For additional assistance on 

benefits, contact one of our 

information offices:

NATIONAL: WASHINGTON, DC

(202) 691-6199 TDD: (800) 877-8339

NCSinfo@bls.gov www.bls.gov/ebs

REGIONAL:

ATLANTA

(404) 893-4222

BOSTON

(617) 565-2327

CHICAGO

(312) 353-1880

DALLAS

(972) 850-4800

KANSAS CITY

(816) 285-7000

NEW YORK

(646) 264-3600

PHILADELPHIA

(215) 597-3282

SAN FRANCISCO

(415) 625-2270

BUREAU OF LABOR STATISTICS

U.S. DEPARTMENT OF LABOR

www.bls.gov/ebs 

GLOSSARY

The next Program Perspectives will feature 

defined contribution retirement plans.

Fee-for-service health care plan. In 

fee-for-service plans, a premium is paid 

to a private insurance carrier to provide 

a specific package of health benefits. The 

plan only finances, it does not deliver, the 

health care services. Some employers may 

choose to self-fund a fee-for-service plan 

in which case the employer, as opposed to 

an insurance company, assumes responsibility for payment of physician or hospital 

services.

In-network provider. An in-network 

provider is a group of hospitals and 

physicians that contract with an insurance company to provide comprehensive 

medical services. Many plans require the 

plan participant to go to these providers 

to get coverage. Other plans will allow 

the participant to receive medical services 

outside the network from out-of-network 

providers at a higher cost. Preferred provider organizations, point-of-service, and 

exclusive provider organization medical 

plans will have incentives, and in some 

cases, require the participant to use innetwork providers. A traditional fee-forservice plan will not have a network, so 

patients may visit the physician or hospital 

of their choice. 

Access to a benefit plan. Employees are 

considered to have access to a benefit plan 

if it is available for their use. For example, 

if an employee is permitted to participate 

in a medical care plan offered by the 

employer, he or she is placed in a category 

with those having access to medical care, 

regardless of whether he or she chooses to 

participate.

Deductible. The deductible is the amount 

of covered expenses that an individual or 

family must pay before any charges are 

paid by the medical care plan. Deductibles 

that apply separately to a specific category 

of expenses, such as deductible for each 

hospital admission, are excluded.

Coinsurance. Coinsurance is the percentage of covered health care costs that the 

plan pays during the plan year until the 

participant reaches the out-of-pocket 

maximum.

Out-of-pocket maximum. The out-ofpocket maximum is the annual limit of 

covered expenses that a participant or 

family must pay after the deductible has 

been satisfied. Once reached, covered expenses are fully reimbursed by the insurer 

for the rest of the year.

TABLE 2

Characteristic Fixed 

coinsurance

Variable coinsurance 

In-network Out-of-network

All workers 80 80 60

By bargaining status

Union workers 80 85 70

Nonunion workers 80 80 60

By full-time/part-time status

Full-time 80 80 60

Part-time 80 80 60

Median coinsurance rates for fee-for-service plans, 

private industry, National Compensation Survey, 

2008, in percent

annual individual out-of-pocket 

maximum. For all private industry 

workers, the median individual 

out-of-pocket maximum is $2,000, 

and the 10th to 90th percentile 

values are $800 and $3,500, 

respectively. (See table 1.) The 

median individual out-of-pocket 

maximum for full-time workers 

is $2,000, and the median family 

out-of-pocket maximum is $4,000, 

while for part-time workers the 

median is $1,700 for individual 

and $3,500 for family. Union 

workers have a median individual 

out-of-pocket maximum of $1,750 

and a median family out-of-pocket maximum of $4,000, while the 

median for nonunion workers is 

$2,000 for individual and $4,000 

for family. Once the out-of-pocket 

maximum is reached, the insurer 

pays all covered expenses until 

the end of the plan year. ●
U.S. BUREAU OF LABOR STATISTICS 

2 PROGRAM PERSPECTIVES • OCTOBER 2010 

from cover page►

CHART 1

affected more by very large individual costs making comparisons 

more difficult. At the 10th percentile, 10 percent of the workers have 

a cost that is at or below that level, 

while 90 percent are at or above it. 

At the 90th percentile, 90 percent of 

the workers have a cost that is at or 

below that level, while 10 percent 

are at or above it. The two percentiles provide a range that represents 

the individual costs for 80 percent 

of workers that have a medical plan 

with the particular plan feature 

being discussed. Estimates in this 

issue are from the Bureau of Labor 

Statistics National Compensation 

Survey: Health Plan Provisions 

in Private Industry in the United 

States, 2008 and Employee Benefits 

in the United States, March 2008

(on the Internet at www.bls.gov/

ncs/ebs/detailedprovisions/2008/

ebbl0042.pdf and www.bls.gov/

ncs/ebs/sp/ebnr0014.pdf). Estimates on premium costs—for 

single and family coverage—are 

available at www.bls.gov/ncs/ebs/

benefits/2008/benefits_health.htm.

How much are 

deductibles?

Most (93 percent) workers with 

fee-for-service plans are required to 

pay an annual deductible before the 

plan pays for medical expenses. The 

deductibles for both individual and 

family coverage vary by medical 

plan. The median individual deductible for all private industry workers 

is $500, while the 10th percentile 

is $150, and the 90th percentile is 

$1,500. For families, the median 

deductible is $1,000, with the 10th 

percentile at $450, and the 90th percentile at $4,000. (See table 1.)

Deductibles tend to be lower for 

union workers than for nonunion 

workers. For example, the median 

individual deductible for union 

workers is $275, and the median 

individual deductible for nonunion 

workers is $500. Union workers 

also have lower family deductibles 

than nonunion workers. Family 

deductibles range from $300 at the 

10th percentile to $2,000 at the 90th 

percentile for union workers, lower 

than nonunion workers, whose 

deductible percentiles are $500 and 

$4,000, respectively. Additionally, 

union workers are more likely to 

have access to employer-provided 

health care benefits than nonunion 

workers. In the private industry, 88 

percent of union workers have access, compared with 69 percent of 

Percent of workers with access to medical care benefits, private industry, 

National Compensation Survey, March 2008

Fl l

Workers

All

Union

Nonunion

Full-time

Part-time

Percent

0 20 40 60 80 100
U.S. BUREAU OF LABOR STATISTICS 

2 PROGRAM PERSPECTIVES • OCTOBER 2010 

from cover page►

CHART 1

affected more by very large individual costs making comparisons 

more difficult. At the 10th percentile, 10 percent of the workers have 

a cost that is at or below that level, 

while 90 percent are at or above it. 

At the 90th percentile, 90 percent of 

the workers have a cost that is at or 

below that level, while 10 percent 

are at or above it. The two percentiles provide a range that represents 

the individual costs for 80 percent 

of workers that have a medical plan 

with the particular plan feature 

being discussed. Estimates in this 

issue are from the Bureau of Labor 

Statistics National Compensation 

Survey: Health Plan Provisions 

in Private Industry in the United 

States, 2008 and Employee Benefits 

in the United States, March 2008

(on the Internet at www.bls.gov/

ncs/ebs/detailedprovisions/2008/

ebbl0042.pdf and www.bls.gov/

ncs/ebs/sp/ebnr0014.pdf). Estimates on premium costs—for 

single and family coverage—are 

available at www.bls.gov/ncs/ebs/

benefits/2008/benefits_health.htm.

How much are 

deductibles?

Most (93 percent) workers with 

fee-for-service plans are required to 

pay an annual deductible before the 

plan pays for medical expenses. The 

deductibles for both individual and 

family coverage vary by medical 

plan. The median individual deductible for all private industry workers 

is $500, while the 10th percentile 

is $150, and the 90th percentile is 

$1,500. For families, the median 

deductible is $1,000, with the 10th 

percentile at $450, and the 90th percentile at $4,000. (See table 1.)

Deductibles tend to be lower for 

union workers than for nonunion 

workers. For example, the median 

individual deductible for union 

workers is $275, and the median 

individual deductible for nonunion 

workers is $500. Union workers 

also have lower family deductibles 

than nonunion workers. Family 

deductibles range from $300 at the 

10th percentile to $2,000 at the 90th 

percentile for union workers, lower 

than nonunion workers, whose 

deductible percentiles are $500 and 

$4,000, respectively. Additionally, 

union workers are more likely to 

have access to employer-provided 

health care benefits than nonunion 

workers. In the private industry, 88 

percent of union workers have access, compared with 69 percent of 

Percent of workers with access to medical care benefits, private industry, 

National Compensation Survey, March 2008

Fl l

Workers

All

Union

Nonunion

Full-time

Part-time

Percent

0 20 40 60 80 100
For additional assistance on 

benefits, contact one of our 

information offices:

NATIONAL: WASHINGTON, DC

(202) 691-6199 TDD: (800) 877-8339

NCSinfo@bls.gov www.bls.gov/ebs

REGIONAL:

ATLANTA

(404) 893-4222

BOSTON

(617) 565-2327

CHICAGO

(312) 353-1880

DALLAS

(972) 850-4800

KANSAS CITY

(816) 285-7000

NEW YORK

(646) 264-3600

PHILADELPHIA

(215) 597-3282

SAN FRANCISCO

(415) 625-2270

BUREAU OF LABOR STATISTICS

U.S. DEPARTMENT OF LABOR

www.bls.gov/ebs 

GLOSSARY

The next Program Perspectives will feature 

defined contribution retirement plans.

Fee-for-service health care plan. In 

fee-for-service plans, a premium is paid 

to a private insurance carrier to provide 

a specific package of health benefits. The 

plan only finances, it does not deliver, the 

health care services. Some employers may 

choose to self-fund a fee-for-service plan 

in which case the employer, as opposed to 

an insurance company, assumes responsibility for payment of physician or hospital 

services.

In-network provider. An in-network 

provider is a group of hospitals and 

physicians that contract with an insurance company to provide comprehensive 

medical services. Many plans require the 

plan participant to go to these providers 

to get coverage. Other plans will allow 

the participant to receive medical services 

outside the network from out-of-network 

providers at a higher cost. Preferred provider organizations, point-of-service, and 

exclusive provider organization medical 

plans will have incentives, and in some 

cases, require the participant to use innetwork providers. A traditional fee-forservice plan will not have a network, so 

patients may visit the physician or hospital 

of their choice. 

Access to a benefit plan. Employees are 

considered to have access to a benefit plan 

if it is available for their use. For example, 

if an employee is permitted to participate 

in a medical care plan offered by the 

employer, he or she is placed in a category 

with those having access to medical care, 

regardless of whether he or she chooses to 

participate.

Deductible. The deductible is the amount 

of covered expenses that an individual or 

family must pay before any charges are 

paid by the medical care plan. Deductibles 

that apply separately to a specific category 

of expenses, such as deductible for each 

hospital admission, are excluded.

Coinsurance. Coinsurance is the percentage of covered health care costs that the 

plan pays during the plan year until the 

participant reaches the out-of-pocket 

maximum.

Out-of-pocket maximum. The out-ofpocket maximum is the annual limit of 

covered expenses that a participant or 

family must pay after the deductible has 

been satisfied. Once reached, covered expenses are fully reimbursed by the insurer 

for the rest of the year.

TABLE 2

Characteristic Fixed 

coinsurance

Variable coinsurance 

In-network Out-of-network

All workers 80 80 60

By bargaining status

Union workers 80 85 70

Nonunion workers 80 80 60

By full-time/part-time status

Full-time 80 80 60

Part-time 80 80 60

Median coinsurance rates for fee-for-service plans, 

private industry, National Compensation Survey, 

2008, in percent

annual individual out-of-pocket 

maximum. For all private industry 

workers, the median individual 

out-of-pocket maximum is $2,000, 

and the 10th to 90th percentile 

values are $800 and $3,500, 

respectively. (See table 1.) The 

median individual out-of-pocket 

maximum for full-time workers 

is $2,000, and the median family 

out-of-pocket maximum is $4,000, 

while for part-time workers the 

median is $1,700 for individual 

and $3,500 for family. Union 

workers have a median individual 

out-of-pocket maximum of $1,750 

and a median family out-of-pocket maximum of $4,000, while the 

median for nonunion workers is 

$2,000 for individual and $4,000 

for family. Once the out-of-pocket 

maximum is reached, the insurer 

pays all covered expenses until 

the end of the plan year. ●