

Sales and office ....................................................... 2.8 57 188 0 132 231 – –

Sales and related ................................................. 0.9 122 – 234 0 961 – –

Office and administrative support ........................ 3.9 88 – 137 368 55 – –

Full time ................................................................... 0.8 0 81 42 453 – 0.8 0.1

Part time .................................................................. 8.4 65 69 158 – 282 – –

Establishment characteristics

Service-providing industries ..................................... 1.1 43 117 90 518 – 1.1 1 ( )

Trade, transportation, and utilities ....................... 1.0 71 208 67 128 129 1.0 1 ( )

Information ........................................................... 4.6 0 9 279 0 512 – –

Financial activities ................................................ 1.8 0 57 0 67 52 – 0.0

Education and health services ............................. 3.2 16 32 279 – 1,446 3.2 1 ( )

Educational services ........................................ 1.7 – 58 – 592 379 1.7 0.1

Health care and social assistance ................... 3.7 44 109 265 – 1,427 3.7 0.0

Geographic areas

Northeast ................................................................. 3.0 0 9 264 426 223 3.0 0.1

New England ....................................................... 3.1 0 120 – 294 189 – –

Middle Atlantic ..................................................... 4.0 12 0 289 335 316 4.0 0.1

South ....................................................................... 0.9 68 127 0 136 984 0.9 0.2

South Atlantic ....................................................... 1.3 76 131 0 114 1,402 1.3 0.1

West South Central .............................................. 1.6 – 224 130 581 – – –

Midwest .................................................................... 1.0 75 142 29 555 91 0.9 0.3

East North Central ............................................... 1.3 59 207 26 416 864 1.2 0.4

West North Central .............................................. 0.6 – 114 151 430 0 – –

West:

Mountain ............................................................ 1.4 – – 0 – – 1.4 0.0

1 Less than 0.05.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee Benefit

Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

10
Table 5. Medical care benefits: Type and amount of annual individual deductible, private industry workers, 2018

(All workers participating in medical care plans = 100 percent)

Characteristics

With deductible

With no

deductible

Not

Total with determinable

deductible

With fixed deductible With variable deductible

Other

deductible Total with 2

fixed

deductible

Median

deductible

amount

Total with

variable

deductible

Median deductible amount

In-network Out-ofnetwork

Most

generous

coverage1

Worker characteristics

All workers ............................................................... 91 – – 61 $1,500 $3,000 $1,500 – 9 3 ( )

Management, professional, and related .................. 92 25 $1,500 66 1,500 2,700 1,250 – 8 3 ( )

Management, business, and financial ................. 93 29 1,500 64 1,500 – – – 7 –

Professional and related ...................................... 91 23 1,500 68 1,500 3,000 1,350 – 9 3 ( )

Sales and office ....................................................... 91 – – 64 1,500 3,000 2,000 – – –

Sales and related ................................................. 97 – – 69 2,000 4,000 – – – –

Office and administrative support ........................ 88 – – 61 1,500 3,000 2,000 – – –

Full time ................................................................... 91 – – 62 1,500 3,000 1,350 – 9 3 ( )

Part time .................................................................. 84 27 1,300 57 1,250 2,500 2,000 – – –

Establishment characteristics

Service-providing industries ..................................... 91 – – 61 1,500 3,000 1,500 – 9 3 ( )

Trade, transportation, and utilities ....................... 94 26 – 69 1,500 3,000 – – 5 3 ( )

Information ........................................................... 91 45 – 47 1,350 – – – – –

Financial activities ................................................ 96 – – 68 1,600 3,000 – – – –

Education and health services ............................. 83 32 1,500 51 – 2,000 1,350 – 17 3 ( )

Educational services ........................................ 90 28 – 62 – 2,000 – – 10 3 ( )

Health care and social assistance ................... 82 33 – 49 – – 1,500 – 18 –

Geographic areas

Northeast ................................................................. 88 26 1,000 62 1,350 2,000 1,500 – 12 3 ( )

New England ....................................................... 94 33 – 61 1,500 – – – – –

Middle Atlantic ..................................................... 86 23 1,200 63 1,300 2,000 1,500 – 14 3 ( )

South ....................................................................... 95 30 1,500 66 1,500 3,000 1,350 – 4 3 ( )

South Atlantic ....................................................... 95 32 1,500 63 1,350 3,000 1,350 – 5 3 ( )

West South Central .............................................. 95 26 – 69 1,500 3,300 – – – –

Midwest .................................................................... 95 31 – 64 1,500 3,000 – – 5 3 ( )

East North Central ............................................... 94 30 1,500 64 1,500 3,000 – – 6 3 ( )

West North Central .............................................. 97 35 – 63 1,500 3,000 – – – –

West:

Mountain ............................................................ 94 39 – 55 1,500 3,000 – – 6 –

1 Refers to deductible or coinsurance amounts for the most generous benefits received in plans with more than two tiers of benefits. 2 Deductible amount vary by additional factors such as employee length of service, salary range, or age of enrollee. 3 Less than 0.5.

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related terms,

see the "Glossary of Employee Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

11
Table 5. Standard errors for medical care benefits: Type and amount of annual individual deductible, private industry workers, 2018

Characteristics

With deductible

With no

deductible

Not

Total with determinable

deductible

With fixed deductible With variable deductible

Other

deductible Total with 2

fixed

deductible

Median

deductible

amount

Total with

variable

deductible

Median deductible amount

In-network Out-ofnetwork

Most generous

coverage1

Worker characteristics

All workers ............................................................... 0.9 – – 1.5 $40 $276 $255 – 0.9 0.1

Management, professional, and related .................. 1.0 2.4 $120 2.7 58 297 245 – 1.0 3 ( )

Management, business, and financial ................. 1.2 3.0 154 3.2 183 – – – 1.2 0.0

Professional and related ...................................... 1.3 3.0 156 3.3 64 307 280 – 1.3 0.1

Sales and office ....................................................... 2.8 – – 3.1 0 39 261 – – –

Sales and related ................................................. 0.9 – – 3.6 118 1,121 – – – –

Office and administrative support ........................ 3.9 – – 3.6 68 0 562 – – –

Full time ................................................................... 0.8 – – 1.5 27 211 226 – 0.8 0.1

Part time .................................................................. 8.4 5.5 368 6.6 224 493 353 – – –

Establishment characteristics

Service-providing industries ..................................... 1.1 – – 1.8 96 286 385 – 1.1 3 ( )

Trade, transportation, and utilities ....................... 1.0 3.1 – 2.7 0 0 – – 1.0 3 ( )

Information ........................................................... 4.6 8.1 – 6.0 65 – – – – –

Financial activities ................................................ 1.8 – – 3.0 163 222 – – – 0.0

Education and health services ............................. 3.2 4.3 434 4.7 – 518 228 – 3.2 3 ( )

Educational services ........................................ 1.7 4.4 – 4.2 – 277 – – 1.7 0.1

Health care and social assistance ................... 3.7 4.9 – 5.4 – – 271 – 3.7 0.0

Geographic areas

Northeast ................................................................. 3.0 2.8 72 3.7 211 16 0 – 3.0 0.1

New England ....................................................... 3.1 7.2 – 7.8 0 – – – – –

Middle Atlantic ..................................................... 4.0 2.7 347 4.3 251 140 365 – 4.0 0.1

South ....................................................................... 0.9 2.1 145 2.4 0 0 399 – 0.9 0.2

South Atlantic ....................................................... 1.3 3.3 0 3.3 164 396 199 – 1.3 0.1

West South Central .............................................. 1.6 3.3 – 4.5 97 638 – – – –

Midwest .................................................................... 1.0 2.3 – 2.9 0 0 – – 0.9 0.3

East North Central ............................................... 1.3 3.2 254 3.9 58 137 – – 1.2 0.4

West North Central .............................................. 0.6 2.6 – 2.9 0 255 – – – –

West:

Mountain ............................................................ 1.4 7.6 – 7.5 0 443 – – 1.4 0.0

1 Refers to deductible or coinsurance amounts for the most generous benefits received in plans with more than two tiers of benefits. 2 Deductible amount vary by additional factors such as employee length of service, salary range, or age of enrollee. 3 Less than 0.05.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

12
Table 6. Medical care benefits: Amount of annual family deductible, private industry workers, 2018

(All workers participating in medical care plans = 100 percent)

Characteristics With

deductible

Amount of annual deductible

With no

deductible

Not

10th determinable

percentile

25th

percentile

50th

percentile

(median)

75th

percentile

90th

percentile

Worker characteristics

All workers ............................................................... 89 $700 $1,300 $3,000 $5,000 $8,000 11 1 ( )

Management, professional, and related .................. 89 800 1,200 3,000 4,000 – 11 1 ( )

Management, business, and financial ................. 92 900 1,150 3,000 3,800 6,000 8 –

Professional and related ...................................... 87 750 1,200 3,000 4,000 10,000 13 1 ( )

Sales and office ....................................................... 89 – – 3,000 5,200 6,000 – –

Sales and related ................................................. 95 1,000 2,000 3,750 5,500 7,000 – –

Office and administrative support ........................ 87 – 1,500 3,000 4,500 6,000 – –

Full time ................................................................... 90 700 1,300 3,000 5,000 8,000 10 1 ( )

Part time .................................................................. 80 – 1,200 3,000 4,500 – – –

Establishment characteristics

Service-providing industries ..................................... 89 750 1,250 3,000 4,500 9,000 11 1 ( )

Trade, transportation, and utilities ....................... 92 – 1,500 3,000 5,000 6,000 8 1 ( )

Information ........................................................... 91 1,000 1,100 2,700 3,750 5,000 – –

Financial activities ................................................ 96 1,000 1,800 3,000 4,200 5,700 – –

Education and health services ............................. 82 600 1,000 3,000 – 10,000 18 1 ( )

Educational services ........................................ 88 – 1,000 2,000 – 7,000 12 1 ( )

Health care and social assistance ................... 81 600 1,200 3,000 – 12,000 19 –

Geographic areas

Northeast ................................................................. 88 500 1,000 2,700 4,000 6,000 12 1 ( )

New England ....................................................... 94 800 – – 4,000 6,000 – –

Middle Atlantic ..................................................... 85 500 1,000 2,700 3,800 6,000 15 1 ( )

South ....................................................................... 93 900 1,500 3,000 5,000 10,000 7 1 ( )

South Atlantic ....................................................... 93 – 1,200 3,000 5,000 10,000 7 1 ( )

West South Central .............................................. 92 – 2,000 3,000 5,000 9,000 – –

Midwest .................................................................... 95 – 1,500 3,000 5,000 6,450 5 1 ( )

East North Central ............................................... 93 – 1,500 3,000 5,000 7,500 6 1 ( )

West North Central .............................................. 97 – 1,500 3,000 5,000 6,000 – –

West:

Mountain ............................................................ 93 1,000 2,250 3,000 5,500 – 7 –

1 Less than 0.5.

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key

provisions, and related terms, see the "Glossary of Employee Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

13
Table 6. Standard errors for medical care benefits: Amount of annual family deductible, private industry workers, 2018

Characteristics With

deductible

Amount of annual deductible

With no

deductible

Not

10th determinable

percentile

25th

percentile

50th

percentile

(median)

75th

percentile

90th

percentile

Worker characteristics

All workers ............................................................... 1.3 $129 $256 $0 $640 $1,583 1.3 0.1

Management, professional, and related .................. 1.6 77 192 0 0 – 1.6 1 ( )

Management, business, and financial ................. 1.1 147 344 0 227 409 1.1 0.0

Professional and related ...................................... 2.5 35 210 0 847 2,830 2.5 0.1

Sales and office ....................................................... 2.8 – – 0 297 900 – –

Sales and related ................................................. 1.8 0 180 416 0 1,952 – –

Office and administrative support ........................ 3.8 – 222 36 491 574 – –

Full time ................................................................... 1.3 127 274 0 640 1,839 1.3 0.1

Part time .................................................................. 8.1 – 251 158 1,270 – – –

Establishment characteristics

Service-providing industries ..................................... 1.6 43 267 0 739 2,282 1.6 1 ( )

Trade, transportation, and utilities ....................... 0.9 – 114 0 189 267 0.9 1 ( )

Information ........................................................... 4.6 0 325 396 79 883 – –

Financial activities ................................................ 1.8 0 438 0 404 36 – 0.0

Education and health services ............................. 3.2 163 224 418 – 2,875 3.2 1 ( )

Educational services ........................................ 2.1 – 126 557 – 1,109 2.1 0.1

Health care and social assistance ................... 3.7 179 265 359 – 2,899 3.7 0.0

Geographic areas

Northeast ................................................................. 2.9 82 165 502 587 505 2.9 0.1

New England ....................................................... 3.1 11 – – 510 377 – –

Middle Atlantic ..................................................... 3.9 27 71 549 585 680 3.9 0.1

South ....................................................................... 1.0 168 165 0 261 1,366 0.9 0.2

South Atlantic ....................................................... 0.9 – 326 0 247 1,197 1.0 0.1

West South Central .............................................. 1.4 – 517 0 889 2,461 – –

Midwest .................................................................... 1.0 – 158 0 253 1,263 0.9 0.3

East North Central ............................................... 1.4 – 326 0 533 1,514 1.2 0.4

West North Central .............................................. 0.6 – 293 0 889 0 – –

West:

Mountain ............................................................ 1.5 213 313 0 1,526 – 1.5 0.0

1 Less than 0.05.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee Benefit

Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

14
Table 7. Medical care benefits: Type and amount of annual family deductible, private industry workers, 2018

(All workers participating in medical care plans = 100 percent)

Characteristics

With deductible

With no

deductible

Not

Total with determinable

deductible

With fixed deductible With variable deductible

Other

deductible Total with 2

fixed

deductible

Median

deductible

amount

Total with

variable

deductible

Median deductible amount

In-network Out-ofnetwork

Most

generous

coverage1

Worker characteristics

All workers ............................................................... 89 – – 61 $3,000 $6,000 $3,000 – 11 3 ( )

Management, professional, and related .................. 89 25 $3,000 64 3,000 6,000 2,500 – 11 3 ( )

Management, business, and financial ................. 92 29 3,000 64 3,000 5,200 – – 8 –

Professional and related ...................................... 87 22 3,000 64 3,000 6,000 2,700 – 13 3 ( )

Sales and office ....................................................... 89 – – 63 3,000 6,800 3,000 – – –

Sales and related ................................................. 95 – – 69 4,000 10,000 – – – –

Office and administrative support ........................ 87 – – 61 3,000 6,000 3,000 – – –

Full time ................................................................... 90 – – 61 3,000 6,000 2,700 – 10 3 ( )

Part time .................................................................. 80 23 3,000 57 2,700 6,000 – – – –

Establishment characteristics

Service-providing industries ..................................... 89 – – 60 3,000 6,000 3,000 – 11 3 ( )

Trade, transportation, and utilities ....................... 92 23 3,000 69 3,000 6,000 – – 8 3 ( )

Information ........................................................... 91 45 – 47 2,700 – – – – –

Financial activities ................................................ 96 – – 68 3,200 6,000 – – – –

Education and health services ............................. 82 31 3,000 51 2,500 4,800 2,700 – 18 3 ( )

Educational services ........................................ 88 26 – 62 – 4,000 – – 12 3 ( )

Health care and social assistance ................... 81 32 – 49 2,500 4,800 3,000 – 19 –

Geographic areas

Northeast ................................................................. 88 25 2,000 62 3,000 4,000 3,000 – 12 3 ( )

New England ....................................................... 94 33 – 61 3,000 6,000 – – – –

Middle Atlantic ..................................................... 85 22 3,000 63 2,700 4,000 3,000 – 15 3 ( )

South ....................................................................... 93 28 3,000 65 3,000 6,400 2,700 – 7 3 ( )

South Atlantic ....................................................... 93 30 3,000 63 3,000 6,000 2,700 – 7 3 ( )

West South Central .............................................. 92 24 – 69 3,200 7,800 – – – –

Midwest .................................................................... 95 31 3,000 64 3,000 6,000 – – 5 3 ( )

East North Central ............................................... 93 29 3,000 64 3,000 6,000 – – 6 3 ( )

West North Central .............................................. 97 35 – 63 3,000 7,000 – – – –

West:

Mountain ............................................................ 93 38 – 55 3,000 6,000 – – 7 –

1 Refers to deductible or coinsurance amounts for the most generous benefits received in plans with more than two tiers of benefits. 2 Deductible amount vary by additional factors such as employee length of service, salary range, or age of enrollee. 3 Less than 0.5.

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related

terms, see the "Glossary of Employee Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

15
Table 7. Standard errors for medical care benefits: Type and amount of annual family deductible, private industry workers, 2018

Characteristics

With deductible

With no

deductible

Not

Total with determinable

deductible

With fixed deductible With variable deductible

Other

deductible Total with 2

fixed

deductible

Median

deductible

amount

Total with

variable

deductible

Median deductible amount

In-network Out-ofnetwork

Most

generous

coverage1

Worker characteristics

All workers ............................................................... 1.3 – – 1.5 $0 $0 $458 – 1.3 0.1

Management, professional, and related .................. 1.6 2.4 $36 2.0 0 222 490 – 1.6 3 ( )

Management, business, and financial ................. 1.1 2.9 51 3.2 0 647 – – 1.1 0.0

Professional and related ...................................... 2.5 2.9 63 2.1 0 0 484 – 2.5 0.1

Sales and office ....................................................... 2.8 – – 3.1 0 805 780 – – –

Sales and related ................................................. 1.8 – – 3.6 456 2,104 – – – –

Office and administrative support ........................ 3.8 – – 3.5 0 0 0 – – –

Full time ................................................................... 1.3 – – 1.5 0 0 449 – 1.3 0.1

Part time .................................................................. 8.1 5.2 0 6.6 555 1,379 – – – –

Establishment characteristics

Service-providing industries ..................................... 1.6 – – 1.8 0 73 263 – 1.6 3 ( )

Trade, transportation, and utilities ....................... 0.9 2.8 266 2.7 0 175 – – 0.9 3 ( )

Information ........................................................... 4.6 8.1 – 6.0 129 – – – – –

Financial activities ................................................ 1.8 – – 3.0 328 329 – – – 0.0

Education and health services ............................. 3.2 4.4 365 4.7 661 1,270 451 – 3.2 3 ( )

Educational services ........................................ 2.1 4.5 – 4.2 – 438 – – 2.1 0.1

Health care and social assistance ................... 3.7 5.1 – 5.4 681 1,258 484 – 3.7 0.0

Geographic areas

Northeast ................................................................. 2.9 2.7 585 3.7 336 508 0 – 2.9 0.1

New England ....................................................... 3.1 7.2 – 7.8 540 1,742 – – – –

Middle Atlantic ..................................................... 3.9 2.4 521 4.3 592 264 663 – 3.9 0.1

South ....................................................................... 1.0 2.3 0 2.4 0 384 534 – 0.9 0.2

South Atlantic ....................................................... 0.9 3.4 100 3.3 55 0 142 – 1.0 0.1

West South Central .............................................. 1.4 3.5 – 4.4 398 989 – – – –

Midwest .................................................................... 1.0 2.3 36 2.8 0 186 – – 0.9 0.3

East North Central ............................................... 1.4 3.0 109 3.9 0 0 – – 1.2 0.4

West North Central .............................................. 0.6 2.7 – 2.9 0 808 – – – –

West:

Mountain ............................................................ 1.5 7.9 – 7.5 0 630 – – 1.5 0.0

1 Refers to deductible or coinsurance amounts for the most generous benefits received in plans with more than two tiers of benefits. 2 Deductible amount vary by additional factors such as employee length of service, salary range, or age of enrollee. 3 Less than 0.05.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

16
Table 8. Medical care benefits: Type and percent of coinsurance, private industry workers, 2018

(All workers participating in medical care plans with coinsurance = 100 percent)

Characteristics

Fixed coinsurance Variable coinsurance

With other

With fixed coinsurance

coinsurance

Median

coinsurance

percentage

With variable

coinsurance

Median coinsurance percentage

In-network Out-ofnetwork

Most

generous

coverage1

Worker characteristics

All workers ............................................................... – – 81 80 60 90 –

Management, professional, and related .................. – – 83 80 60 90 –

Management, business, and financial ................. – – 86 80 60 90 –

Professional and related ...................................... 20 80 80 80 60 90 –

Sales and office ....................................................... – – 83 80 60 90 –

Sales and related ................................................. – – 88 80 60 – –

Office and administrative support ........................ 20 80 80 80 60 90 –

Full time ................................................................... – – 81 80 60 90 –

Part time .................................................................. – – 81 80 60 90 –

Establishment characteristics

Service-providing industries ..................................... – – 79 80 60 90 –

Trade, transportation, and utilities ....................... – – 85 80 60 90 –

Information ........................................................... – – 88 80 60 – –

Financial activities ................................................ 10 80 90 80 60 90 –

Education and health services ............................. – – 65 80 60 90 –

Educational services ........................................ 35 80 65 90 70 90 –

Health care and social assistance ................... – – 65 80 60 90 –

Geographic areas

Northeast ................................................................. – – 85 80 60 100 –

New England ....................................................... – – 77 80 60 90 –

Middle Atlantic ..................................................... – – 88 80 60 100 –

South ....................................................................... 14 80 86 80 60 90 –

South Atlantic ....................................................... 14 80 86 80 60 90 –

West South Central .............................................. 13 75 87 80 60 90 –

Midwest .................................................................... – – 82 80 60 90 –

East North Central ............................................... – – 82 80 60 90 –

West North Central .............................................. – – 81 80 60 80 –

West:

Mountain ............................................................ – – 67 80 60 85 –

1 Refers to deductible or coinsurance amounts for the most generous benefits received in plans with more than two tiers of benefits.

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major

plans, key provisions, and related terms, see the "Glossary of Employee Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

17
Table 8. Standard errors for medical care benefits: Type and percent of coinsurance, private industry workers, 2018

Characteristics

Fixed coinsurance Variable coinsurance

With other

With fixed coinsurance

coinsurance

Median

coinsurance

percentage

With variable

coinsurance

Median coinsurance percentage

In-network Out-ofnetwork

Most

generous

coverage1

Worker characteristics

All workers ............................................................... – – 1.4 0.0 0.0 0.0 –

Management, professional, and related .................. – – 2.3 0.0 0.0 0.0 –

Management, business, and financial ................. – – 3.2 0.0 0.0 0.0 –

Professional and related ...................................... 2.6 4.9 2.6 0.0 0.0 4.1 –

Sales and office ....................................................... – – 2.1 0.0 0.0 0.0 –

Sales and related ................................................. – – 2.7 0.0 7.8 – –

Office and administrative support ........................ 2.5 0.0 2.5 0.0 0.0 0.0 –

Full time ................................................................... – – 1.5 0.0 0.0 0.0 –

Part time .................................................................. – – 4.8 0.0 0.0 7.7 –

Establishment characteristics

Service-providing industries ..................................... – – 1.8 0.0 0.0 0.0 –

Trade, transportation, and utilities ....................... – – 1.6 0.0 0.0 0.0 –

Information ........................................................... – – 4.1 2.6 0.0 – –

Financial activities ................................................ 2.0 0.9 2.0 0.0 0.0 13.1 –

Education and health services ............................. – – 5.7 1.8 0.0 4.5 –

Educational services ........................................ 7.3 2.2 7.3 4.4 3.0 0.0 –

Health care and social assistance ................... – – 6.4 0.9 0.0 6.0 –

Geographic areas

Northeast ................................................................. – – 3.0 0.0 0.0 2.6 –

New England ....................................................... – – 9.8 0.0 3.2 11.4 –

Middle Atlantic ..................................................... – – 2.2 0.0 0.0 0.0 –

South ....................................................................... 1.6 3.2 1.6 0.0 0.0 0.0 –

South Atlantic ....................................................... 2.1 1.3 2.1 0.0 0.0 0.0 –

West South Central .............................................. 2.4 0.0 2.4 0.0 0.0 1.3 –

Midwest .................................................................... – – 2.2 0.0 0.0 10.8 –

East North Central ............................................... – – 2.6 0.0 0.0 6.3 –

West North Central .............................................. – – 4.0 0.0 0.0 7.1 –

West:

Mountain ............................................................ – – 10.6 0.0 1.6 21.2 –

1 Refers to deductible or coinsurance amounts for the most generous benefits received in plans with more than two tiers of benefits.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee

Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

18
Table 9. Medical care benefits: Amount of annual individual out-of-pocket maximum,1

 private industry workers, 2018

(All workers participating in medical care plans = 100 percent)

Characteristics

With out-ofpocket

maximum

Amount of out-of-pocket maximum With no

out-ofpocket

maximum

Not

10th determinable

percentile

25th

percentile

50th

percentile

(median)

75th

percentile

90th

percentile

Worker characteristics

All workers ............................................................... 97 $1,000 $1,500 $2,500 $3,500 $4,850 2 2 ( )

Management, professional, and related .................. 98 1,200 1,500 2,500 3,450 4,850 1 2 ( )

Management, business, and financial ................. 98 1,200 1,500 2,500 3,400 4,850 1 2 ( )

Professional and related ...................................... 99 1,100 1,500 2,400 3,500 4,850 – –

Sales and office ....................................................... 98 1,000 1,500 2,500 3,500 4,500 – –

Sales and related ................................................. 100 1,000 2,000 3,000 4,100 4,500 – –

Office and administrative support ........................ 97 1,000 1,500 2,500 3,300 4,500 – –

Full time ................................................................... 98 1,000 1,500 2,400 3,450 4,700 2 2 ( )

Part time .................................................................. 96 1,000 2,000 2,900 4,300 – – –

Establishment characteristics

Service-providing industries ..................................... 98 1,000 1,500 2,500 3,500 4,850 – –

Trade, transportation, and utilities ....................... 100 1,000 1,600 2,500 3,650 4,300 – –

Information ........................................................... 100 1,000 1,350 2,300 3,500 4,000 – –

Financial activities ................................................ 96 1,000 1,500 2,000 2,750 3,500 – –

Education and health services ............................. 99 1,000 1,600 2,400 3,500 6,350 1 1

Educational services ........................................ 95 1,000 1,400 2,000 3,000 4,450 4 2 ( )

Health care and social assistance ................... 99 – 1,600 2,500 3,750 6,350 – –

Geographic areas

Northeast ................................................................. 96 1,000 1,600 2,500 3,700 6,600 – –

New England ....................................................... 94 1,000 – 2,500 3,450 4,200 – –

Middle Atlantic ..................................................... 96 1,000 1,500 2,500 4,050 6,850 – –

South ....................................................................... 98 1,000 1,650 2,500 3,500 4,500 – –

South Atlantic ....................................................... 98 1,000 1,750 2,500 3,450 4,300 – –

West South Central .............................................. 99 1,000 – – 3,500 4,500 – –

Midwest .................................................................... 98 1,000 1,500 2,250 3,200 4,550 2 2 ( )

East North Central ............................................... 97 1,000 1,500 – 3,400 4,550 3 2 ( )

West North Central .............................................. 99 1,000 1,500 2,000 3,000 4,100 – –

West:

Mountain ............................................................ 98 – 1,250 2,000 3,500 5,450 – –

1 The out-of-pocket maximum is the annual limit on the amount of covered expenses that a participant or a family must pay after the deductible has been satisfied. Once reached, covered

expenses are fully reimbursed for the rest of the year. 2 Less than 0.5.

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key

provisions, and related terms, see the "Glossary of Employee Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

19
Table 9. Standard errors for medical care benefits: Amount of annual individual out-of-pocket maximum,1

 private industry

workers, 2018

Characteristics

With out-ofpocket

maximum

Amount of out-of-pocket maximum With no

out-ofpocket

maximum

Not

10th determinable

percentile

25th

percentile

50th

percentile

(median)

75th

percentile

90th

percentile

Worker characteristics

All workers ............................................................... 0.4 $0 $0 $57 $24 $177 0.4 0.1

Management, professional, and related .................. 0.4 202 9 167 90 460 0.3 0.2

Management, business, and financial ................. 0.4 109 105 56 65 521 0.4 0.1

Professional and related ...................................... 0.5 198 0 159 135 521 – –

Sales and office ....................................................... 0.7 0 120 0 120 188 – –

Sales and related ................................................. 0.2 138 184 166 34 159 – 0.0

Office and administrative support ........................ 1.0 0 22 228 297 401 – –

Full time ................................................................... 0.5 0 0 129 67 238 0.4 0.1

Part time .................................................................. 3.1 18 146 297 700 – – 0.0

Establishment characteristics

Service-providing industries ..................................... 0.5 0 46 44 9 152 – –

Trade, transportation, and utilities ....................... 0.1 0 205 85 185 167 – 0.0

Information ........................................................... 0.1 0 210 551 292 65 – 0.0

Financial activities ................................................ 1.7 0 108 94 114 50 – –

Education and health services ............................. 0.6 162 132 130 343 513 0.2 0.5

Educational services ........................................ 1.2 0 133 71 524 303 1.2 0.2

Health care and social assistance ................... 0.6 – 86 105 476 1,045 – –

Geographic areas

Northeast ................................................................. 1.2 112 38 34 379 832 – –

New England ....................................................... 2.6 271 – 556 279 223 – –

Middle Atlantic ..................................................... 1.2 199 108 53 623 840 – –

South ....................................................................... 0.6 76 124 105 64 93 – –

South Atlantic ....................................................... 0.9 9 176 158 66 163 – –

West South Central .............................................. 0.4 248 – – 71 97 – –

Midwest .................................................................... 0.6 0 0 190 302 340 0.6 0.1

East North Central ............................................... 0.9 0 0 – 227 389 0.8 0.1

West North Central .............................................. 0.2 62 321 55 189 392 – 0.0

West:

Mountain ............................................................ 1.0 – 343 204 202 428 – –

1 The out-of-pocket maximum is the annual limit on the amount of covered expenses that a participant or a family must pay after the deductible has been satisfied. Once reached, covered

expenses are fully reimbursed for the rest of the year.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee Benefit

Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

20
Table 10. Medical care benefits: Amount of annual family out-of-pocket maximum,1

 private industry workers, 2018

(All workers participating in medical care plans = 100 percent)

Characteristics

With out-ofpocket

maximum

Amount of out-of-pocket maximum With no

out-ofpocket

maximum

Not

10th determinable

percentile

25th

percentile

50th

percentile

(median)

75th

percentile

90th

percentile

Worker characteristics

All workers ............................................................... 97 $2,000 $3,000 $5,000 $7,000 $10,000 3 2 ( )

Management, professional, and related .................. 98 2,400 3,000 5,000 7,000 10,000 2 2 ( )

Management, business, and financial ................. 98 2,400 3,100 5,000 7,000 10,100 2 2 ( )

Professional and related ...................................... 98 2,400 3,000 5,000 7,000 10,000 – –

Sales and office ....................................................... 98 2,000 3,000 5,000 7,000 9,500 – –

Sales and related ................................................. 100 2,400 3,500 6,000 8,200 9,500 – –

Office and administrative support ........................ 97 2,000 3,000 5,000 6,800 9,400 – –

Full time ................................................................... 97 2,000 3,000 5,000 7,000 9,750 3 2 ( )

Part time .................................................................. 96 2,400 4,000 6,000 9,500 – – –

Establishment characteristics

Service-providing industries ..................................... 97 2,000 3,000 5,000 7,200 10,200 – –

Trade, transportation, and utilities ....................... 99 2,000 3,250 – 7,500 8,700 – –

Information ........................................................... 99 2,400 3,000 5,200 7,000 8,000 – –

Financial activities ................................................ 96 2,000 3,200 4,200 6,000 7,000 – –

Education and health services ............................. 97 2,000 3,200 5,000 7,500 12,700 2 1

Educational services ........................................ 93 2,000 2,700 4,000 6,000 8,900 6 2 ( )

Health care and social assistance ................... 98 – 3,200 5,250 7,800 12,700 – –

Geographic areas

Northeast ................................................................. 95 2,250 3,200 5,000 8,000 13,200 – –

New England ....................................................... 94 – 3,200 5,200 – 9,750 – –

Middle Atlantic ..................................................... 96 2,200 3,000 5,000 8,500 13,700 – –

South ....................................................................... 97 2,000 3,300 5,200 7,000 9,000 – –

South Atlantic ....................................................... 97 2,000 3,300 – 7,000 8,900 – –

West South Central .............................................. 99 2,000 3,100 5,400 – 9,400 – –

Midwest .................................................................... 97 2,000 3,000 4,500 6,500 9,500 3 2 ( )

East North Central ............................................... 97 2,000 3,000 4,500 7,000 10,000 3 2 ( )

West North Central .............................................. 99 1,950 2,650 4,000 6,000 8,200 – –

West:

Mountain ............................................................ 98 – 2,500 3,850 7,000 10,700 – –

1 The out-of-pocket maximum is the annual limit on the amount of covered expenses that a participant or a family must pay after the deductible has been satisfied. Once reached, covered

expenses are fully reimbursed for the rest of the year. 2 Less than 0.5.

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans,

key provisions, and related terms, see the "Glossary of Employee Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

21
Table 10. Standard errors for medical care benefits: Amount of annual family out-of-pocket maximum,1

 private industry

workers, 2018

Characteristics

With out-ofpocket

maximum

Amount of out-of-pocket maximum With no

out-ofpocket

maximum

Not

10th determinable

percentile

25th

percentile

50th

percentile

(median)

75th

percentile

90th

percentile

Worker characteristics

All workers ............................................................... 0.5 $0 $0 $0 $226 $232 0.4 0.1

Management, professional, and related .................. 0.4 201 0 0 66 547 0.3 0.2

Management, business, and financial ................. 0.4 112 209 156 88 786 0.4 0.1

Professional and related ...................................... 0.6 350 0 309 344 1,107 – –

Sales and office ....................................................... 0.7 0 243 6 325 795 – –

Sales and related ................................................. 0.2 501 443 275 109 626 – 0.0

Office and administrative support ........................ 1.0 0 101 0 332 1,137 – –

Full time ................................................................... 0.5 0 0 0 0 393 0.5 0.1

Part time .................................................................. 3.1 516 280 848 1,701 – – 0.0

Establishment characteristics

Service-providing industries ..................................... 0.5 73 123 0 335 269 – –

Trade, transportation, and utilities ....................... 0.6 0 340 – 222 570 – 0.0

Information ........................................................... 0.4 616 423 950 475 0 – 0.0

Financial activities ................................................ 1.7 0 210 219 322 685 – –

Education and health services ............................. 0.8 462 278 243 757 969 0.5 0.5

Educational services ........................................ 1.6 186 295 0 599 375 1.5 0.2

Health care and social assistance ................... 0.9 – 291 772 1,104 2,192 – –

Geographic areas

Northeast ................................................................. 1.2 376 45 308 484 1,268 – –

New England ....................................................... 2.6 – 717 699 – 1,078 – –

Middle Atlantic ..................................................... 1.3 367 269 271 1,198 1,665 – –

South ....................................................................... 0.8 75 192 194 0 289 – –

South Atlantic ....................................................... 1.3 41 295 – 204 309 – –

West South Central .............................................. 0.9 441 299 149 – 623 – –

Midwest .................................................................... 0.7 0 0 348 589 933 0.6 0.1

East North Central ............................................... 0.9 0 36 503 481 632 0.9 0.1

West North Central .............................................. 0.3 137 467 428 0 161 – 0.0

West:

Mountain ............................................................ 1.0 – 599 513 515 766 – –

1 The out-of-pocket maximum is the annual limit on the amount of covered expenses that a participant or a family must pay after the deductible has been satisfied. Once reached, covered

expenses are fully reimbursed for the rest of the year.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee

Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

22
Table 11. Medical care benefits: High deductible and nonhigh

deductible plans,1

 private industry workers, 2018

(All workers participating in medical care plans = 100 percent)

Characteristics High deductible

health plans

Nonhigh deductible

health plans

Worker characteristics

All workers ............................................................... 45 54

Management, professional, and related .................. 47 53

Management, business, and financial ................. 46 54

Professional and related ...................................... 47 53

Sales and office ....................................................... 50 50

Sales and related ................................................. 63 37

Office and administrative support ........................ 44 55

Full time ................................................................... 46 54

Part time .................................................................. 38 61

Establishment characteristics

Service-providing industries ..................................... 46 54

Trade, transportation, and utilities ....................... 51 49

Information ........................................................... 40 59

Financial activities ................................................ 51 49

Education and health services ............................. 35 65

Educational services ........................................ 38 62

Health care and social assistance ................... 34 66

Geographic areas

Northeast ................................................................. 36 64

New England ....................................................... 38 62

Middle Atlantic ..................................................... 35 65

South ....................................................................... 51 49

South Atlantic ....................................................... 51 49

West South Central .............................................. 51 49

Midwest .................................................................... 51 49

East North Central ............................................... 50 50

West North Central .............................................. 52 47

West:

Mountain ............................................................ 59 41

1 The sum of the columns may not equal 100 since only plans with fixed, variable, or no deductibles are

included. Plans with other deductible formulas are not included. A high deductible health plan (HDHP) is a health

plan which typically has a higher deductible and lower premium than a traditional health plan. An individual plan

must have a minimum deductible of $1,350 to be classified as a HDHP. Normally the plan includes catastrophic

coverage to protect against large medical expenses, but the insured is responsible for routine out-of-pocket

expenses.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of

major plans, key provisions, and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

23
Table 11. Standard errors for medical care benefits: High deductible

and nonhigh deductible plans,1

 private industry workers, 2018

Characteristics High deductible

health plans

Nonhigh deductible

health plans

Worker characteristics

All workers ............................................................... 1.4 1.4

Management, professional, and related .................. 2.5 2.5

Management, business, and financial ................. 3.2 3.2

Professional and related ...................................... 2.9 2.9

Sales and office ....................................................... 2.5 2.5

Sales and related ................................................. 3.0 3.0

Office and administrative support ........................ 2.9 2.9

Full time ................................................................... 1.5 1.5

Part time .................................................................. 5.6 5.6

Establishment characteristics

Service-providing industries ..................................... 1.7 1.7

Trade, transportation, and utilities ....................... 2.4 2.4

Information ........................................................... 8.2 8.3

Financial activities ................................................ 2.7 2.8

Education and health services ............................. 4.9 4.9

Educational services ........................................ 4.0 4.0

Health care and social assistance ................... 5.7 5.7

Geographic areas

Northeast ................................................................. 2.8 2.8

New England ....................................................... 4.7 4.7

Middle Atlantic ..................................................... 3.6 3.7

South ....................................................................... 2.3 2.2

South Atlantic ....................................................... 1.8 1.9

West South Central .............................................. 6.5 6.3

Midwest .................................................................... 2.8 2.8

East North Central ............................................... 3.6 3.6

West North Central .............................................. 4.2 4.1

West:

Mountain ............................................................ 8.0 8.0

1 A high deductible health plan (HDHP) is a health plan which typically has a higher deductible and lower

premium than a traditional health plan. An individual plan must have a minimum deductible of $1,350 to be

classified as a HDHP. Normally the plan includes catastrophic coverage to protect against large medical expenses,

but the insured is responsible for routine out-of-pocket expenses.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of

major plans, key provisions, and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

24
Table 12. High deductible plans:1

 Amount of annual individual deductible, private

industry workers, 2018

(Includes workers participating in high deductible health plans)

Characteristics

Amount of annual deductible

10th

percentile

25th

percentile

50th

percentile

(median)

75th

percentile

90th

percentile

Worker characteristics

All workers ............................................................... $1,500 $1,500 $2,000 $3,000 $5,000

Management, professional, and related .................. 1,500 1,500 2,000 3,000 5,000

Management, business, and financial ................. 1,500 1,500 1,750 2,700 5,000

Professional and related ...................................... 1,500 1,500 2,000 3,000 5,000

Sales and office ....................................................... 1,500 1,500 2,500 3,000 5,000

Sales and related ................................................. 1,500 1,750 2,750 3,000 5,000

Office and administrative support ........................ 1,500 1,500 2,000 3,000 5,000

Full time ................................................................... 1,500 1,500 2,000 3,000 5,000

Part time .................................................................. 1,500 1,500 2,250 2,750 –

Establishment characteristics

Service-providing industries ..................................... 1,500 1,500 2,000 3,000 5,000

Trade, transportation, and utilities ....................... 1,500 1,500 2,500 2,750 5,000

Information ........................................................... 1,350 1,500 1,500 2,000 –

Financial activities ................................................ 1,500 1,700 2,000 2,750 3,000

Education and health services ............................. 1,500 2,000 3,000 5,000 6,300

Educational services ........................................ 1,500 1,500 2,500 3,500 4,500

Health care and social assistance ................... 1,500 2,000 – 5,000 6,300

Geographic areas

Northeast ................................................................. 1,500 1,500 2,000 2,750 4,000

New England ....................................................... 1,500 1,500 2,000 2,750 3,550

Middle Atlantic ..................................................... 1,500 1,500 2,000 2,750 4,500

South ....................................................................... 1,500 1,500 2,000 3,000 5,000

South Atlantic ....................................................... 1,500 1,500 2,500 3,000 5,000

West South Central .............................................. 1,500 1,550 2,000 – 5,000

Midwest .................................................................... 1,500 1,500 2,000 3,000 5,000

East North Central ............................................... 1,500 1,500 2,000 3,000 5,000

West North Central .............................................. 1,500 1,500 2,000 2,750 –

West:

Mountain ............................................................ 1,500 1,500 – – 6,300

1 A high deductible health plan (HDHP) is a health plan which typically has a higher deductible and lower premium than a traditional health

plan. An individual plan must have a minimum deductible of $1,350 to be classified as a HDHP. Normally the plan includes catastrophic

coverage to protect against large medical expenses, but the insured is responsible for routine out-of-pocket expenses.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions,

and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

25
Table 12. Standard errors for high deductible health plans:1

 Amount of annual individual

deductible, private industry workers, 2018

Characteristics

Amount of annual deductible

10th

percentile

25th

percentile

50th

percentile

(median)

75th

percentile

90th

percentile

Worker characteristics

All workers ............................................................... $0 $0 $0 $0 $0

Management, professional, and related .................. 0 0 94 282 0

Management, business, and financial ................. 0 0 239 137 1,249

Professional and related ...................................... 0 0 0 612 0

Sales and office ....................................................... 0 0 124 0 500

Sales and related ................................................. 0 258 214 36 605

Office and administrative support ........................ 0 0 0 122 811

Full time ................................................................... 0 0 0 0 0

Part time .................................................................. 0 0 591 323 –

Establishment characteristics

Service-providing industries ..................................... 0 0 18 0 0

Trade, transportation, and utilities ....................... 0 9 374 90 1,200

Information ........................................................... 133 0 0 121 –

Financial activities ................................................ 0 131 0 13 77

Education and health services ............................. 0 487 499 729 413

Educational services ........................................ 0 185 369 634 1,268

Health care and social assistance ................... 0 412 – 1,369 351

Geographic areas

Northeast ................................................................. 0 0 257 27 810

New England ....................................................... 0 0 246 121 285

Middle Atlantic ..................................................... 0 0 345 38 879

South ....................................................................... 0 0 386 346 0

South Atlantic ....................................................... 0 82 381 599 0

West South Central .............................................. 0 69 328 – 0

Midwest .................................................................... 0 26 0 240 296

East North Central ............................................... 0 67 192 123 0

West North Central .............................................. 0 67 0 67 –

West:

Mountain ............................................................ 0 0 – – 0

1 A high deductible health plan (HDHP) is a health plan which typically has a higher deductible and lower premium than a traditional health

plan. An individual plan must have a minimum deductible of $1,350 to be classified as a HDHP. Normally the plan includes catastrophic

coverage to protect against large medical expenses, but the insured is responsible for routine out-of-pocket expenses.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions,

and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

26
Table 13. Nonhigh deductible plans: Amount of annual individual deductible, private industry workers, 2018

(All workers participating in nonhigh deductible health plans = 100 percent)

Characteristics With

deductible

Amount of annual deductible

With no

10th deductible

percentile

25th

percentile

50th

percentile

(median)

75th

percentile

90th

percentile

Worker characteristics

All workers ............................................................... 84 $250 $350 $500 $1,000 $1,000 16

Management, professional, and related .................. 85 250 350 500 1,000 1,000 15

Management, business, and financial ................. 87 250 400 500 800 1,000 13

Professional and related ...................................... 83 250 – 500 1,000 1,000 17

Sales and office ....................................................... 82 250 – 500 1,000 1,000 18

Office and administrative support ........................ 79 – – 500 1,000 1,000 21

Full time ................................................................... 84 250 – 500 1,000 1,000 16

Establishment characteristics

Service-providing industries ..................................... 83 250 350 500 1,000 1,000 17

Trade, transportation, and utilities ....................... 89 – 350 500 1,000 1,000 11

Education and health services ............................. 74 250 300 500 1,000 – 26

Educational services ........................................ 84 200 250 500 – 1,000 16

Health care and social assistance ................... 72 250 300 500 1,000 1,250 28

Geographic areas

Northeast ................................................................. 81 200 300 500 750 1,000 19

Middle Atlantic ..................................................... 78 – 250 500 800 1,100 22

South ....................................................................... 91 250 350 500 1,000 1,100 9

South Atlantic ....................................................... 91 250 – 500 1,000 1,000 9

Midwest .................................................................... 91 250 350 600 1,000 1,000 9

East North Central ............................................... 89 250 400 550 1,000 1,000 11

West:

Mountain ............................................................ 85 250 – 600 1,000 1,250 15

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of

major plans, key provisions, and related terms, see the "Glossary of Employee Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

27
Table 13. Standard errors for nonhigh deductible plans: Amount of annual individual deductible, private

industry workers, 2018

Characteristics With

deductible

Amount of annual deductible

With no

10th deductible

percentile

25th

percentile

50th

percentile

(median)

75th

percentile

90th

percentile

Worker characteristics

All workers ............................................................... 1.7 $0 $57 $0 $42 $0 1.7

Management, professional, and related .................. 1.8 0 59 0 92 29 1.8

Management, business, and financial ................. 1.9 70 103 0 160 18 1.9

Professional and related ...................................... 2.5 0 – 44 52 87 2.5

Sales and office ....................................................... 5.1 46 – 16 0 27 5.1

Office and administrative support ........................ 6.2 – – 125 18 0 6.2

Full time ................................................................... 1.5 0 – 0 68 0 1.5

Establishment characteristics

Service-providing industries ..................................... 2.1 0 31 18 72 0 2.1

Trade, transportation, and utilities ....................... 2.0 – 41 51 121 58 2.0

Education and health services ............................. 5.2 0 74 64 76 – 5.2

Educational services ........................................ 2.5 0 46 0 – 0 2.5

Health care and social assistance ................... 6.1 0 78 133 39 303 6.1

Geographic areas

Northeast ................................................................. 4.9 49 65 0 47 26 4.9

Middle Atlantic ..................................................... 6.4 – 16 0 106 199 6.4

South ....................................................................... 1.9 0 49 29 105 100 1.9

South Atlantic ....................................................... 2.6 0 – 16 220 87 2.6

Midwest .................................................................... 1.8 45 95 142 0 0 1.8

East North Central ............................................... 2.3 69 66 123 0 0 2.3

West:

Mountain ............................................................ 2.9 26 – 95 80 209 2.9

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of

Employee Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

28
Table 14. Medical care benefits: Coverage for services provided,1

private industry workers, 2018

(All workers participating in medical care plans = 100 percent)

Characteristics Hospital room and

board Physician office visit

Worker characteristics

All workers ............................................................... 95 100

Management, professional, and related .................. 95 100

Management, business, and financial ................. 90 100

Professional and related ...................................... 98 100

Sales and office ....................................................... 94 100

Sales and related ................................................. 95 100

Office and administrative support ........................ 93 100

Full time ................................................................... 94 100

Part time .................................................................. 100 100

Establishment characteristics

Service-providing industries ..................................... 95 100

Trade, transportation, and utilities ....................... 96 100

Information ........................................................... 88 100

Financial activities ................................................ 93 100

Education and health services ............................. 98 100

Educational services ........................................ 100 100

Health care and social assistance ................... 98 100

Geographic areas

Northeast ................................................................. 98 100

New England ....................................................... 98 100

Middle Atlantic ..................................................... 98 100

South ....................................................................... 94 100

South Atlantic ....................................................... 92 99

West South Central .............................................. 96 100

Midwest .................................................................... 93 99

East North Central ............................................... 94 100

West North Central .............................................. 89 98

West:

Mountain ............................................................ 96 100

1 The remaining workers include both workers not receiving the benefit and workers for whom the availability of

the benefit could not be determined.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

29
Table 14. Standard errors for medical care benefits: Coverage for

services provided,1

 private industry workers, 2018

Characteristics Hospital room and

board Physician office visit

Worker characteristics

All workers ............................................................... 0.8 0.1

Management, professional, and related .................. 1.2 0.0

Management, business, and financial ................. 2.3 0.0

Professional and related ...................................... 0.9 0.0

Sales and office ....................................................... 1.6 2 ( )

Sales and related ................................................. 2.4 0.0

Office and administrative support ........................ 1.5 0.1

Full time ................................................................... 0.8 0.1

Part time .................................................................. 0.2 0.0

Establishment characteristics

Service-providing industries ..................................... 0.9 0.0

Trade, transportation, and utilities ....................... 1.4 0.0

Information ........................................................... 6.7 0.0

Financial activities ................................................ 1.2 0.0

Education and health services ............................. 2.0 0.0

Educational services ........................................ 0.0 0.0

Health care and social assistance ................... 2.3 0.0

Geographic areas

Northeast ................................................................. 1.2 0.0

New England ....................................................... 1.4 0.0

Middle Atlantic ..................................................... 1.6 0.0

South ....................................................................... 1.1 0.3

South Atlantic ....................................................... 1.8 0.4

West South Central .............................................. 0.8 0.3

Midwest .................................................................... 1.9 0.1

East North Central ............................................... 1.3 0.0

West North Central .............................................. 5.6 0.4

West:

Mountain ............................................................ 3.1 0.0

1 The remaining workers include both workers not receiving the benefit and workers for whom the availability of

the benefit could not be determined. 2 Less than 0.05.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

30
Table 15. Medical care benefits: Median copayment per visit by service provided, private

industry workers, 2018

(Includes all workers participating in plans with specified copayments)

Characteristics Hospital room and board Physician office visit

Worker characteristics

All workers ............................................................... $250 $25

Management, professional, and related .................. 250 25

Management, business, and financial ................. 250 25

Professional and related ...................................... – 25

Sales and office ....................................................... 250 25

Sales and related ................................................. 250 25

Office and administrative support ........................ 250 25

Full time ................................................................... 250 25

Part time .................................................................. 250 –

Establishment characteristics

Service-providing industries ..................................... 250 25

Trade, transportation, and utilities ....................... 300 25

Information ........................................................... 350 25

Financial activities ................................................ 250 25

Education and health services ............................. – 25

Educational services ........................................ 250 25

Health care and social assistance ................... 200 25

Geographic areas

Northeast ................................................................. 250 25

New England ....................................................... 250 25

Middle Atlantic ..................................................... 250 20

South ....................................................................... 250 25

South Atlantic ....................................................... 250 25

West South Central .............................................. 250 25

Midwest .................................................................... 250 25

East North Central ............................................... 250 25

West North Central .............................................. 250 25

West:

Mountain ............................................................ 250 25

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions,

and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

31
Table 15. Standard errors for medical care benefits: Median copayment per visit by

service provided, private industry workers, 2018

Characteristics Hospital room and board Physician office visit

Worker characteristics

All workers ............................................................... $0 $0

Management, professional, and related .................. 0 0

Management, business, and financial ................. 0 0

Professional and related ...................................... – 0

Sales and office ....................................................... 47 0

Sales and related ................................................. 0 0

Office and administrative support ........................ 71 0

Full time ................................................................... 0 0

Part time .................................................................. 0 –

Establishment characteristics

Service-providing industries ..................................... 0 0

Trade, transportation, and utilities ....................... 58 0

Information ........................................................... 61 5

Financial activities ................................................ 8 0

Education and health services ............................. – 5

Educational services ........................................ 0 7

Health care and social assistance ................... 34 5

Geographic areas

Northeast ................................................................. 0 3

New England ....................................................... 0 0

Middle Atlantic ..................................................... 30 5

South ....................................................................... 0 0

South Atlantic ....................................................... 0 0

West South Central .............................................. 0 6

Midwest .................................................................... 30 0

East North Central ............................................... 32 0

West North Central .............................................. 56 7

West:

Mountain ............................................................ 0 6

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions,

and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

32
Table 16. Hospital room and board benefits: Extent of coverage, private industry

workers, 2018

(All workers participating in medical care plans = 100 percent)

Characteristics Full coverage Coverage

with limits1 No coverage Notdeterminable

Worker characteristics

All workers ............................................................... 4 91 – 5

Management, professional, and related .................. 4 91 – 5

Management, business, and financial ................. 1 89 – 10

Professional and related ...................................... 5 92 – 2

Sales and office ....................................................... – 92 – 6

Sales and related ................................................. – 95 – 5

Office and administrative support ........................ – 90 – 7

Full time ................................................................... 3 92 – 6

Part time .................................................................. – 86 – 2 ( )

Establishment characteristics

Service-providing industries ..................................... 4 91 – 5

Trade, transportation, and utilities ....................... – 95 – 4

Information ........................................................... – 88 – 12

Financial activities ................................................ – 90 – 7

Education and health services ............................. – 85 – 2

Educational services ........................................ 8 92 – –

Health care and social assistance ................... – 84 – 2

Geographic areas

Northeast ................................................................. – 87 – 2

New England ....................................................... 10 88 – 2

Middle Atlantic ..................................................... – 86 – 2

South ....................................................................... – 93 – 6

South Atlantic ....................................................... – 91 – 8

West South Central .............................................. 1 95 – 4

Midwest .................................................................... – 91 – 7

East North Central ............................................... – 92 – 6

West North Central .............................................. – 88 – 11

West:

Mountain ............................................................ – 95 – 4

1 Limits may be set in terms of dollar or day ceiling on benefits, a requirement that the participant pay a percentage of costs

(coinsurance), or a requirement that the participant pay a specific amount (deductible or copayment) before reimbursement begins

or services are rendered. 2 Less than 0.5.

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data

do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee

Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

33
Table 16. Standard errors for hospital room and board benefits: Extent of

coverage, private industry workers, 2018

Characteristics Full coverage Coverage

with limits1 No coverage Notdeterminable

Worker characteristics

All workers ............................................................... 0.8 1.1 – 0.8

Management, professional, and related .................. 0.5 1.3 – 1.2

Management, business, and financial ................. 0.4 2.3 – 2.3

Professional and related ...................................... 1.0 1.3 – 0.9

Sales and office ....................................................... – 1.8 – 1.6

Sales and related ................................................. – 2.5 – 2.4

Office and administrative support ........................ – 1.9 – 1.5

Full time ................................................................... 0.5 0.9 – 0.8

Part time .................................................................. – 8.4 – 0.2

Establishment characteristics

Service-providing industries ..................................... 1.0 1.4 – 0.9

Trade, transportation, and utilities ....................... – 1.6 – 1.4

Information ........................................................... – 6.7 – 6.7

Financial activities ................................................ – 2.0 – 1.2

Education and health services ............................. – 4.5 – 2.0

Educational services ........................................ 2.2 2.2 – 0.0

Health care and social assistance ................... – 5.2 – 2.3

Geographic areas

Northeast ................................................................. – 4.4 – 1.2

New England ....................................................... 1.6 2.1 – 1.4

Middle Atlantic ..................................................... – 6.2 – 1.6

South ....................................................................... – 1.2 – 1.1

South Atlantic ....................................................... – 1.9 – 1.8

West South Central .............................................. 0.3 1.0 – 0.8

Midwest .................................................................... – 2.0 – 1.9

East North Central ............................................... – 1.5 – 1.3

West North Central .............................................. – 5.5 – 5.6

West:

Mountain ............................................................ – 3.6 – 3.1

1 Limits may be set in terms of dollar or day ceiling on benefits, a requirement that the participant pay a percentage of costs

(coinsurance), or a requirement that the participant pay a specific amount (deductible or copayment) before reimbursement begins

or services are rendered.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key

provisions, and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

34
Table 17. Hospital room and board benefits: Type of coverage limits,

private industry workers, 2018

(All workers participating in medical care plans with hospital room and board coverage with limits

= 100 percent)

Characteristics Copayment

only

Coinsurance

only

Copayment

and

Coinsurance

Worker characteristics

All workers ............................................................... 13 70 5

Management, professional, and related .................. 17 66 5

Management, business, and financial ................. 12 75 4

Professional and related ...................................... 20 60 5

Sales and office ....................................................... 12 74 4

Sales and related ................................................. – 83 –

Office and administrative support ........................ 15 69 5

Full time ................................................................... 14 70 4

Part time .................................................................. 6 72 7

Establishment characteristics

Service-providing industries ..................................... 14 69 5

Trade, transportation, and utilities ....................... 7 79 5

Information ........................................................... – 82 –

Financial activities ................................................ – 84 –

Education and health services ............................. – 58 –

Educational services ........................................ 16 53 8

Health care and social assistance ................... – 59 –

Geographic areas

Northeast ................................................................. 16 67 2

New England ....................................................... – 69 –

Middle Atlantic ..................................................... – 67 –

South ....................................................................... 12 70 5

South Atlantic ....................................................... 12 72 6

West South Central .............................................. 9 71 4

Midwest .................................................................... 5 78 4

East North Central ............................................... 6 78 4

West North Central .............................................. – 80 –

West:

Mountain ............................................................ – 76 –

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of

major plans, key provisions, and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

35
Table 17. Standard errors for hospital room and board benefits: Type

of coverage limits, private industry workers, 2018

Characteristics Copayment

only

Coinsurance

only

Copayment

and

Coinsurance

Worker characteristics

All workers ............................................................... 2.1 2.2 0.7

Management, professional, and related .................. 3.4 3.0 1.0

Management, business, and financial ................. 1.8 2.3 1.0

Professional and related ...................................... 5.1 3.9 1.4

Sales and office ....................................................... 3.2 3.4 0.7

Sales and related ................................................. – 3.3 –

Office and administrative support ........................ 4.4 4.3 0.9

Full time ................................................................... 2.3 2.2 0.7

Part time .................................................................. 1.8 3.9 1.5

Establishment characteristics

Service-providing industries ..................................... 2.7 2.8 0.8

Trade, transportation, and utilities ....................... 1.1 1.7 1.1

Information ........................................................... – 5.2 –

Financial activities ................................................ – 2.8 –

Education and health services ............................. – 3.9 –

Educational services ........................................ 2.4 5.5 2.3

Health care and social assistance ................... – 4.5 –

Geographic areas

Northeast ................................................................. 1.8 2.6 0.5

New England ....................................................... – 3.3 –

Middle Atlantic ..................................................... – 3.1 –

South ....................................................................... 1.3 2.5 1.1

South Atlantic ....................................................... 2.1 3.6 1.9

West South Central .............................................. 1.1 5.0 1.3

Midwest .................................................................... 1.3 2.2 0.5

East North Central ............................................... 1.8 2.9 0.5

West North Central .............................................. – 2.7 –

West:

Mountain ............................................................ – 1.7 –

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of

major plans, key provisions, and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

36
Table 18. Physician office visit benefits: Extent of coverage, private industry

workers, 2018

(All workers participating in medical care plans = 100 percent)

Characteristics Full coverage Coverage

with limits1 No coverage Notdeterminable

Worker characteristics

All workers ............................................................... 2 98 – 2 ( )

Management, professional, and related .................. – 99 – –

Management, business, and financial ................. – 99 – –

Professional and related ...................................... – 98 – –

Sales and office ....................................................... 1 99 – 2 ( )

Sales and related ................................................. – 99 – –

Office and administrative support ........................ 1 99 – 2 ( )

Full time ................................................................... 2 98 – 2 ( )

Part time .................................................................. – 100 – –

Establishment characteristics

Service-providing industries ..................................... 1 99 – –

Trade, transportation, and utilities ....................... – 100 – –

Information ........................................................... – 100 – –

Financial activities ................................................ – 98 – –

Education and health services ............................. – 97 – –

Educational services ........................................ – 98 – –

Health care and social assistance ................... – 97 – –

Geographic areas

Northeast ................................................................. – 96 – –

New England ....................................................... – 96 – –

Middle Atlantic ..................................................... – 96 – –

South ....................................................................... – 98 – 2 ( )

South Atlantic ....................................................... – 99 – 1

West South Central .............................................. – 98 – 2 ( )

Midwest .................................................................... – 98 – 1

East North Central ............................................... – 99 – –

West North Central .............................................. – 98 – 2

West:

Mountain ............................................................ – 99 – –

1 Limits may be set in terms of dollar or day ceiling on benefits, a requirement that the participant pay a percentage of costs

(coinsurance), or a requirement that the participant pay a specific amount (deductible or copayment) before reimbursement begins

or services are rendered. 2 Less than 0.5.

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data

do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee

Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

37
Table 18. Standard errors for physician office visit benefits: Extent of coverage,

private industry workers, 2018

Characteristics Full coverage Coverage

with limits1 No coverage Notdeterminable

Worker characteristics

All workers ............................................................... 0.4 0.5 – 0.1

Management, professional, and related .................. – 0.6 – 0.0

Management, business, and financial ................. – 0.4 – 0.0

Professional and related ...................................... – 0.9 – 0.0

Sales and office ....................................................... 0.3 0.3 – 2 ( )

Sales and related ................................................. – 0.7 – 0.0

Office and administrative support ........................ 0.2 0.2 – 0.1

Full time ................................................................... 0.5 0.5 – 0.1

Part time .................................................................. – 0.3 – 0.0

Establishment characteristics

Service-providing industries ..................................... 0.4 0.4 – 0.0

Trade, transportation, and utilities ....................... – 0.0 – 0.0

Information ........................................................... – 0.0 – 0.0

Financial activities ................................................ – 0.7 – 0.0

Education and health services ............................. – 1.2 – 0.0

Educational services ........................................ – 1.3 – 0.0

Health care and social assistance ................... – 1.4 – 0.0

Geographic areas

Northeast ................................................................. – 2.2 – 0.0

New England ....................................................... – 3.6 – 0.0

Middle Atlantic ..................................................... – 2.6 – 0.0

South ....................................................................... – 0.6 – 0.3

South Atlantic ....................................................... – 0.7 – 0.4

West South Central .............................................. – 0.5 – 0.3

Midwest .................................................................... – 0.3 – 0.1

East North Central ............................................... – 0.4 – 0.0

West North Central .............................................. – 0.4 – 0.4

West:

Mountain ............................................................ – 0.4 – 0.0

1 Limits may be set in terms of dollar or day ceiling on benefits, a requirement that the participant pay a percentage of costs

(coinsurance), or a requirement that the participant pay a specific amount (deductible or copayment) before reimbursement begins

or services are rendered. 2 Less than 0.05.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key

provisions, and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

38
Table 19. Outpatient prescription drug benefits:1

 Type of coverage, private industry workers, 2018

(All workers participating in outpatient prescription drug plans = 100 percent)

Characteristics Generic drugs Brand-name drugs

on formulary

Brand-name

nonformulary drugs

Mail order

drugs

Subject to an

annual deductible2

Worker characteristics

All workers ............................................................... 100 99 88 85 35

Management, professional, and related .................. 100 99 92 85 38

Management, business, and financial ................. 100 98 92 84 40

Professional and related ...................................... 100 100 92 86 36

Sales and office ....................................................... 100 99 84 87 37

Sales and related ................................................. 100 100 74 90 35

Office and administrative support ........................ 100 99 88 86 38

Full time ................................................................... 100 99 88 86 35

Part time .................................................................. 100 100 82 71 32

Establishment characteristics

Service-providing industries ..................................... 100 99 88 84 36

Trade, transportation, and utilities ....................... 100 99 76 87 31

Information ........................................................... 100 100 84 86 40

Financial activities ................................................ 100 99 92 91 42

Education and health services ............................. 100 100 93 72 41

Educational services ........................................ 100 100 93 91 37

Health care and social assistance ................... 100 100 93 69 41

Geographic areas

Northeast ................................................................. 100 100 89 85 35

New England ....................................................... 100 100 92 93 27

Middle Atlantic ..................................................... 100 100 88 83 39

South ....................................................................... 100 99 90 84 34

South Atlantic ....................................................... 100 99 91 84 32

West South Central .............................................. 100 99 90 82 33

Midwest .................................................................... 100 99 86 84 37

East North Central ............................................... 100 99 86 85 36

West North Central .............................................. 100 100 87 82 41

West:

Mountain ............................................................ 100 96 84 75 55

1 Outpatient prescription drug benefits include both stand-alone drug plans and prescription drug benefits included as part of a medical plan. 2 This could be a prescription drug annual deductible or a medical plan deductible.

Note: For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

39
Table 19. Standard errors for outpatient prescription drug benefits:1

 Type of coverage, private industry

workers, 2018

Characteristics Generic drugs Brand-name drugs

on formulary

Brand-name

nonformulary drugs

Mail order

drugs

Subject to an

annual deductible2

Worker characteristics

All workers ............................................................... 3 ( ) 0.3 0.8 1.8 1.6

Management, professional, and related .................. 3 ( ) 0.7 1.2 1.9 2.7

Management, business, and financial ................. 0.1 1.6 1.4 3.3 3.1

Professional and related ...................................... 0.0 0.2 2.0 2.3 3.6

Sales and office ....................................................... 0.0 0.3 1.0 1.5 2.3

Sales and related ................................................. 0.0 0.1 1.9 2.2 3.5

Office and administrative support ........................ 0.0 0.4 1.1 1.7 2.8

Full time ................................................................... 3 ( ) 0.3 0.8 1.6 1.5

Part time .................................................................. 0.0 3 ( ) 3.1 7.2 6.2

Establishment characteristics

Service-providing industries ..................................... 3 ( ) 0.4 1.0 2.2 2.0

Trade, transportation, and utilities ....................... 0.0 0.4 2.2 2.5 2.4

Information ........................................................... 0.0 3 ( ) 4.1 2.4 7.9

Financial activities ................................................ 0.0 0.5 1.6 1.9 2.6

Education and health services ............................. 0.0 0.0 2.0 8.1 5.4

Educational services ........................................ 0.0 0.0 1.4 2.4 4.9

Health care and social assistance ................... 0.0 0.0 2.3 9.3 6.3

Geographic areas

Northeast ................................................................. 0.0 0.1 1.9 5.5 4.2

New England ....................................................... 0.0 0.2 3.3 3.2 7.9

Middle Atlantic ..................................................... 0.0 0.1 2.1 7.7 5.4

South ....................................................................... 0.0 0.3 0.9 2.3 2.4

South Atlantic ....................................................... 0.0 0.3 1.3 2.9 3.6

West South Central .............................................. 0.0 0.7 0.9 5.3 4.0

Midwest .................................................................... 0.0 0.2 1.7 2.2 2.5

East North Central ............................................... 0.0 0.2 2.1 2.1 2.1

West North Central .............................................. 0.0 0.2 2.8 5.2 6.3

West:

Mountain ............................................................ 0.0 3.2 2.6 12.8 5.8

1 Outpatient prescription drug benefits include both stand-alone drug plans and prescription drug benefits included as part of a medical plan. 2 This could be a prescription drug annual deductible or a medical plan deductible. 3 Less than 0.05.

Note: For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee Benefit Terms" at

www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

40
Table 20. Outpatient prescription drug benefits:1

 Generic drug limits, private industry workers, 2018

(All workers participating in outpatient prescription drug plans with generic drug coverage = 100 percent)

Characteristics Copayment

Median

copayment

per

prescription

Coinsurance

Median

coinsurance

per

prescription

Coinsurance

exists and a

minimum or

maximum

dollar amount

applies

Combination

of copayment

and

coinsurance

or another

limit

No cost per

fill or refill

Not

determinable

Worker characteristics

All workers ............................................................... 72 $10 22 80 8–4–

Management, professional, and related .................. 72 10 22 80 8–6–

Management, business, and financial ................. 70 10 24 80 8–5–

Professional and related ...................................... 73 10 20 85 8–6–

Sales and office ....................................................... 74 10 21 80 9141

Sales and related ................................................. 74 10 21 80 11 – – 2 ( )

Office and administrative support ........................ 74 10 20 80 8–4–

Full time ................................................................... 72 10 22 80 8–4–

Part time .................................................................. 68 10 19 80 13 – – 2 ( )

Establishment characteristics

Service-providing industries ..................................... 72 10 21 80 9–5–

Trade, transportation, and utilities ....................... 68 10 28 80 14 – – 1

Information ........................................................... 67 10 31 80 ––––

Financial activities ................................................ 68 10 28 80 8–22

Education and health services ............................. 73 10 9 80 –––2

Educational services ........................................ 80 10 6 90 2 – 13 –

Health care and social assistance ................... 72 10 9 80 –––2

Geographic areas

Northeast ................................................................. 72 10 22 80 11 – – 1

New England ....................................................... 83 10 – – – – – 2 ( )

Middle Atlantic ..................................................... 67 10 24 80 12 – – 1

South ....................................................................... 69 10 24 80 10 – 6 –

South Atlantic ....................................................... 73 10 21 80 9––1

West South Central .............................................. 63 10 29 80 12 – – 2 ( )

Midwest .................................................................... 73 10 20 80 6–3–

East North Central ............................................... 73 10 20 80 71––

West North Central .............................................. 73 10 21 80 – – – 2 ( )

West:

Mountain ............................................................ 55 10 26 80 8––1

1 Outpatient prescription drug benefits include both stand-alone drug plans and prescription drug benefits included as part of a medical plan. 2 Less than 0.5.

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key

provisions, and related terms, see the "Glossary of Employee Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

41
Table 20. Standard errors for outpatient prescription drug benefits:1

 Generic drug limits, private industry workers, 2018

Characteristics Copayment

Median

copayment

per

prescription

Coinsurance

Median

coinsurance

per

prescription

Coinsurance

exists and a

minimum or

maximum

dollar amount

applies

Combination

of copayment

and

coinsurance

or another

limit

No cost per

fill or refill

Not

determinable

Worker characteristics

All workers ............................................................... 1.8 0 1.5 0 1.0 – 1.0 –

Management, professional, and related .................. 2.5 0 2.1 0 1.4 – 1.0 –

Management, business, and financial ................. 3.0 0 3.1 0 1.9 – 0.9 –

Professional and related ...................................... 3.4 0 2.7 6 1.7 – 1.6 –

Sales and office ....................................................... 2.3 0 2.2 0 1.3 0.2 0.9 0.6

Sales and related ................................................. 2.4 0 2.8 0 1.8 – – 0.3

Office and administrative support ........................ 2.9 0 2.6 0 1.6 – 0.9 –

Full time ................................................................... 1.8 0 1.5 0 0.9 – 0.6 –

Part time .................................................................. 7.8 1 4.6 0 3.7 – – 0.2

Establishment characteristics

Service-providing industries ..................................... 2.3 0 1.8 0 1.2 – 1.3 –

Trade, transportation, and utilities ....................... 2.5 0 2.7 0 2.3 – – 0.4

Information ........................................................... 5.2 0 4.8 0 – – – 0.0

Financial activities ................................................ 3.9 0 3.7 0 1.6 – 0.5 1.7

Education and health services ............................. 5.8 0 1.8 0 – – – 1.0

Educational services ........................................ 3.6 0 1.3 9 0.6 – 3.7 –

Health care and social assistance ................... 6.7 0 2.1 0 – – – 1.1

Geographic areas

Northeast ................................................................. 5.3 0 3.7 0 2.5 – – 0.4

New England ....................................................... 6.6 0 – – – – – 0.1

Middle Atlantic ..................................................... 7.4 0 4.8 0 3.0 – – 0.6

South ....................................................................... 2.1 0 2.0 0 1.8 – 1.4 –

South Atlantic ....................................................... 2.7 0 2.5 0 2.4 – – 0.9

West South Central .............................................. 4.4 0 3.8 0 2.9 – – 0.1

Midwest .................................................................... 2.4 0 1.8 0 1.3 – 0.8 –

East North Central ............................................... 3.3 0 2.5 0 1.6 0.3 – –

West North Central .............................................. 2.6 0 2.1 0 – – – 0.1

West:

Mountain ............................................................ 6.1 0 5.2 0 1.8 – – 0.7

1 Outpatient prescription drug benefits include both stand-alone drug plans and prescription drug benefits included as part of a medical plan.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee Benefit

Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

42
Table 21. Outpatient prescription drug benefits:1

 Brand-name drugs on formulary limits, private industry workers, 2018

(All workers participating in outpatient prescription drug plans with brand-name drug on formulary coverage = 100 percent)

Characteristics Copayment

Median

copayment

per

prescription

Coinsurance

Median

coinsurance

per

prescription

Coinsurance

exists and a

minimum or

maximum

dollar amount

applies

Combination

of copayment

and

coinsurance

or another

limit

No cost per

fill or refill

Not

determinable

Worker characteristics

All workers ............................................................... 58 $35 36 75 22 – 4 –

Management, professional, and related .................. 56 35 37 80 22 – 5 –

Management, business, and financial ................. 54 35 41 75 25 – 3 –

Professional and related ...................................... 58 40 35 80 20 – 6 –

Sales and office ....................................................... 54 35 41 75 28 1 3 1

Sales and related ................................................. 46 30 49 75 37 – – 1

Office and administrative support ........................ 57 35 38 75 24 1 3 1

Full time ................................................................... 58 35 36 75 21 – 3 –

Part time .................................................................. 48 30 38 75 31 – – 2 ( )

Establishment characteristics

Service-providing industries ..................................... 56 35 36 75 23 – – 1

Trade, transportation, and utilities ....................... 47 30 49 75 35 2 – –

Information ........................................................... 48 35 50 80 29 – – 2 ( )

Financial activities ................................................ 40 35 55 70 31 – 2 –

Education and health services ............................. 59 30 23 80 14 – – 2

Educational services ........................................ 76 30 11 80 72––

Health care and social assistance ................... 56 30 25 80 16 – – 2

Geographic areas

Northeast ................................................................. 59 35 33 75 20 – – 1

New England ....................................................... 68 30 29 80 21 – – 2 ( )

Middle Atlantic ..................................................... 56 35 35 75 20 1 – –

South ....................................................................... 52 35 41 80 26 – – 1

South Atlantic ....................................................... 58 35 38 80 26 – – 1

West South Central .............................................. 46 35 46 80 27 – – 2 ( )

Midwest .................................................................... 56 35 39 75 23 2 3 1

East North Central ............................................... 54 30 40 75 24 1 – –

West North Central .............................................. 59 35 36 80 19 – 3 –

West:

Mountain ............................................................ 43 30 39 75 20 – – 1

1 Outpatient prescription drug benefits include both stand-alone drug plans and prescription drug benefits included as part of a medical plan. 2 Less than 0.5.

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key

provisions, and related terms, see the "Glossary of Employee Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

43
Table 21. Standard errors for outpatient prescription drug benefits:1

 Brand-name drugs on formulary limits, private industry

workers, 2018

Characteristics Copayment

Median

copayment

per

prescription

Coinsurance

Median

coinsurance

per

prescription

Coinsurance

exists and a

minimum or

maximum

dollar amount

applies

Combination

of copayment

and

coinsurance

or another

limit

No cost per

fill or refill

Not

determinable

Worker characteristics

All workers ............................................................... 2.1 0 2.1 5 1.5 – 1.0 –

Management, professional, and related .................. 3.4 7 3.3 6 2.4 – 1.0 –

Management, business, and financial ................. 3.3 2 3.6 0 2.7 – 0.8 –

Professional and related ...................................... 4.8 7 4.4 0 3.2 – 1.6 –

Sales and office ....................................................... 3.1 6 2.9 0 2.3 0.3 0.8 0.6

Sales and related ................................................. 3.1 6 3.5 0 3.2 – – 0.3

Office and administrative support ........................ 3.9 5 3.6 0 2.8 0.4 0.8 0.9

Full time ................................................................... 2.2 0 2.2 6 1.6 – 0.6 –

Part time .................................................................. 6.5 7 5.7 5 4.6 – – 0.2

Establishment characteristics

Service-providing industries ..................................... 2.7 0 2.6 0 1.9 – – 0.3

Trade, transportation, and utilities ....................... 2.8 6 3.0 0 2.8 0.5 – –

Information ........................................................... 6.5 4 6.7 0 5.0 – – 0.2

Financial activities ................................................ 3.7 2 3.5 0 2.3 – 0.5 –

Education and health services ............................. 5.4 6 4.5 5 2.9 – – 1.0

Educational services ........................................ 3.4 2 1.7 0 1.5 0.5 – –

Health care and social assistance ................... 6.2 7 5.3 6 3.4 – – 1.1

Geographic areas

Northeast ................................................................. 4.2 3 3.9 5 2.4 – – 0.4

New England ....................................................... 8.7 5 7.3 7 5.5 – – 0.1

Middle Atlantic ..................................................... 5.3 1 5.6 5 3.1 0.2 – –

South ....................................................................... 2.4 0 2.7 0 2.1 – – 0.5

South Atlantic ....................................................... 3.4 0 3.8 2 3.5 – – 0.9

West South Central .............................................. 4.5 0 5.0 0 2.1 – – 0.1

Midwest .................................................................... 2.5 5 2.9 7 3.2 0.5 0.7 0.8

East North Central ............................................... 2.8 5 3.6 2 4.3 0.4 – –

West North Central .............................................. 4.8 2 4.7 0 4.0 – 0.6 –

West:

Mountain ............................................................ 5.1 5 7.7 0 4.4 – – 0.8

1 Outpatient prescription drug benefits include both stand-alone drug plans and prescription drug benefits included as part of a medical plan.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee Benefit

Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

44
Table 22. Outpatient prescription drug benefits:1

 Brand-name drugs not on formulary limits, private industry workers, 2018

(All workers participating in outpatient prescription drug plans with brand-name drug not on formulary coverage = 100 percent)

Characteristics Copayment

Median

copayment

per

prescription

Coinsurance

Median

coinsurance

per

prescription

Coinsurance

exists and a

minimum or

maximum

dollar amount

applies

Combination

of copayment

and

coinsurance

or another

limit

No cost per

fill or refill

Not

determinable

Worker characteristics

All workers ............................................................... 55 $60 38 60 22 – 2 –

Management, professional, and related .................. 52 60 42 60 25 1 4 1

Management, business, and financial ................. 52 60 43 60 27 – 3 –

Professional and related ...................................... 52 60 41 60 24 2 5 1

Sales and office ....................................................... 54 50 40 60 26 2 – –

Sales and related ................................................. 53 60 42 60 24 – – 1

Office and administrative support ........................ 55 50 39 60 26 2 – –

Full time ................................................................... 56 60 37 60 22 – 3 –

Part time .................................................................. 41 50 42 60 29 – – 2 ( )

Establishment characteristics

Service-providing industries ..................................... 54 60 38 60 24 – 3 –

Trade, transportation, and utilities ....................... 53 60 43 60 26 3 – –

Information ........................................................... 53 60 44 60 25 – – 2 ( )

Financial activities ................................................ 38 60 57 55 36 – – 2

Education and health services ............................. 52 50 28 60 16 – – 2

Educational services ........................................ 76 50 15 65 7 – – 2 ( )

Health care and social assistance ................... 48 50 30 60 17 – – 2

Geographic areas

Northeast ................................................................. 55 50 37 60 21 – – 1

New England ....................................................... 64 50 – – – – – 2 ( )

Middle Atlantic ..................................................... 51 50 38 55 22 – – 1

South ....................................................................... 52 60 41 65 26 – – 1

South Atlantic ....................................................... 58 60 38 65 26 – – 1

West South Central .............................................. 46 60 44 65 24 – – 2 ( )

Midwest .................................................................... 54 60 40 60 24 – – 1

East North Central ............................................... 51 60 42 60 26 3 – –

West North Central .............................................. 58 60 38 65 19 – – 2 ( )

West:

Mountain ............................................................ 39 50 41 60 20 – – 2

1 Outpatient prescription drug benefits include both stand-alone drug plans and prescription drug benefits included as part of a medical plan. 2 Less than 0.5.

Note: Because of rounding, sums of individual items may not equal totals. Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key

provisions, and related terms, see the "Glossary of Employee Benefit Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

45
Table 22. Standard errors for outpatient prescription drug benefits:1

 Brand-name drugs not on formulary limits, private

industry workers, 2018

Characteristics Copayment

Median

copayment

per

prescription

Coinsurance

Median

coinsurance

per

prescription

Coinsurance

exists and a

minimum or

maximum

dollar amount

applies

Combination

of copayment

and

coinsurance

or another

limit

No cost per

fill or refill

Not

determinable

Worker characteristics

All workers ............................................................... 2.3 1 2.4 0 1.6 – 0.6 –

Management, professional, and related .................. 4.0 0 3.8 2 ( ) 3.0 0.3 1.0 0.4

Management, business, and financial ................. 3.7 0 4.0 2 3.2 – 0.8 –

Professional and related ...................................... 5.9 12 5.3 2 3.7 0.5 1.6 0.6

Sales and office ....................................................... 3.2 5 3.2 0 2.4 0.4 – –

Sales and related ................................................. 4.0 2 4.5 0 3.1 – – 0.4

Office and administrative support ........................ 3.9 3 3.8 4 3.1 0.5 – –

Full time ................................................................... 2.3 0 2.4 0 1.7 – 0.6 –

Part time .................................................................. 7.4 0 7.4 2 5.4 – – 0.3

Establishment characteristics

Service-providing industries ..................................... 2.9 0 3.0 0 2.1 – 0.7 –

Trade, transportation, and utilities ....................... 2.4 13 2.4 6 2.5 0.7 – –

Information ........................................................... 7.2 0 7.5 1 6.5 – – 0.2

Financial activities ................................................ 4.1 1 3.9 0 3.1 – – 1.7

Education and health services ............................. 5.0 0 6.0 4 3.1 – – 1.1

Educational services ........................................ 3.9 3 1.9 4 1.0 – – 0.3

Health care and social assistance ................... 5.8 0 7.1 4 3.6 – – 1.2

Geographic areas

Northeast ................................................................. 4.8 3 5.0 7 2.6 – – 0.5

New England ....................................................... 12.3 8 – – – – – 0.1

Middle Atlantic ..................................................... 5.0 4 6.5 6 3.2 – – 0.7

South ....................................................................... 2.4 0 2.6 1 2.3 – – 0.6

South Atlantic ....................................................... 3.5 0 4.0 4 3.8 – – 1.0

West South Central .............................................. 3.6 0 3.8 5 2.7 – – 0.1

Midwest .................................................................... 3.2 6 3.7 1 3.1 – – 0.9

East North Central ............................................... 3.5 7 4.3 5 3.9 0.8 – –

West North Central .............................................. 6.5 12 6.9 6 5.1 – – 0.1

West:

Mountain ............................................................ 3.0 0 11.9 3 3.3 – – 0.9

1 Outpatient prescription drug benefits include both stand-alone drug plans and prescription drug benefits included as part of a medical plan. 2 Less than 0.5.

Note: Dashes indicate that no data were reported or that data do not meet publication criteria. For definitions of major plans, key provisions, and related terms, see the "Glossary of Employee Benefit

Terms" at www.bls.gov/ncs/ebs/detailedprovisions/2018/ownership/private/glossary.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

46
Appendix table 1. Survey establishment response, private

industry, 2018

Establishments Number of

establishments

Total in sampling frame1 ........................................................ 6,317,276

 Total in sample .................................................................... 3,355

 Responding2 ...................................................................... 2,222

 Refused3 ............................................................................ 921

 Out of business or not in survey scope .............................. 212

1 The sampling frame was developed from state unemployment insurance reports and is

based on the 2012 North American Industry Classification System (NAICS). With some

minor exceptions, an establishment is a single economic unit that engages in one, or

predominantly one, type of economic activity. For private industries, an establishment is

usually a single physical location. Excluded from the survey are workers employed in federal

and quasi-federal agencies, military personnel, agricultural workers, volunteers, unpaid

workers, individuals receiving long-term disability compensation, and those working

overseas. In addition, private industry excludes workers in private households, the

self-employed, workers who set their own pay (e.g., proprietors, owners, major stockholders,

and partners in unincorporated firms), and family members paid token wages. 2 Establishments that provided data at the initial interview. 3 Establishments that did not provide data at the initial interview. Data for establishments

not responding at the time of update interviews are imputed. For information on nonresponse

adjustment and imputation, see “National Compensation Measures,” BLS Handbook of

Methods available at www.bls.gov/opub/hom/ncs/home.htm.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

47
Appendix table 2. Number of workers represented, private

industry, 2018

Occupational group1 Estimated number

of workers2

All workers ............................................................................. 118,998,000

Management, professional, and related ............................ 32,454,400

Management, business, and financial ........................... 11,543,600

Professional and related ................................................ 20,910,700

Service ............................................................................... 28,250,500

Protective service .......................................................... 1,288,500

Sales and office ................................................................. 30,109,900

Sales and related ........................................................... 12,767,300

Office and administrative support .................................. 17,342,600

Natural resources, construction, and maintenance ........... 9,778,600

Construction, extraction, farming, fishing, and forestry .. 4,991,400

Installation, maintenance, and repair ............................. 4,787,200

Production, transportation, and material moving ............... 18,404,600

Production ...................................................................... 9,664,000

Transportation and material moving .............................. 8,740,700

1 The 2010 Standard Occupational Classification system is used to classify workers. 2 The numbers of workers represented by the survey are rounded to the nearest 100.

Estimates of the number of workers provide a description of the size and composition of the

labor force included in the survey. Estimates are not intended, however, for comparison to

other statistical series to measure employment trends or levels.

Source: U.S. Bureau of Labor Statistics, National Compensation Survey.

48
Technical Note

Most estimates of detailed benefit provisions are expressed in terms of the percentage of workers participating in 

a particular benefit plan or the percentage covered by a specific provision. Some estimates, however, provide 

values other than percentages of workers, such as the median eligibility service requirement, percentiles of 

annual individual deductible amount, percentiles of annual individual out-of-pocket maximum, or median 

copayment amounts. 

All estimates shown in the table are based on the set of workers specified underneath the table title and on any 

subsets indicated by column headers. For example, the statement may indicate that or "All workers participating 

in medical care plans = 100 percent." Standard error tables do not include base statements as they provide 

measures of reliability for the corresponding estimate table. Estimates in the non-shaded columns generally 

indicate percentages of workers. Estimates in shaded columns measure values other than the percentage of 

workers, such as dollar amounts or months of service required for eligibility.

Some estimates are classified as "not determinable." Situations that result in this classification can vary. In 

detailed provisions of employer-sponsored health plans, the "not determinable" classification is used when no 

information on a particular plan feature is available from the Summary Plan Description (SPD). The SPD is used 

as a primary source of information on the provisions of health plans. For example, a SPD may indicate that the 

plan includes some coverage for substance abuse but does not explicitly mention outpatient coverage. In this 

case, coverage for outpatient substance abuse rehabilitation benefits would be captured as “not determinable”. 

Estimates by worker average wage are grouped into six wage categories: the lowest 10 percent, the lowest 25 

percent, the second 25 percent, the third 25 percent, the highest 25 percent, and the highest 10 percent. The 

categories use percentile values based on unpublished March 2018 wages and salaries from the Employer Costs 

for Employee Compensation. 

Percentiles are computed using average hourly earnings from sampled occupations within an establishment.

Establishments in the survey are asked to report only individual worker earnings and scheduled hours of work for 

each sampled job. For the calculation of the percentile values, the individual worker hourly wages are weighted 

and arrayed from lowest to highest. The values corresponding to the percentiles are:

49
The lowest 10- and 25-percent wage categories include those occupations with an average hourly wage less than 

the 10th percentile value and 25th percentile value, respectively. The second 25-percent category includes those 

occupations that make at or above the 25th percentile value but less than the 50th percentile value. The third 25-

percent category includes those occupations that make at or above the 50th percentile value but less than the 

75th percentile value. Finally, the highest 25- and 10-percent wage categories include those occupations with an 

average hourly wage greater than or equal to the 75th percentile value and 90th percentile value, respectively.

Note: Individual workers can fall into a wage category different from the average for the occupation into which 

they are classified because average hourly wages for the occupation are used to produce the benefit estimates.

Sample size

See appendix table 1.

Survey scope

See appendix table 2. Excluded from the survey are workers employed in federal and quasi-federal agencies, 

military personnel, agricultural workers, volunteers, unpaid workers, individuals receiving long-term disability 

compensation, and those working overseas. In addition, private industry excludes workers in private households, 

the self-employed, workers who set their own pay (e.g., proprietors, owners, major stockholders, and partners in 

unincorporated firms), and family members paid token wages.

Survey methods

For technical information on survey methods, see "National Compensation Measures," in the BLS Handbook of 

Methods at www.bls.gov/opub/hom/ncs/home.htm. The concepts section of the Handbook provides definitions 

for worker and establishment characteristics, including geographic areas.

Additional information

For BLS research articles on employee benefits, see the Monthly Labor Review at www.bls.gov/opub/mlr, Beyond 

the Numbers: Pay and Benefits at www.bls.gov/opub/btn, The Economics Daily at www.bls.gov/opub/ted, as well 

as the NCS publications page on benefits at www.bls.gov/ncs/ncspubs.htm. 

Characteristics

Average hourly wage percentiles

10 25 50

(median) 75 90

Private industry workers $10.00 $12.75 $18.78 $30.08 $46.73

50
Healthcare Benefits

Healthcare benefits provide preventive and protective medical, dental, vision, or prescription drug 

coverage to employees and their families. Most employer-provided plans cover the employee and the 

employee’s dependents, including spouse and children.

High deductible health plan (HDHP). This type of plan typically features a higher deductible and lower 

insurance premiums than those of traditional health plans. Normally the plan includes catastrophic 

coverage to protect against large medical expenses, but the insured is responsible for routine out-ofpocket expenses up until they meet the plan deductible. For 2018, the Internal Revenue Service (IRS) 

minimum deductible amount allowed for single coverage HDHP plans was $1,350; for 2015-17 the 

amount was $1,300.

Medical care

Medical care plans provide services or payments for services rendered in the hospital or by a qualified 

medical care provider.

Limitations on coverage

Overall limits. The NCS uses this term to refer to restrictions that apply to all or most benefits under the 

plan, as opposed to selected individual benefits. An example of an overall limit is a $300-per-year 

deductible that must be paid before medical expenses become eligible for reimbursement. Another 

example is an 80-percent coinsurance that applies to all categories of care except outpatient surgery.

Coverage limits. Limits may be set in terms of dollar or day ceiling on benefits, a requirement that the 

participant pay a percentage of costs (coinsurance), or a requirement that the participant pay a specific 

amount (deductible or copayment) before reimbursement begins or services are rendered. For example, 

a $250 copayment for hospital room and board.

Maximum out-of-pocket expense. The annual dollar amount limit a participant or family is required to pay 

out-of-pocket during, in addition to the plan deductible. Until it is met, the plan and the member share in 

the cost of covered expenses. Once reached, covered expenses are fully reimbursed for the rest of the 

year.

Deductible. The deductible is a dollar amount that an insured person pays during the benefit period—

usually a year—before the insurer starts to make payments for covered medical services. Plans may have 

both individual and family deductibles. Some plans have separate deductibles for specific services. For 

example, a plan may have a hospitalization deductible per admission. Deductibles may vary between 

services received from an approved provider (that is, a provider with whom the insurer has a contract or 

an agreement specifying payment levels and other requirements) and those received from providers not 

on the approved list or as part of a different tier of benefits. Some deductibles vary based on other 

factors (aside from plan network), such as employee length of service, salary range, or enrollee age. 

51
Coinsurance. This form of medical cost sharing requires an insured person to pay a stated percentage of 

medical expenses after the deductible amount, if any, is paid. After any deductible amount and 

coinsurance are paid, the insurer is responsible for the rest of the reimbursement for covered benefits, up 

to the maximum allowed charges. The individual is responsible for any charges in excess of what the 

insurer determines to be “usual, customary, and reasonable.” Coinsurance rates may differ between 

services received from an approved provider and those received from providers not on the approved list.

Copayments. The fixed dollar amount that an insured person must pay when a service is received before 

any remaining charges are paid by the insurer.

Plan networks 

In-network. Healthcare providers (e.g., specialists, hospitals, laboratories) that have accepted contracted 

rates with the insurer are considered in-network. The insured person typically pays a lower price for using 

services within the network.

Out-of-network. Services received outside the network, healthcare providers with contracted rates, 

typically carry a higher cost to the insured person.

Most-generous coverage. Insurers may offer more than two tiers of benefits and provide the insured 

person with the most-generous coverage, lowest costs (deductible, copayment, or coinsurance amounts), 

for using the preferred provider(s). The insured person may also receive services from the other innetwork providers.

Outpatient prescription drugs

Prescription drug plans include both stand-alone drug plans and prescription drug benefits included as 

part of a medical care plan. Outpatient prescription drugs dispensed during a hospital stay are covered as

hospital miscellaneous charges.

Formulary drugs. These are both generic and brand-name drugs approved by the healthcare provider. 

Drugs not approved by the healthcare provider are nonformulary drugs, for which enrollees receive less 

generous benefits, such as a higher copayment per prescription.

Brand-name drugs. These are drugs that once were, or still are, under patents.

Generic drugs. These are drugs that are not under any patents. Once a drug’s patent has expired, some 

plans provide more generous coverage for same-formula generic drugs than for name-brand drugs; the 

practice is adopted as a cost containment measure.

Mail-order drugs. These are drugs that can be ordered through the mail. As a cost containment measure, 

some plans use mail-order pharmacies that typically provide a 3-month supply of maintenance drugs.

52