Page 24 - Erlanger Health System
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BENCHMARKING
Benchmarking — PPO — hospital industryry
Benchmarking – PPO – Hospital Indust
Industry Industry Industry Industry Industry Industry
Erlanger Erlanger Hospital Hospital Hospital Hospital Hospital Hospital
National National National Southern Southern Southern
2020 2020 25th Mean 75th 25th Mean 75th
P Paarraammeetteerrss PPO 1 PPO 2 Includes SIC: 8062, Includes SIC: 8062, Includes SIC: 8062, Includes SIC: 8062, Includes SIC: 8062, Includes SIC: 8062,
8063, 8069 8063, 8069 8063, 8069 8063, 8069 8063, 8069 8063, 8069
Median PPO In -Network
Deductible
• Employee $850 $1,250 $550 $1,250 $1,558 $821 $1,588 $2,500
• Family $2,250 $3,750 $1,303 $2,791 $3,750 $1,868 $3,673 $5,000
Median PPO Out -Network
Deductible
• Employee No Coverage No Coverage N/A N/A N/A N/A N/A N/A
• Family No Coverage No Coverage N/A N/A N/A N/A N/A N/A
Median PPO In -Network Copay
• Primary $15 $15 $19 $23 $30 $25 $25 $35
• Specialist $30 $30 $28 $39 $50 $28 $40 $55
• ER $250 $250 $168 $261 $370 $221 $305 $370
• Urgent Care $25 $25 $14 $37 $50 $14 $36 $50
Median PPO In -Network
Coinsurance
• Inpatient 80% 80% 80% 84% 90% 80% 83% 90%
• Outpatient 80% 80% 80% 84% 90% 80% 83% 90%
Median PPO Out -Network
Coinsurance
• Inpatient No Coverage No Coverage N/A N/A N/A N/A N/A N/A
• Outpatient No Coverage No Coverage N/A N/A N/A N/A N/A N/A
Median PPO In -Network OOP
Max
(Includes Deductible)
• Employee $5,000 $4,000 $3,500 $4,724 $6,168 $4,000 $4,976 $6,168
• Family $10,000 $8,000 $7,774 $10,448 $12,900 $8,308 $12,084 $13,200
Median Pharmacy Copays
(Retail)
• Generic $10 $10 $10 $12 $15 $10 $15 $15
• Formulary $40 $40 $30 $43 $50 $35 $55 $60
• Non-Formulary $65 $65 $55 $77 $80 $55 $98 $100
Average EE $ Contribution (PPO) Nicotine Free / User Nicotine Free / User
• Employee $162.50 / $211.25 $97.50 / $126.75 N/A $163 N/A N/A $170 N/A
• Employee + Spouse $390 / $507 $251.33 / $326.73 N/A $464 N/A N/A $494 N/A
• Employee + Child(ren) $338 / $439.40 $216.67 / $281.67 N/A $394 N/A N/A $389 N/A
• Family $595.83 / $774.58 $383.50 / $498.55 N/A $636 N/A N/A $659 N/A
Average EE % Contribution
(PPO)
• Employee N/A N/A N/A 23% N/A N/A 24% N/A
• Employee + Spouse N/A N/A N/A 31% N/A N/A 32% N/A
• Employee + Child(ren) N/A N/A N/A 28% N/A N/A 29% N/A
• Family N/A N/A N/A 29% N/A N/A 30% N/A
Actuarial Values
• Net Benefit $541 $542
• Benefit Ratio 84% 84%
• Weighted Average 2
24 Lockton Companies
Benchmarking — PPO — hospital industryry
Benchmarking – PPO – Hospital Indust
Industry Industry Industry Industry Industry Industry
Erlanger Erlanger Hospital Hospital Hospital Hospital Hospital Hospital
National National National Southern Southern Southern
2020 2020 25th Mean 75th 25th Mean 75th
P Paarraammeetteerrss PPO 1 PPO 2 Includes SIC: 8062, Includes SIC: 8062, Includes SIC: 8062, Includes SIC: 8062, Includes SIC: 8062, Includes SIC: 8062,
8063, 8069 8063, 8069 8063, 8069 8063, 8069 8063, 8069 8063, 8069
Median PPO In -Network
Deductible
• Employee $850 $1,250 $550 $1,250 $1,558 $821 $1,588 $2,500
• Family $2,250 $3,750 $1,303 $2,791 $3,750 $1,868 $3,673 $5,000
Median PPO Out -Network
Deductible
• Employee No Coverage No Coverage N/A N/A N/A N/A N/A N/A
• Family No Coverage No Coverage N/A N/A N/A N/A N/A N/A
Median PPO In -Network Copay
• Primary $15 $15 $19 $23 $30 $25 $25 $35
• Specialist $30 $30 $28 $39 $50 $28 $40 $55
• ER $250 $250 $168 $261 $370 $221 $305 $370
• Urgent Care $25 $25 $14 $37 $50 $14 $36 $50
Median PPO In -Network
Coinsurance
• Inpatient 80% 80% 80% 84% 90% 80% 83% 90%
• Outpatient 80% 80% 80% 84% 90% 80% 83% 90%
Median PPO Out -Network
Coinsurance
• Inpatient No Coverage No Coverage N/A N/A N/A N/A N/A N/A
• Outpatient No Coverage No Coverage N/A N/A N/A N/A N/A N/A
Median PPO In -Network OOP
Max
(Includes Deductible)
• Employee $5,000 $4,000 $3,500 $4,724 $6,168 $4,000 $4,976 $6,168
• Family $10,000 $8,000 $7,774 $10,448 $12,900 $8,308 $12,084 $13,200
Median Pharmacy Copays
(Retail)
• Generic $10 $10 $10 $12 $15 $10 $15 $15
• Formulary $40 $40 $30 $43 $50 $35 $55 $60
• Non-Formulary $65 $65 $55 $77 $80 $55 $98 $100
Average EE $ Contribution (PPO) Nicotine Free / User Nicotine Free / User
• Employee $162.50 / $211.25 $97.50 / $126.75 N/A $163 N/A N/A $170 N/A
• Employee + Spouse $390 / $507 $251.33 / $326.73 N/A $464 N/A N/A $494 N/A
• Employee + Child(ren) $338 / $439.40 $216.67 / $281.67 N/A $394 N/A N/A $389 N/A
• Family $595.83 / $774.58 $383.50 / $498.55 N/A $636 N/A N/A $659 N/A
Average EE % Contribution
(PPO)
• Employee N/A N/A N/A 23% N/A N/A 24% N/A
• Employee + Spouse N/A N/A N/A 31% N/A N/A 32% N/A
• Employee + Child(ren) N/A N/A N/A 28% N/A N/A 29% N/A
• Family N/A N/A N/A 29% N/A N/A 30% N/A
Actuarial Values
• Net Benefit $541 $542
• Benefit Ratio 84% 84%
• Weighted Average 2
24 Lockton Companies
