Self-insured group health plans covered approximately 34 million participants, DOL annual report finds

The Department of Labor (DOL) has released to Congress its eighth annual report on self-insured group health plans with data from Form 5500, Annual Return/Report of Employee Benefit Plan, as well as data from certain financial filings of self-insured employers. Approximately 54,500 health plans filed a Form 5500 for 2015 (the most recent complete data available), an increase of nearly six percent from the health plans that filed a Form 5500 for 2014. Of health plans filing a 2015 Form 5500, about 22,900 were self-insured and approximately 3,900 mixed self-insurance with insurance (mixed-insured).

The IRS and the DOL developed Form 5500 for employee benefit plans to satisfy annual reporting requirements under ERISA and the Tax Code. The Patient Protection and Affordable Care Act (ACA) generally requires the DOL to prepare an annual report about self-insured group health plans filing Form 5500. Generally, sponsors of self-insured plans pay their plans’ covered health expenses directly, as the plans incur claims.

Plan type. The DOL report states that approximately 21,800 of the self-insured group health plans filing a 2015 Form 5500 were sponsored by a single employer while 1,100 plans were multiemployer plans. About 3,400 of the mixed-insured group health plans filing a 2015 Form 5500 were sponsored by a single employer; approximately 500 plans were multiemployer plans.

On average, about 48,900 group health plans filed a Form 5500 in the years 2006-2015. While the number of health plans filing a Form 5500 has increased over this period, the fraction of group health plans that are self-insured or mixed-insured has declined somewhat from about 52 percent in 2006 to 49 percent in 2015.

Number of participants. Overall, the 22,900 self-insured group health plans filing a 2015 Form 5500 covered approximately 34 million participants, 30 million of whom were active participants. The 3,900 mixed-insured group health plans filing a 2015 Form 5500 covered approximately 26 million participants, 22 million of whom were active participants.

In general, plans covering a larger number of participants are more likely to be self-insured than plans with fewer participants. While 51 percent of plans are fully-insured, only 17 percent of participants in plans that file the Form 5500 are covered by these plans.

Benefits offered. The report also notes that of the 22,900 self-insured group health plans in 2015, 4,900 offered only health benefits and approximately 17,900 offered other benefits in addition to health benefits. Of the 3,900 mixed-insured group health plans, approximately 200 offered only health benefits and about 3,700 offered other benefits in addition to health benefits.

Incomplete data. The DOL cautions that data in the report should be interpreted with care for several reasons, including the fact that, of the self-insured plans that filed a Form 5500 in 2015, 76 percent did not report their financial information, so the data may be incomplete. Also, plans providing several types of welfare benefits may report health benefits, along with such benefits as disability or life insurance, on a single Form 5500, making it difficult to determine how different benefits are financed, and whether the plan is self-insured or fully insured.

SOURCE: “Annual Report to Congress on Self-Insured Group Health Plans,” March 2018.

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