Do men and women traditional pay premium differences for group health plan coverage regardless of industry? If yes, what is the difference? Their use of healthcare services are very different. Can you provide me with any guidance estimating the total group health costs that employed men versus employed women spend in any one given year?
Dear Healthy Differences:
Men and women traditionally do not pay different premiums for group health coverage.
There are a number of reasons: First it would be a public relations nightmare. Second, when setting rates under group plans you are covering an employee and their family. Any given group within this array will include both males and females so the experience pool will reflect their collective experience.
While there are actuarial studies that show the cost difference between males and females, I would be reluctant to give you a range since it's based on other factors including:
- Age (females bear children in their earlier years)
- Occupation (blue collar workers dependent upon their industry both male and female incur greater claim costs at later ages)
- Education (we know teachers, while not highly compensated, are educated enough to know how to use the medical system. Workers in healthcare--no matter what educational level--have access to healthcare and use it more frequently that the average).
- Income (we know that higher paid people will seek higher cost treatments for their ailments)...
...and any other number of variations.
Employers do not track experience by male or female and most insurance companies have been barred by state insurance regulations from charging separate premiums (even for life insurance) for males and females so I don't know if they track experience separately.
SOURCE: Barry Barnett, a principal in the Healthcare Solutions practice at PricewaterhouseCoopers. Barnett is based in Teaneck, NJ.
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