Wednesday, May 12, 2004 - 11:15 AM

Benefits Coverage for Adult Vaccines in Employer-Sponsored Health Plans

Matthew M. Davis1, Jeannie S Thrall1, Acham Gebremariam1, Daniel B. Fishbein2, Kathy Bishop1, Jeanne M Santoli2, Abigail M. Shefer2, and Sarah J. Clark1. (1) Division of General Pediatrics, University of Michigan, 300 North Ingalls, Room 6E06, Campus Box 0456, Ann Arbor, MI, USA, (2) ISD-HSREB, CDC - NIP, 1600 Clifton Road, NE, MS E-52, Atlanta, GA, USA

Absence of insurance benefits coverage for adult vaccines in employer-sponsored health plans may contribute to undervaccination among nonelderly adults. Benefits coverage rates for specific vaccines are unknown.

To formulate national estimates of the proportion of private and public employees whose health plans include benefits coverage for influenza, pneumococcal, hepatitis B, MMR, and varicella vaccines ("5 vaccines").

This cross-sectional study (Oct 2002 to Sept 2003) involved a national random sample of all US private employers stratified by size (# employees), and a similarly stratified national random sample of all US state and local government employers. We investigated whether plans included coverage for 5 vaccines and also analyzed each plan's risk type (self-insured or fully insured), premiums, deductibles, copays, and preventive care caps.

PRIVATE EMPLOYER PLANS: 596 of 892 eligible employers responded (67%). 130 employers offered no plans; 466 employers provided information on 732 plans. Vaccine benefits differed for self-insured plans (MMR and varicella coverage in <40% of plans) vs fully insured plans (>75%; p<.05). Higher enrollment in plans with better coverage mitigated these plan differences, however, so that 71% of plan enrollees overall (95% CI: 58%, 84%) had coverage for all 5 vaccines, 8% (3%, 12%) had coverage for none, and the remainder had a mix of vaccine benefits. 69% (51%, 86%) of self-insured plan enrollees had coverage for all 5 vaccines, compared to 76% (64%, 88%) of fully insured plan enrollees. Private plans with 5-vaccine coverage versus plans with coverage for none did not differ in employee premiums, deductibles, or copays. 25% of enrollees faced preventive care caps, which were higher ($440) for 5-vaccine plans than for 0-vaccine plans ($208; p<.05). PUBLIC EMPLOYER PLANS: 349 of 487 eligible public employers participated (72%) and provided information on 990 plans. 71% (58%, 84%) of plan enrollees had coverage for all 5 vaccines, versus 14% (3%, 25%) with coverage for none. Vaccine benefits differed only regarding annual preventive care caps faced by about 30% of enrollees: $385 for 5 vaccine plans vs $138 for 0-vaccine plans (p<.005).

Employer-sponsored health plans provide benefits for 5 adult vaccines for about 70% of enrollees. This degree of underinsurance may contribute to rates of undervaccination among nonelderly adults.

1) Estimates of vaccine underinsurance for adults in employer-sponsored plans