Medical Trends Around the World 2016 - Mercer Marsh ...

 
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Medical Trends Around the World 2016 - Mercer Marsh ...
Medical Trends
Around the World
2016
Medical Trends Around the World 2016 - Mercer Marsh ...
Medical Trends Around the World 2016 - Mercer Marsh ...
Introduction................................................................................................................................................ 2

           1          High Medical Spend Continues: Is Lack of Action to Blame?......................................................... 4

           2          The Rise in Non-communicable Disease Claims: the Impact of Lifestyle Choices........................ 8

           3          The Burden of Risk: an Insurer’s Look at Rising Costs .................................................................15

           4          The Rising Effect of Stress Is Evident .......................................................................................... 21

           5          The Role of Government and/or Industry Associations Influencing Health................................ 29

           6          Conclusion ................................................................................................................................... 30

           About This Survey...................................................................................................................................... 31

Contents
                                                                                                                                                                        1
Medical Trends Around the World 2016 - Mercer Marsh ...
Top Trends               The results of Mercer Marsh Benefits (MMB)’s                                              We’re grateful to the insurers that took the
                                             second annual Medical Trends Around the World                                             time and attention to respond to our survey.
                    1. Continuation          survey are in. From February to May 2016, we                                              Without these insights, we wouldn’t be able to
                       of high medical       surveyed 180 insurers across 49 countries,                                                produce such a comprehensive report. For a full
                       trend rate            including almost 90 network affiliates of                                                 list of participating countries and the names of
                                             multinational pools.1                                                                     insurers we’re able to disclose, please refer to
                    2. The rise in non-
                                                                                                                                       the Appendix. (Note: Because the US is a very
                       communicable
                                             Despite remaining stable, medical trend rates                                             different healthcare market, we haven’t included
                       disease claims
                                             continue to outpace local inflation and are on                                            it in this report. For information on US trends,
                       and the impact of
                                             average three times the general inflation rate.                                           please consult Mercer’s National Survey of
                       lifestyle choices
                                             They are driven by high healthcare spending in                                            Employer-sponsored Health Plans.)
                    3. The burden of         emerging markets and Western Europe. Several
                       risk: an insurer’s    factors explain the growing costs: higher — often
                       look a rising costs   lifestyle-related — risk factors; regulations that
                                             transfer the burden of cost to private plans and,
                    4. The rising effect     in some countries, foreign exchange rates.
                       of stress
                                             It is no secret that an aging global population
                    5. The role of
                                             will likely increase healthcare costs. But you can
                       government
                                             optimize your health and well-being strategy
                       and/or industry
                                             by keeping on top of these trends to manage
                       associations in
                                             company spend while securing more rewarding
                       influencing health
                                             futures for your business and your employees
                                             around the world.

Introduction
Top Trends Shaping Employer-
sponsored Medical Plans
                                             1
                                                 171 completed the full survey; 9 additional insurers provided medical trend data to support our findings.
Medical Trends Around the World 2016 - Mercer Marsh ...
About Mercer Marsh Benefits

Mercer Marsh Benefits (MMB) provides clients
with a single source for managing every aspect of
employee benefits. Located in 135 countries and
servicing clients in more than 150 countries, our
benefits professionals are deeply knowledgeable
about their local markets. Mercer and Marsh
have more than 75 years of experience in the
employee benefits brokerage and consulting
business, working with clients of all sizes.

In partnership with an integrated,
multidisciplinary team of nearly 300 professionals
advising multinational corporate headquarters,
we provide expert advice and coordinated
delivery of global and local solutions to help
our multinational clients leverage their buying
power. Blending technical knowledge with an
understanding of global business issues and
client-focused strategies, we have the expertise
and tools you need to help manage your cross-
border benefits and rewards programs.

In addition, our global health specialists
work extensively with more than 100 health
management and clinical resources around the
world. Together, our integrated global teams help
you enhance the physical and financial health of
your multinational workforce.

                                                     3
Medical Trends Around the World 2016 - Mercer Marsh ...
Insurers reported their actual 2015 and projected
                                  2016 medical trend rates by responding to the
                                  following question:

                                        Based on your block of group or overall medical
                                        insurance business, what actual medical trend rate
                                        did you experience in 2015, and what rate are you
                                        projecting for 2016? All aspects of healthcare including
                                        hospitalization, outpatient, medications, maternity and
                                        vision can be included in your assessment but where
                                        possible, please exclude dental. The trend rate should
                                        account for per person increases in cost due to medical
                                        inflation, changes in utilization patterns and other
                                        factors like changes in government regulation.

                                  Seventy-three percent of countries (29 out of
                                  40) who responded to this question still show a
                                  medical trend rate double that of inflation, similar
                                  to last year’s results. We should note that

1
                                  inflation rates have generally been low and have
                                  held steady according to our source data.2
                                  However, we observed only moderate
                                  fluctuations in medical trend rates, with most
                                  only slightly higher than last year’s results.

High Medical Trend Rate
Continues: Is Lack of
Action to Blame?                  2
                                      S ources for inflation rates include:
                                        •   International Monetary Fund, World Economic Outlook Database, April 2016

Medical Trend Rates Continue to         •
                                        •
                                            LA Economic Trends, April 2016 update
                                            International Labour Organization, World Employment and Social Outlook, 2016
Outpace Inflation                       •   European Commission, February 2016
Medical Trends Around the World 2016 - Mercer Marsh ...
2015 medical                    2016 projected                                                         2015 medical                                 2016 projected
                         trend rate    2015 estimated    medical trend 2016 forecast                                            trend rate          2015 estimated           medical trend 2016 forecast
                        experience*       inflation†         rate*       inflation†                                            experience*             inflation†                rate*       inflation†
Global ‡                   9.9%            3.9%             9.8%           3.5%        Spain                                        4.9%                 -0.5%                     5.1%                 -0.4%
North America                                                                          Sweden                                       5.5%                   0.7%                   5.7%                    1.1%
Canada                     6.3%             1.1%            6.0%            1.3%       Switzerland                                  4.2%                   -1.1%                  4.9%                  -0.6%
Asia (average)            10.3%             1.7%            11.5%           2.1%       Turkey                                      10.1%                    7.7%                  11.8%                  9.8%
China                     10.3%             1.4%            11.5%           1.8%       Ukraine                                     38.0%                  48.7%                  15.0%                   15.1%
Hong Kong                  7.5%            3.0%             7.7%           2.5%        United Kingdom                               5.9%                    0.1%                  6.4%                   0.8%
India                      9.7%            4.9%             8.5%           5.3%        Latin America (average)                     11.8%                   6.7%                  12.8%                   8.0%
Indonesia                 12.7%            6.4%             11.8%          4.3%        Argentina                                   30.3%                  28.1%                 33.3%                   33.7%
Malaysia                  14.4%             2.1%            17.3%           3.1%       Brazil                                      16.0%                   9.0%                  18.6%                   8.7%
Philippines                9.4%             1.4%           10.0%           2.0%        Chile                                        6.5%                   4.3%                    7.8%                   4.1%
Singapore                  9.9%           -0.5%             9.9%           0.2%        Colombia                                      8.1%                  5.0%                   9.0%                    7.3%
South Korea                7.0%            0.7%            10.0%            1.3%       Dominican Republic                           4.6%                   0.8%                   6.0%                   3.6%
Taiwan                     8.7%           -0.3%             10.1%           0.7%       Mexico                                      10.5%                   2.7%                  11.0%                   2.9%
Thailand                   9.3%           -0.9%             9.9%           0.2%        Panama                                      10.8%                    0.1%                 10.5%                   0.8%
Vietnam                   14.3%            0.6%            19.3%            1.3%       Peru                                         7.4%                   3.5%                   6.3%                    3.1%
Europe, Middle East &
                  §
                                                                                       *The above medical trend rates reflect insurer survey results and may not be MMB’s view.
                            9.1%            4.1%            7.8%           2.5%
Africa (average)                                                                       †
                                                                                            Sources for inflation rates include:
                                                                                              •   International Monetary Fund, World Economic Outlook Database, April 2016
Denmark                    2.0%            0.5%             3.8%           0.8%
                                                                                              •   LA Economic Trends, April 2016 update
Egypt                     14.8%            11.0%           16.6%           9.6%               •   International Labour Organization, World Employment and Social Outlook, 2016

France                     2.0%             0.1%            1.8%           0.4%               •   European Commission, February 2016
                                                                                       ‡
                                                                                            Average of 40 participating countries with an acceptable number of responses
Greece                     5.7%            -1.1%            5.1%          0.02%        §
                                                                                            A lthough we received insufficient responses for Middle East, in general, medical inflation there remains high and
Ireland                    9.7%          -0.03%             5.3%           0.9%             consistent with previous two years. Utilization trends show bias toward secondary healthcare facilities, which is often
                                                                                            further compounded by overutilization and overprescribing, so this trend is set to continue. As a result, within medical
Italy                      2.3%             0.1%            2.9%           0.2%             insurance market we are seeing increased emphasis on risk control, either through proactive health management
Latvia                    10.8%            0.2%             9.1%           0.5%             (wellness initiatives) or managed care approaches. The market, however, is not advanced in these approaches and, as
                                                                                            such, we do not foresee this having significant impact on cost in short term.
Lithuania                 22.3%           -0.7%             17.3%          0.6%        ||
                                                                                            Stated values due mainly to increase of deductible.
Netherlands               2.5%||           0.2%            2.5%||          0.3%
Norway                     7.6%            2.2%             6.9%           2.8%
Poland                     10.1%          -0.9%             7.8%          -0.2%
Portugal                   2.9%            0.5%             4.0%            0.7%
Romania                     5.1%          -0.6%             5.7%          -0.4%
Russia                    15.8%           15.5%             17.8%          8.4%

                                                                                                                                                                                                                       5
Medical Trends Around the World 2016 - Mercer Marsh ...
Medical Trend                                0%                      5%                             10%                          15%                    20%                         25%

    Rates: Inpatient            China
                                          7.3%
                                         11.9%                                                   9.3%                    12.8%

    vs. Outpatient                        7.2%
                           Hong Kong      6.1%                                5.7%          8.7%

                                         11.2%
                            Indonesia    12.8%                                                            11.0% 11.8%

                                         13.6%
                             Malaysia    14.5%                                                                                       15.2%          18.1%

                                          10%
                           Philippines   10.5%                                                         10.0%     11.5%

                                         11.3%
                           Singapore      7.8%                                       6.8%               10.3%

                                          7.5%
                       South Korea       13.5%                                                         10.0%                     14.5%

                                          11%
                              Taiwan      8.1%                                                  8.9%                         13.7%

                                         7.7%                                                             9.3%
                             Thailand    9.0%                                                    9.2%

                                         17.2%
                             Vietnam     12.1%                                                                                                  17.2%                 22.1%

                               2015 inpatient medical                 2015 outpatient medical                        2016 projected inpatient               2016 projected outpatient
                               trend rate                             trend rate                                     medical trend rate                     medical trend rate

                       Insurers in Asia provided medical trend rates for                                        trend. Comparing our results to last year’s,
                       inpatient and outpatient coverages separately,                                           one may say little to no change is a step in the
                       as is the norm in most countries across this                                             right direction; however, the trend may reveal
                       region. The data are relatively similar to last year’s                                   the extent to which employers are leading and
                       findings, with the greatest changes reflected in                                         influencing employees regarding taking control
                       South Korea, Thailand and Vietnam (which have                                            of their health.
                       experienced increased rates due to the high
                       prevalence of respiratory conditions in conjunction                                      On a positive note, 13 countries (mostly in Europe,
                       with infectious diseases and new regulation for                                          as evidenced by the regional average) suggest
                       accessing healthcare. For example, in Vietnam, the                                       that medical trend rates will decrease next year.
                       Ministry of Health has recently issued a change to                                       Such a decrease may indicate that this year’s
                       public hospital services that will increase charges                                      moderate change is a sign that health- and well-
                       and potentially drive up costs by 30%.3)                                                 being-related actions being taken by employers
                                                                                                                and employees could have an impact, though the
                       The current year’s data confirm that medical rates                                       realization of these benefits will take time.
                       continue to outpace inflation, which is a long-term

                       3
                            ospital fees to increase by 30%, Viet Nam News, 15 February 2016, available at
                           H
6                          http://vietnamnews.vn/society/282320/hospital-fees-to-increase-by-30-next-month.html.
For information on   This trend is not unlike our findings in the US.
US health trends,    The 2015 Mercer US National Survey of Employer-
refer to Mercer’s    sponsored Health Plans was completed in mid-2015
National Survey      with the participation of 2,486 employers. When
of Employer-         reviewing the results for the average per-
sponsored Health     employee cost of health benefits, the actual cost
Plans 2015 report.   growth for 2015 and the projected cost growth
                     for 2016 remain moderate overall. Overall results
                     reflect a 3.8% increase in 2015, nearly unchanged
                     from 2014’s increase of 3.9%. Whereas large
                     employers held the increase to 2.9%, small
                     employers saw cost rise 5.9%.

                     After years of increases of around 6%, cost
                     growth dipped to nearly 2% in 2013 and now
                     seems to be settling at a new plateau of around
                     4%. Although health benefit cost increases
                     are still outpacing CPI and growth in workers’
                     earnings, the gap is smaller than in past years.
                     Employers are predicting that costs will rise by
                     4.3% in 2016. That number reflects the changes
                     they intend to make this year to medical plan
                     offerings and plan design or contribution
                     strategy. We asked them how much costs would
                     rise in their largest medical plan if they made no
                     changes, and the average estimated increase
                     before changes was 6.3%. This is the lowest
                     underlying trend we’ve seen in a long time,
                     which has typically been closer to 8% or 9%. Of
                     course, general inflation is also very low — in fact,
                     it dipped below zero in 2015. In that context, a
                     6% underlying trend in health benefit cost still
                     represents a significant real increase in costs.

                                                                             7
Based on (dollar)                                                          0%   10%     20%    30%   40%        50%         60%   70%        80%        90%

                    amount claimed,                                                      56%
                                                                                         52%
                    what were the top                                       Cancer       53%
                    three causes of                                                      64%
                                                                                         82%
                    claims cost in
                                                                                         53%
                    2015 based on your                                                   59%
                                                  Diseases of the circulatory system     41%
                    book of group or                                                     73%
                                                                                         68%
                    overall business?
                                                                                         29%
                                                                                         46%
                                                           Gastrointestinal diseases     25%
                                                                                          9%
                                                                                          9%

                                                                                         27%
                                                                                         46%
                                                             Respiratory conditions      15%
                                                                                         18%
                                                                                         27%

                                                                                         23%
                                                                                          4%
                                                            Osteomuscular diseases       43%

2
                                                                                          0%
                                                                                          9%

                                                                                         18%
                                                                                         14%
                                                          Obstetrics and pregnancy       16%
                                                                                         27%
                                                                                         27%

                                                                                         15%
                                                                                         18%
                                                  Endocrine and metabolic diseases        8%
                                                                                         27%
                                                                                         23%

                                                                                         15%

Rise in Non-                             Accidents, conditions derived from violence
                                                                                         18%
                                                                                         16%
                                                                                         18%

communicable Disease                                                                      5%

Claims: the Impact
                                                                                         15%
                                                                                         23%
                                                                Infectious diseases       9%

of Lifestyle Choices                                                                     36%
                                                                                          5%

                                                                                         10%

Claims for Lifestyle-related Illnesses        Other (not classified in above groups)
                                                                                          4%
                                                                                         18%

Continue to Increase                                                                      0%
                                                                                          5%

                                               Global                             Asia                    Europe               M iddle East/               Latin America
                                                                                                                                Africa (MEA)                (LATAM)
Although retrospective claims costs represent         Gastrointestinal health concerns also have                           of outpatient procedures, behind circulatory
just one data point in understanding a                emerged into the top three claims categories                         and gastrointestinal conditions. Cardiovascular
population’s health profile and are heavily           globally. The prevalence of infectious diseases                      conditions, cancer and respiratory diseases in Asia
influenced by the scope of coverage, cost of          in emerging markets, the rise in liver diseases                      can be associated with exposure to polluted air,
treatment and other factors, they do provide an       and diagnosis of inflammatory bowel disease are                      solid fuels used at home and infectious respiratory
indication of key health risks and opportunities      just a few issues that could be attributed to the                    diseases including tuberculosis. Tobacco use is
to promote preventive care. Employers seeking         increase in gastrointestinal infections and claims.                  also high, with the 2015 World Health Organization
to rely on such data to inform wellness initiatives                                                                        reporting that, in some countries, more than 50%
should also consider other data sources, such         In Asia, inpatient claims for gastrointestinal                       of adult males are smokers.
as annual medical examination anonymized              conditions are trending higher than are
aggregated results, health risk assessments and       circulatory claims. Cancer is now fourth in terms
employee surveys.

The data show that “we” remain in control of          Asia Cost of Claims: Inpatient vs. Outpatient
the solution. Diseases of the circulatory system                                                          0%         10%   20%      30%        40%     50%       60%       70%
have risen to be the leading cause of claims cost                                                   46%
                                                                                         Cancer
                                                                                                    16%
in Asia and the Middle East/Africa, surpassing                                                      46%
                                                                        Gastrointestinal diseases
even cancer. Gastrointestinal disease is now                                                        34%
                                                                                                    41%
ranked third highest in claims cost globally.                  Diseases of the circulatory system
                                                                                                    41%

Cardiovascular health concerns can often be                               Respiratory conditions    32%
                                                                                                    55%
attributed to health choices made by each                                     Infectious diseases   23%
                                                                                                    21%
person, and as such, there are actions that the       Accidents, conditions derived from violence   16%
                                                                                                    11%
collective “we” — employees and employers — can                                                     13%
                                                                     Disease of the sense organs
take to help control these issues, with the proper                                                   2%

                                                               Endocrine and metabolic diseases     11%
access to information to live healthier lives.                                                      18%
                                                                       Obstetrics and pregnancy     11%
                                                                                                     4%
Only in Latin America did the top three causes                          Genitourinary conditions    7%
                                                                                                    9%
of claims costs remain unchanged, with cancer,                                    Blood diseases    5%
                                                                                                    2%
diseases of the circulatory system and obstetrics
                                                                         Osteomuscular diseases      5%
ranking highest respectively. This rise in the                                                      11%
                                                                                                    2%
amount of medical spend on cardiovascular                                      Mental conditions
                                                                                                    0%

disease is particularly concerning in emerging                                     Skin diseases     2%
                                                                                                    13%
markets, suggesting earlier onset of lifestyle-                             Congenital anomalies    2%
                                                                                                    0%
related diseases.                                                                                    2%
                                                           Other (not classified in above groups)
                                                                                                    11%
                                                                                                    0%
                                                                         Neurological conditions
                                                                                                    2%

                                                                                                               Inpatient          Outpatient
                                                                                                                                                                            9
Based on                                                                      0%   10%            20%   30%         40%        50%     60%           70%

     (frequency)                                                             43%
                                                                             66%
     incidence of claims,                        Respiratory conditions      23%
     what were the top                                                       45%
                                                                             64%
     three causes of
                                                                             40%
     claims in 2015                                                          43%
                                    Diseases of the circulatory system       35%
     based on your                                                           64%
                                                                             36%
     book of group or
     overall business?                                                       38%
                                                                             43%
                                              Gastrointestinal diseases      40%
                                                                             36%
                                                                             23%

                                                                             31%
                                                                             14%
                                               Osteomuscular diseases        46%
                                                                              9%
                                                                             27%

                                                                             26%
                                                                             38%
                                                    Infectious diseases      15%
                                                                             27%
                                                                             32%

                                                                             21%
                                                                             21%
                                                                Cancer       21%
                                                                             18%
                                                                             23%

                                                                             15%
                                                                             16%
                                             Obstetrics and pregnancy        10%
                                                                             27%
                                                                             27%

                                                                             15%
                                                                             11%
                                  Other (not classified in other groups)     20%
                                                                              0%
                                                                             14%

                                                                             14%
                                                                             16%
                                     Endocrine and metabolic diseases         8%
                                                                             36%
                                                                             23%

                                                                             12%
                                                                              5%
                            Accidents, conditions derived from violence      19%
                                                                              9%
                                                                              9%

10                                Global                              Asia                    Europe               M iddle East/         Latin America
                                                                                                                    Africa (MEA)          (LATAM)
Lower Frequency of Cancer Claims
                                                                                       Asia Frequency of Claims: Inpatient vs. Outpatient
The survey revealed little change in the top three                                                                                            0%            10%            20%               30%        40%   50%   60%   70%
most frequent causes of claims, except that the                                                                                       41%
                                                                                                          Gastrointestinal diseases
                                                                                                                                      30%
amount of claims related to cancer has lowered
                                                                                                                                       39%
                                                                                                            Respiratory conditions
in comparison to our results from last year. This                                                                                      64%

could be due to changes in how carriers manage                                                                  Infectious diseases
                                                                                                                                       34%
                                                                                                                                       25%
claims in terms of treatment arrangements                                                                                  Cancer
                                                                                                                                       29%
                                                                                                                                       11%
with health vendors. The survey also confirmed
                                                                                                                                       25%
                                                                                                 Diseases of the circulatory system
the continued high frequency of respiratory                                                                                            34%
                                                                                                                                       16%
conditions in growth markets.                                                                            Obstetrics and pregnancy       5%

                                                                                                 Endocrine and metabolic diseases      14%
                                                                                                                                       13%
Given the continued rise of cardiovascular                                                                                             11%
                                                                                                          Genitourinary conditions
illness, employers should expect to see a                                                                                              11%
                                                                                                                                        9%
correlation between absenteeism rates and                                                              Disease of the sense organs
                                                                                                                                        5%

lowered productivity. As well as the direct cost                                             Other (not classified in above groups)
                                                                                                                                        9%
                                                                                                                                        9%
of unplanned absence, such illness results in an                                        Accidents, conditions derived from violence
                                                                                                                                        7%
                                                                                                                                       11%
associated reduction in productivity of 36.6% in                                                                                        5%
                                                                                                                     Skin diseases
the US and 31.6% in Europe.4                                                                                                           13%

                                                                                                                    Blood diseases      4%
                                                                                                                                        2%

As observed previously, the survey also showed a                                                           Osteomuscular diseases       4%
                                                                                                                                       14%
rise in gastrointestinal conditions in Asia.                                                                                            2%
                                                                                                                 Mental conditions
                                                                                                                                        2%

                                                                                                           Neurological conditions      0%
                                                                                                                                        2%

                                                                                                                                                     Inpatient                             Outpatient

4
    S ociety for Human Resource Management (in conjunction with Kronos). Total Financial Impact of Absences across the United States, China, Australia, Europe, India and Mexico, 2014.
                                                                                                                                                                                                                           11
0%                      20%                         40%                   60%                         80%                     100%
     To what extent                                                                                      30%                                             44%                                   17%             7% 2%
                                 Increased non-communicable disease (e.g., heart                                                                                                                                             Global
     do you think the                d isease, cancers, stroke, chronic respiratory
                                                                                                       25%
                                                                                                          32%
                                                                                                                                                  39%
                                                                                                                                                                 54%
                                                                                                                                                                                        24%
                                                                                                                                                                                                           9%
                                                                                                                                                                                                             10%
                                                                                                                                                                                                                 3% 2%
                                                                                                                                                                                                                    2%
                                                                                                                                                                                                                             Asia
                                                                                                                                                                                                                             Europe
                           d iseases, diabetes, Alzheimer’s disease, mental illness
     following will                                            and kidney diseases)                           36%
                                                                                                                    45%
                                                                                                                                                               41%
                                                                                                                                                                              46%
                                                                                                                                                                                                 14%
                                                                                                                                                                                                                9%
                                                                                                                                                                                                                9%
                                                                                                                                                                                                                             MEA
                                                                                                                                                                                                                             LATAM
     increase employer-     Increased communicable disease (e.g., malaria, lower       6%              17%                      21%                              33%                                 23%                    Global
                                                                                         7%                              38%                                    27%                                 28%                      Asia
     sponsored             respiratory, HIV/AIDS, tuberculosis, measles, h  epatitis
                                                                                      1% 5%            13%                              39%                                                42%                               Europe
                            B, other outbreaks of infection such as E bola, dengue                     27%                      9%                     28%                         18%                    18%               MEA
     healthcare costs                                 fever, Zika and chikungunya)        9%              14%                               36%                                     27%                      14%             LATAM

     in your country                                                                     4%            16%                           29%                                     36%                            15%              Global
                                                                                         4%                   28%                                   32%                                        36%                           Asia
     over the next                                  Increased accidents/violence          5%      6%                 25%                                  35%                                     29%                        Europe
                                                                                                                    46%                                          27%                               27%                       MEA
     three years?                                                                            9%                                41%                                                41%                            9%          LATAM

                                                                                          9%                          33%                                              40%                             14%    4%             Global
                                   Increased workplace and/or personal-related           5%                          38%                                                 43%                             12%    2%           Asia
                                                                                           11%                          31%                                           38%                            14%     6%              Europe
                                                                   stress/pressure       9%                        27%                                                 55%                                 9%               MEA
                                                                                          9%                            36%                                           32%                            18%      5%             LATAM

                                                                                              14%                                37%                                        30%                        16%          3%       Global
                                                                                             11%                                  46%                                                34%                         7% 2%       Asia
                                                                               Aging          14%                               35%                                    27%                          19%            5%        Europe
                                                                                             9%          9%                         36%                                             37%                           9%         MEA
                                                                                                        27%                                 27%                               28%                          18%               LATAM

                                                                                           9%                         33%                                            37%                              18%       3%           Global
                                                                                          7%                            41%                                                    41%                          11%              Asia
                                                       Rising employee expectations         11%                     23%                                   39%                                  20%            7%             Europe
                                                                                           9%                                               64%                                           9%             18%                 MEA
                                                                                         5%                         36%                                          36%                                   23%                   LATAM

                                                                                                18%                                 36%                                         32%                         12%     2% Global
                                            Availability and access to new medical           11%                                41%                                           34%                          11%     3%   Asia
                                                                                               15%                                38%                                         32%                           14%      1% Europe
                                                           technologies, providers             18%                                 37%                                       27%                          18%               MEA
                                                                                                                         50%                                          23%                        23%               4%        LATAM

                                                                                                 18%                       22%                                   39%                                 17%            4%       Global
                                                                                                   21%                                 32%                                        34%                       9%      4%       Asia
                                Changes to health provider fee guides/schedules                14%              11%                                43%                                        26%                  6%        Europe
                                                                                                 18%                            27%                                     37%                                18%               MEA
                                                                                                    23%                                    32%                                      36%                          9%          LATAM

                                                                                               15%                          28%                                26%                         21%             10%               Global
                          Changes to public/government social security s chemes             11%                         29%                                    36%                                 21%       3%             Asia
                                                                                                 19%                         23%                         20%                        22%                  16%                 Europe
                                                  and/or health reform/legislation                            36%                                       28%                         18%                 18%                  MEA
                                                                                                  18%                                      41%                                    23%                   18%                  LATAM

                                                                                       4%          13%                                36%                                      31%                          16%              Global
                                                                                       4%                      29%                                         46%                                        18%          3%        Asia
                                           Environment factors (e.g., air pollution) 1% 4%                       30%                                      38%                                        27%                     Europe
                                                                                                  18%               9%                            36%                                          37%                           MEA
                                                                                             9%              14%                           32%                                      36%                          9%          LATAM

                                      Expansion of coverage (e.g., higher benefit              12%                             37%                                    27%                           19%            5%        Global
                                                                                                14%                                     48%                                             29%                      7% 2%       Asia
                                     levels, reduction of exclusions, expansion of           8%                22%                                 32%                                  29%                       9%         Europe
                                                                 covered services)           9%                                                      82%                                                         9%         MEA
                                                                                                      23%                                   36%                               18%                    18%            5%       LATAM

                                                                                          7%                 18%                                 38%                                    25%               12%                Global
                            All forms of medical plan fraud and abuse (Initiated by       9%                      23%                                         48%                                    16%     4%             Asia
                                                                                         4% 8%                             34%                                       31%                              23%                    Europe
                                           users, doctors and/or health vendors)              18%                                           46%                                     18%                 18%                  MEA
                                                                                           9%                       27%                                        41%                                    23%                    LATAM

                                   Very large extent                    Large extent                               Some extent                                 Modest extent                                No extent at all
12
Lifestyle-related Conditions and Other Non-communicable Disease Conditions
to Continue to Drive Cost

Not surprisingly, increased incidence of non-           organizations seek to redesign the benefits
communicable diseases (for example, heart               strategy to make it more cost-effective,
disease, cancers, stroke, chronic respiratory           analyzing the level of employee contributions
diseases, diabetes, Alzheimer’s disease, mental         according to local resources and market needs.
illness and kidney diseases) is still projected to be   Many interventions are not possible without
the leading cause of higher healthcare costs over       the combined efforts of employers, employees,
the next three years.                                   carriers, governments and health providers.

Increasing employer health plan costs can be            A few notable changes from last year’s
attributed to three main causes:                        findings include:

1. Changes in many social security systems over         • In Asia, we observed an increase related to the
   the past few years imply a greater transfer of         expected rise in incidence of communicable
   the burden of cost to employers.                       diseases such as malaria, lower respiratory
                                                          disorders, HIV/AIDS, tuberculosis, measles, and
2. The increase in non-communicable diseases              hepatitis B.
   in an aging workforce drives the utilization of
   new, more expensive technologies.                    • Latin American insurers consistently indicated
                                                          increased availability of and access to new
3. The pressure of attracting and retaining               medical technologies and providers.
   diverse and competitive talent compels
   companies to offer enticing health benefits          • Increased workplace and/or personal-related
   packages.                                              stress/pressure is now more evident across all
                                                          markets as a potential concern.
This requires consideration of accountable
models under which employees take more                  • On average, globally, insurers noted a growing
responsibility for their health. Sharing the risk         trend toward the expansion of coverage (for
with employees and empowering them to make                example, higher benefit levels, reduction of
consumption and prevention decisions are                  exclusions, expansion of covered services).
important elements employers consider when
defining a health and wellness strategy. Many

                                                                                                            13
Select the top                                                                 0%   20%       40%          60%       80%                   100%

                   three risk factors                                                   82%
                                                                                        80%
                   you believe               Metabolic risk: high blood pressure,
                                                                                        78%
                                            high cholesterol, high blood glucose
                   influence employer-                                                 100%
                                                                                        91%
                   sponsored group
                   medical costs                Dietary risk: high carbohydrates
                                                                                            71%
                                                                                            64%
                   the most.             consumption, low fiber and vegetables,             71%
                                          overweight/obesity, physical inactivity           64%
                                                                                            86%

                                                                                            39%
                                                 Emotional/mental risks: stress,            29%
                                                                                            51%
                                                              sleeping disorders            27%
                                                                                            23%

                                                                                            39%
                                           Occupational risk: work-related risks,           43%
                                                                                            39%
                                          ergonomics, occupational carcinogens              36%
                                                                                            27%

                                                                                            29%

3
                                                       Tobacco smoke: smoking,              21%
                                                                                            28%
                                                              secondhand smoke              45%
                                                                                            41%

                                                                                            18%
                                                       Environmental risk: urban            39%
                                            indoor/outdoor air pollution, ozone,             9%
                                                water sanitation, climate change             9%
                                                                                             5%

                                                                                            11%
                                         Childhood and maternal under-nutrition              9%
                                                                                            11%
                                          including maternity-care-related risks

The Burden of Risk:
                                                                                            18%
                                                                                            14%

an Insurer’s Look at                                                                        7%
                                                                                            6%

Rising Costs                                             Alcohol and drug abuse             9%
                                                                                            0%
                                                                                            9%

Metabolic Risk, Poor Diet Trends            Traffic, violence and safety: includes
                                                                                            4%
                                                                                            9%
Continue and Are Expected                     sexual abuse and intimate partner             1%

to Increase                                                  violence, unsafe sex           0%
                                                                                            5%

                                              Global                                 Asia               Europe         M iddle East/         Latin America
                                                                                                                        Africa (MEA)          (LATAM)
Global                                          Asia                                            Europe                                          MEA                                            LATAM
    1      Metabolic risk                                  Metabolic risk                                  Metabolic risk                                  Metabolic risk                                 Metabolic risk
    2      Dietary risk                                    Dietary risk                                    Dietary risk                                    Dietary risk                                   Dietary risk
    3      Emotional/mental risks:                         Environmental risk: urban     Emotional/mental risks                                            Tobacco smoke                                  Tobacco smoke
           stress, sleeping disorders                      indoor/outdoor air pollution,
                                                           ozone, water sanitation,
                                                           climate change
    4      Occupational risk: work-                        Occupational risk                               Occupational risk                               Occupational risk                              Occupational risk
           related risks, ergonomics,
           occupational carcinogens
    5      Tobacco smoke: smoking,                         Emotional/mental risks                          Tobacco smoke                                   Emotional/mental risks                         Emotional/mental risks
           second-
           hand smoke

This year’s survey also asked insurers to provide                                     Offering a comprehensive medical plan to                                            Emotional and mental health risks (such as stress
their perspective on the rising costs of healthcare.                                  employees is no guarantee of optimal health                                         or sleeping disorders) and occupational risks also
                                                                                      outcomes in the working population. Prevention                                      ranked in the top five cost-influencers in each
Consistently across the world, metabolic risks                                        and health risk management now play an                                              region. Our fourth trend, “The Rise of Stress Is
such as high blood pressure, high cholesterol,                                        important role in the administration of the health                                  Evident,” will explore this area in more detail.
obesity/overweight and high blood glucose                                             and benefits strategies. Wellness and prevention
were among the top three influencers of group                                         programs that promote behavioral change and                                         As we consider the top risk factors influencing
medical costs, followed by dietary risk (defined                                      develop a culture of health will be the focus of                                    group medical costs, we also asked insurers to
as high carbohydrate consumption, low fiber and                                       high-performing organizations in the next few                                       name the top components of cost under their
vegetable consumption, and physical inactivity).                                      years in order to have in place the productivity                                    book of group or overall business.
These data are supported by the belief that non-                                      and health resources necessary to support
communicable diseases will increase healthcare                                        business needs.5
costs to employers to a very large extent over
the next three years, along with the rising cost of
claims relating to circulatory system issues and
diabetes and its complications.

5
     rossmeier J, Fabius R, Flynn J, Noeldner S, Fabius D, Goetzel R, Anderson D. “Linking Workplace Health Promotion Best Practices and Organizational Financial Performance: Tracking Market Performance of Companies With Highest Scores on
    G
    the HERO Scorecard,” Journal of Occupational and Environmental Medicine, Volume 58, Issue 1 (2016), pp. 16–23.                                                                                                                                15
In 2015, what were
     the top three
     components of                                                               1%
     cost under your                                                                             10%
     book of group or
     overall business?

                                        33%                                                                          11%

                                                                                                                             13%

                                                             18%                                    14%

                          Hospital,           Outpatient           Outpatient   Inpatient fees   Inpatient     Lab tests /         Outpatient fees
                          surgery room,       fees                 medicines                     medicines,    diagnostics         (specialists)
                          inpatient room,     (physicians)                                       materials,
                          inpatient                                                              prostheses,
                          equipment                                                              supplies
                          rental expenses

16
Globally, the survey results pointed to hospital
and inpatient fees as the top components of
cost; however, in emerging markets, the higher-
ranked components included outpatient services
and medicines.

A closer look at the sources of cost reveals that
57% correspond to inpatient services and 43% to
outpatient services. Cost-management efforts
might focus on fees paid to clinical staff (32%)
or hospital rent fees (33%), and opportunities
remain to negotiate prices for medicines,
equipment and new technologies. Consumer-
driven programs aim to empower users to make
more informed choices, such as using closed
networks or leveraging referral programs based
on quality and cost-effectiveness. For example,
centers of excellence for specialized services,
including back surgery, cardiovascular conditions,
maternity (promoting natural birth) and cancer,
could be helpful in redirecting patients to
institutions where services are provided on the
basis of superior health outcomes, evidence-
based practices and cost-effectiveness.

                                                     17
0%                     20%                          40%                     60%                          80%                     100%
     To what extent does                                                                                          46%                                 7%          15%                               32%                       Global

     your organization                                               Coinsurance                             39%
                                                                                                                         59%
                                                                                                                                          4%      10%
                                                                                                                                                                     9%                   20%
                                                                                                                                                                                         47%
                                                                                                                                                                                                                 12%          Asia
                                                                                                                                                                                                                              Europe
                                                                                                      27%                           18%                                 36%                                 19%               MEA
     perform the                                                                                                  45%                             5%          14%                               36%                           LATAM
                                                                                                                       60%                                              12%                 15%             13%               Global
     following to help                                                                                               54%                                            16%                    18%              12%               Asia
                                                             Deductibles/excesses                                      60%                                               13%               12%             15%                Europe
     manage plan                                                                                                  46%                                                 36%                                 18%                 MEA
                                                                                                                                      77%                                                      5%      9%     9%              LATAM
     member health and/                                                                                                             72%                                                  7%         10%       11%             Global
                                                                                                                             61%                                        7%          9%                  23%                   Asia
     or contain medical                  Negotiated rates with health providers
                                                                                                                              64%
                                                                                                                                      78%
                                                                                                                                                                                    18%
                                                                                                                                                                                                6%      10%
                                                                                                                                                                                                          18%
                                                                                                                                                                                                                6%            Europe
                                                                                                                                                                                                                              MEA
     costs for employer-                                                                                                                  82%                                                        5%    9%    4%           LATAM
                                                                                                                             61%                                              14%               14%          11%              Global
     sponsored medical                Negotiated packaged/bundled pricing for                                     46%
                                                                                                                                69%
                                                                                                                                                       9%                     25%
                                                                                                                                                                                      14%              9%
                                                                                                                                                                                                         20%
                                                                                                                                                                                                               8%
                                                                                                                                                                                                                              Asia
                                                                                                                                                                                                                              Europe
                                                              specific procedures
     insurance?                                                                                                         55%
                                                                                                                                      77%
                                                                                                                                                                        18%                           27%
                                                                                                                                                                                                        23%
                                                                                                                                                                                                                              MEA
                                                                                                                                                                                                                              LATAM
                                                                                                                            67%                                                     12%             11%          10%          Global
                                     Pre-authorization including assessment of                                           59%                                            9%           11%                   21%                Asia
                                                                                                                          61%                                                 15%                    16%           8%         Europe
                                     reasonableness of procedure/supply cost                                                                   91%                                                               9%          MEA
                                                                                                                                                91%                                                               9%          LATAM

                             Pre-authorization including assessment of medical                                       53%                                         12%                 21%                     14%              Global
                                                                                                                 43%                                  14%                18%                           25%                    Asia
                           appropriateness of treatment undertaken and a
                                                                         ctive                                    47%                                  10%                     29%                           14%             Europe
                                                                                                                                        82%                                                                 18%               MEA
                                     involvement in determination of treatment                                                        77%                                                       9%            14%             LATAM
                                                                                                             40%                                 14%                     23%                            23%                   Global
                              Access to a nurse or other clinician via telephone,                     29%                       11%                         30%                                      30%                      Asia
                                                                                                                   49%                                        15%                   19%                   17%                 Europe
                                                                     chat or email                   27%                      9%               18%                                     46%                                   MEA
                                                                                                                  45%                                       18%                       23%                    14%              LATAM
                                                                                                                               66%                                              11%                  15%        8%            Global
                                                                                                                    52%                                           14%                    20%                 14%              Asia
                                                   Preferred provider networks                                                      73%                                                   7%           15%       5%           Europe
                                                                                                                  46%                                             27%                           18%             9%            MEA
                                                                                                                                          82%                                                          9%     5% 4%           LATAM
                                                                                                                   48%                                     9%                  25%                          18%               Global
                                                                                                      29%                       11%                         30%                                      30%                      Asia
                                                       Second-opinion services                                           56%                                        9%                   23%                     12%          Europe
                                                                                                                  46%                                  9%             18%                             27%                     MEA
                                                                                                                                68%                                             5%                    27%                     LATAM
                                                                                                       30%                           14%                      26%                                  30%                        Global
                                                                                                       30%                         7%                   31%                                       32%                         Asia
                                                             Centers of excellence                    29%                             18%                         26%                               27%                       Europe
                                                                                                18%                     18%                           27%                                       37%                           MEA
                                                                                                            36%                                 18%                     18%                         28%                       LATAM
                                                                                           11%     7%                    21%                                                   61%                                            Global
                                                                                            13%   2%                     28%                                                     57%                                          Asia
                                                    Support for medical tourism            9%     10%                   16%                                                  65%                                              Europe
                                                                                              18%                       18%                                                   64%                                             MEA
                                                                                           9%       14%                         23%                                               54%                                         LATAM
                                                                                                             39%                                      20%                           27%                      14%              Global
                              Education in order to make plan members smarter                                       52%                                           16%                     18%                14%              Asia
                                                                                                      28%                             21%                                34%                                17%               Europe
                                                       consumers of healthcare                                46%                                                27%                                 27%                     MEA
                                                                                                             41%                                        23%                               27%                     9%          LATAM
                                                                                                    28%                             15%                    20%                                37%                             Global
                                   Provision of medical clinics near or onsite to                  25%                    9%                    21%                                       45%                                 Asia
                                                                                                    28%                             17%                 15%                                 40%                               Europe
                                                      sponsoring employer sites                18%                                       46%                                             27%                  9%             MEA
                                                                                                                  45%                                  9%                      32%                           14%              LATAM
                                                                                                  23%                   8%                   27%                                           42%                                Global
                            Influencing government around legislative c
                                                                       hanges/             14%             7%                            38%                                               41%                               Asia
                                                                                                      28%                   9%                 21%                                         42%                                Europe
                                                                    health reform          9%          9%                  27%                                                      55%                                       MEA
                                                                                                      27%                 5%                23%                                           45%                                 LATAM

                                 This is an active part of                     We are experimenting and/or                            We are currently                                           We have no plans to invest in
18                               our current plan                              have developed plans to initiate                       considering this                                           this area
                                 management approach                           this within the next 24 months
Insurers Are Expanding Their Role to Support Cost-containment

In many of the following categories, we see an     To help understand best practices in this
increase in insurer action beyond the common       area, employers can use the HERO Health
deductible and co-insurance approaches. For        and Well-Being Best Practices Scorecard,
example, the survey revealed a much greater        an online survey tool designed by the Health
percentage of insurers offering negotiated         Enhancement Research Organization (HERO©) in
packaged/bundled pricing for specific              collaboration with Mercer. Data collected from
procedures and an increase in preauthorization     organizations that complete the International
practice and second-opinion services. More         Scorecard (released in early 2016) will help
insurers are also taking a more active approach    build country-specific normative databases to
to influencing government around legislative       further the industry’s understanding of best-
changes/health reform.                             practice approaches to workplace health and
                                                   well-being around the world. This in turn will aid
Although insurers are taking these actions to      organizations in strategic planning, program
control costs, employers should recognize that     evaluation/design and gap analysis.
these strategies are not addressing employee
lifestyle choices. Employers can address the gap
by creating a work environment that supports
health and by educating individuals on the
importance of making healthy choices.

                                                                                                        19
0%                       20%                      40%                        60%                 80%                         100%
                  To what extent
                                                                                                                                   44%                                             31%                     11%      8%         6%          Global
                  do plan members                                                                                20%                                       45%                                  18%                14%            3%       Asia
                                            Basic infrastructure for human health — safe water
                  covered under                                      supply, sanitation, clean air
                                                                                                                                            63%                                                18%           6%     6%        7%           Europe

                                                                                                           9%                                        55%                                             27%                      9%           MEA
                  your medical
                                                                                                                                           59%                                                   32%                          9%           LATAM
                  insurance plans
                                                                                                                      24%                                          46%                                17%               8%        5%
                  have high-quality                                                                                                                                                                                                        Global

                                                                                                                14%                                          57%                                       16%               9%       4%       Asia
                  and comprehensive                                         Healthy food options                            34%                                           39%                         11%          7%         9%           Europe

                  access to the                                                                                                                64%                                                   27%                      9%           MEA

                                                                                                                      23%                                  36%                                       36%                          5%       LATAM
                  following, without
                  significant barriers                                                                                 27%                                       37%                             20%                11%           5%       Global

                                         A trained general clinician such as a family physician or             16%                                    45%                                      25%                     12%         2%     Asia
                  such as poor           nurse to provide continuity, treat minor c
                                                                                   onditions and                             37%                                            34%                           20%            5% 4%            Europe
                  environmental                                          oversee all medical care          9%                            36%                           9%                            46%                                   MEA

                  conditions, a large                                                                                  27%                                 27%                           18%          9%            19%                    LATAM

                  out-of-pocket                                                                                               37%                                                 42%                              19%              2%     Global

                  cost, or treatment               Medically-necessary specialist care, surgery
                                                                                                                 20%                                             54%                                         21%                  5%       Asia
                                                                                                                                     49%                                                 30%                       20%                 1% Europe
                  waiting list?                                               and hospitalization
                                                                                                           9%                                                    73%                                                18%                    MEA

                                                                                                                                         54%                                                     41%                              5%       LATAM

                                                                                                                              39%                                                  41%                            16%             3% 1% Global

4
                                                                                                                 20%                                          50%                                           25%                3% 2%       Asia
                                                  Lab tests and other diagnostics delivered out
                                                                                                                                   45%                                                   38%                        15%           1%1% Europe
                                                                                       of hospital
                                                                                                                       27%                                             46%                            9%            18%                    MEA

                                                                                                                                                 68%                                                        27%                   5%       LATAM

                                                                                                                        29%                                         40%                              15%           10%         6%          Global
                                                                                                                14%                                    48%                                     20%                 13%            5%       Asia
                                                Safe, non-fraudulent medications delivered out
                                                                                                                             35%                                             39%                       11%         6%         9%           Europe
                                                                                       of hospital
                                                                                                           9%                            37%                                 18%                     27%                      9%           MEA

                                                                                                                                     50%                                             23%                    18%               9%           LATAM

                                                                                                                  21%                      20%                               30%                            23%                6%          Global

                                                                                                           7%           14%                                  43%                                      27%                     9%           Asia

The Rising Effect of
                                                           Counseling and treatment for mental
                                                                                                                        29%                                25%                           21%                 18%              7%           Europe
                                                                                health conditions
                                                                                                           9%                18%                                 36%                                        37%                            MEA

Stress Is Evident                                                                                                      27%                           18%                       23%                           32%                           LATAM

                                                                                                                            32%                                          39%                               18%            10%          1% Global
                                                                                                            13%                                   46%                                          27%                       14%
Employers Must Recognize the
                                                                                                                                                                                                                                           Asia
                                                Maternity care including pre- and post delivery
                                                                                                                             36%                                            35%                            19%               9%        1% Europe
                                                                   d iagnostics and supplements
Need for Appropriate Mental                                                                                            27%                                             46%                            9%            18%                    MEA

Health Coverage                                                                                                                                  68%                                                         32%                           LATAM

                                                 Very large extent                    Large extent                                 Some extent                                 Modest extent                            No extent at all
As trend three and our survey results indicated,
mental health (for example, stress-related issues)
and occupational risks were consistently viewed
as top contributors to cost. Several of our survey
questions attempted to gather information that
may reveal progress in these areas.

Compared to last year’s data on this topic, our
survey revealed some improvements in terms of
increased access to the above categories for
employees. Specifically, Latin America and
Europe both confirmed more accessibility to
safe, non-fraudulent medications delivered out
of hospitals. And in response to the belief that
emotional and mental health will contribute
significantly to healthcare costs, all regional
data indicate a small but growing trend to cover
more counseling and treatment for mental health
conditions. The European Agency for Safety and
Health at Work believes strongly in awareness
and understanding of work-related stress and
has even created an e-guide for managing these
issues in the workplace.6

6
    European Agency for Safety and Health at Work. E-guide to managing stress and psychological risks, available at https://osha.europa.eu/en/tools-and-publications/e-guide-managing-stress-and-psychosocial-risks.
                                                                                                                                                                                                                        21
0%                     20%                       40%                         60%                      80%                      100%
     To what extent                                                                             11%        16%                              29%                                  24%                        20%                Global
                              Vaccines recommended by local government health
     does your standard      authorities but not covered by public health s ystem/
                                                                                              7%
                                                                                               10%
                                                                                                       16%
                                                                                                         16%                             25%
                                                                                                                                               45%
                                                                                                                                                                       21%
                                                                                                                                                                                               23%
                                                                                                                                                                                                      28%
                                                                                                                                                                                                                   9%          Asia
                                                                                                                                                                                                                               Europe
     employer-                                                       social security               18%
                                                                                                   18%
                                                                                                              9%
                                                                                                                             23%                         18%
                                                                                                                                                               55%
                                                                                                                                                                                   23%
                                                                                                                                                                                                            18%
                                                                                                                                                                                                            18%
                                                                                                                                                                                                                               MEA
                                                                                                                                                                                                                               LATAM
     sponsored medical                                                                           16%                   18%                           30%                            18%                     18%                Global
                                                                                               13%                    23%                                  36%                                 16%             12%             Asia
     plan cover the          Annual or periodic health check-ups not covered by
                                                                                                   21%                   13%                         29%                           16%                     21%                 Europe
                                              public health system/social security            9%               18%                     18%                                 37%                              18%                MEA
     following?                                                                                14%                    23%                                27%                        18%                     18%                LATAM

                                                                                           6% 4%                    29%                                    26%                                   35%                           Global
                                       Biometrics performed onsite or near to an         2%4%                     34%                                        30%                                   30%                         Asia
                                                                                           6% 1%                 28%                               21%                                     44%                                 Europe
                                                                    employer’s site                      27%                                 27%                           18%                        28%                      MEA
                                                                                                   18%           5%                    27%                                   32%                            18%                LATAM

                                                                                                12%          15%                            32%                                  20%                     21%                   Global
                                                                                              7%          18%                             30%                                     27%                     18%                  Asia
                                                           Health risk assessment               13%          15%                             32%                                 16%                    24%                    Europe
                                                                                               9%                                46%                                       18%                        27%                      MEA
                                                                                                         27%                     9%                      28%                        18%                   18%                  LATAM

                                                                                            7%   8%                  22%                          23%                                       40%                                Global
                                                                                          4% 5%                   25%                            25%                                        41%                                Asia
                                                     Personalized health coaching          5% 5%                 23%                          21%                                         46%                                  Europe
                                                                                             9%                18%                     18%                                          55%                                        MEA
                                                                                                18%                          23%                         18%                        27%                          14%           LATAM

                                                                                               12%      9%                         26%                               24%                           29%                         Global
                          Access to preventive lifestyle programs like weight loss           9%     7%                          32%                                   27%                           25%                       Asia
                                                                                               13%      7%                       25%                           19%                              36%                            Europe
                                                   or smoking cessation programs                  18%                9%                      27%                                          46%                                  MEA
                                                                                                  18%                      18%                      23%                                   36%                          5%      LATAM

                                                                                            8%     14%                             25%                           22%                                 31%                       Global
                                     Case and disease management programs like            2%   16%                                 32%                                     27%                             23%                 Asia
                                                                                            9%    9%                       19%                      22%                                        41%                             Europe
                                       d iabetes or asthma management programs                   27%                                        27%                           18%                        28%                      MEA
                                                                                                23%                                23%                               27%                   9%               18%                LATAM

                                                                                           7%     10%         24%                                           25%                                  34%                           Global
                                   Access to personal counseling (e.g., employee          5%    7%        23%                                            29%                                    36%                            Asia
                                                                                            10%     10%           26%                                         20%                                34%                           Europe
                                                                   a ssistance plan)       9%        18%                                          36%                                          37%                            MEA
                                                                                          5%     13%        18%                                            32%                                    32%                          LATAM

                                                                                               12%               20%                          23%                            22%                       23%                     Global
                           Wellness and health literature (e.g., health n
                                                                         ewsletter,           13%                           34%                                     27%                        16%         10%                Asia
                                                                                              10%     9%                     21%                           26%                                    34%                          Europe
                                                             website, health talks)               18%                      18%                              37%                                      27%                       MEA
                                                                                                  18%                          27%                            23%                        14%             18%                   LATAM

                                                                                           6%    12%                             27%                            21%                              34%                           Global
                                                                                            9%       16%                                 28%                               20%                      27%                        Asia
                                                                        Health fairs      1% 9%                       29%                           16%                                   45%                                  Europe
                                                                                            9%     9%                                        46%                                                36%                            MEA
                                                                                               18%                         18%                           27%                             23%                     14%           LATAM

                                                                                           5%       11%                     24%                        21%                                  39%                                Global
                                                                                          4%       11%                       29%                         19%                                 37%                               Asia
                                                Onsite clinic in the client’s facility    4%        13%                    21%                       20%                                   42%                                 Europe
                                                                                                   18%                     18%                     18%         9%                            37%                               MEA
                                                                                              9%                     27%                                   37%                                        27%                      LATAM

                                                                                           7%     9%                     25%                        18%                                     41%                                Global
                                                 Access to maternity counselling/        2% 9%                       27%                         19%                                      43%                                 Asia
                                                                                           6%   6%                    24%                      15%                                       49%                                   Europe
                                                           management programs              9%                       27%                                           46%                                      18%                MEA
                                                                                                 23%                               23%                           23%                     13%                18%                LATAM

                                   Very large extent                    Large extent                             Some extent                                     Modest extent                               No extent at all
22
Standard Employer-sponsored Medical
Plan Design Remains Largely Unchanged

Many of the approaches commonly offered in
plans today have been in place for some time.

Our survey data suggest that some approaches
(for example, providing wellness and health
literature) are offered slightly less than they
were in the past. That said, we recognize the
importance of providing health-awareness and
behavior-change support through in-house
specialists and specialty vendors. The lack of
large changes to employer-sponsored plan
design reported by the participating insurers may
be attributed to the growing number of experts
and third parties being used by employers to
support more proactive health management.

                                                    23
0%                     20%                     40%                      60%                       80%                  100%
     To what extent do
                                                                                                14%                   22%                                 35%                               21%             8%         Global
     you see employers                   Creating or expanding wellness programs
                                                                                                  19%                         25%                                        43%                             11%   2%      Asia
                                                                                              10%               21%                              35%                                  23%                 11%
     engaging in the                                                                                              45%                                                        46%                           9%
                                                                                                                                                                                                                       Europe
                                                                                                                                                                                                                       MEA
     following to improve                                                                          18%            9%                          36%                                      32%                   5%        LATAM

     plan member health                                                                    6%          16%                          29%                                  30%                         19%               Global
                                Creating or expanding onsite clinical services (e.g.,
     and/or contain                                        onsite medical facilities)
                                                                                           5%          18%                            32%                                   29%                       16%              Asia
                                                                                          4%        14%                           33%                                  27%                         22%                 Europe
     healthcare costs?                                                                                27%                           18%              9%                               46%                              MEA
                                                                                              9%          18%                       18%                                  41%                             14%           LATAM

                                                                                           6%                22%                               38%                                     25%                 9%          Global
                            Requiring employees to pay a portion of the premium or
                                                                                           5%                 27%                               32%                                  23%                 13%           Asia
                                                                raising their portion
                                                                                          4%           19%                                   44%                                       23%                10%          Europe
                                                                                            9%          9%                                46%                                             36%                          MEA
                                                                                              14%                       27%                                27%                            27%                  5%      LATAM

                                                                                                 16%                    23%                              33%                             17%              11%          Global
                                    Requiring employees to pay a portion of claims              16%                   20%                              34%                             17%               13%           Asia
                                         (e.g., coinsurance, deductibles) or raising            16%                   23%                               33%                            17%               11%          Europe

                                                                       their portion          9%             18%                                     46%                                  18%              9%          MEA
                                                                                                  18%                             32%                                  27%                  14%            9%          LATAM

                                                                                                16%                      26%                               28%                        15%             15%              Global
                                                                                                 16%                       30%                                     32%                       11%        11%            Asia
                                     Placing monetary or frequency caps/limits on
                                                                                               13%                    26%                            23%                       17%                  21%                Europe
                                                                   covered services
                                                                                                             36%                              18%                            28%                  9%     9%            MEA
                                                                                              9%               23%                                   36%                               23%               9%            LATAM

                                                                                           7%                 25%                                   35%                              19%              14%              Global
                                                                                          5%                  29%                                    32%                              23%              11%             Asia

                                        Reducing coverage or increasing employee           8%                  26%                                     36%                           14%             16%               Europe

                                            contributions for dependent coverage                  18%                        27%                                      37%                          18%                MEA
                                                                                          5%                 27%                                     36%                               23%               9%            LATAM

                                                                                           8%                 22%                             29%                            20%                    21%                Global
                                                                                          5%                   30%                                    34%                            13%             18%               Asia

                                    Adding additional controls on use of specialists         13%                19%                           26%                        17%                      25%                  Europe
                                                                                           9%                18%                               36%                                    28%                  9%          MEA
                                     and s elect other services, e.g., gate keepers,
                                                                                               18%                          23%                                  36%                               23%                 LATAM
                                         referral requirements, pre-authorizations
                                                                                           5%             21%                              33%                                  27%                   14%              Global
                                                                                          4%             23%                               32%                                 25%                   16%               Asia
                                                                                           6%            19%                               36%                                     29%                 10%             Europe
                                                                                                   18%                        27%                                28%                 9%             18%                MEA
                                            Implementing flexible benefit programs
                                                                                                     23%                      18%                                  41%                              18%                LATAM

                                                                                           4%  9%                   20%                        27%                                      40%                            Global
                                                                                         2% 9%                      25%                           29%                                     35%                          Asia
                                                                                            9%     9%                     21%                       27%                                    34%                         Europe
                                            Implementing flexible benefit programs
                                                                                               18%                                  36%                                               46%                              MEA
                                                                                          5%    9%              13%                                                    73%                                             LATAM

                                     Very large extent                  Large extent                             Some extent                                 Modest extent                            No extent at all
24
Cost-containment Ideas Are in Need of an
Innovative Approach

Employers seem to be operating on a “status quo”
approach, continuing to explore traditional ways
to increase employee accountability through
consumer-driven choices, requiring employees to
pay a portion of claims and/or premiums that they
may not have in the past.

But we are still not observing any increase in
coverages for mental health or other more
modern issues (such as benefits focused on
gender, ethnicity, cultural, generational or
sexual-orientation health concerns).

                                                    25
0%                    20%                     40%                       60%                       80%                        100%
     To what extent
                                                                                           17%                     22%                                36%                                 17%             8%           Global
     are you seeing                                                                        18%                     20%                                  43%                                     14%        5%          Asia
                                                               Preventive care            15%                       28%                               27%                            19%                11%            Europe
     employers seeking                                                                      18%               9%                         36%                                       28%                   9%            MEA
                                                                                              23%                    14%                              41%                                      18%         4%          LATAM
     to expand coverage
     under their insured                                                                 12%
                                                                                        11%
                                                                                                              21%
                                                                                                               27%
                                                                                                                                         26%
                                                                                                                                             27%
                                                                                                                                                                        21%
                                                                                                                                                                                    28%
                                                                                                                                                                                                  20%
                                                                                                                                                                                                           7%
                                                                                                                                                                                                                       Global
                                                                                                                                                                                                                       Asia
                               Primary care, e.g., coverage for treatment by a
     medical plan for                                             family doctor
                                                                                          14%                  20%                        26%                      14%                         26%                     Europe
                                                                                            18%               9%                         36%                                       28%                     9%          MEA
     the following?                                                                     9%              18%                  18%                           27%                                 28%                     LATAM

                                                                                      9%          9%                   28%                                 26%                              28%                        Global
                                                                                    4%   9%                           37%                                          32%                               18%               Asia
                                 Same- or opposite-gender domestic partner            9%          9%                21%                        25%                                       36%                           Europe
                                                                                                  27%                              27%                                             46%                                 MEA
                                                                                                  27%                      14%                       27%                           18%                14%              LATAM

                                                                                   2% 6%              22%                          23%                                          47%                                    Global
                                                                                   2% 4%            23%                               32%                                          39%                                 Asia
                                                                     Infertility      8%             20%                     17%                                             55%                                       Europe
                                                                                                      36%                                      27%                                   37%                               MEA
                                                                                        9%        9%           14%                  23%                                          45%                                   LATAM

                                                                                2% 1% 15%                          17%                                                 65%                                             Global

                           Family planning assistance for same-gendercouples     4% 2%     18%                            21%                                               55%                                       Asia
                                                                                1%    11%       13%                                                          75%                                                       Europe
                                                              (e.g., surrogacy)            27%                                     27%                                             46%                                 MEA
                                                                                  5%    9%                     23%                                                     63%                                             LATAM

                                                                                    4%    15%                              30%                                  33%                                18%                 Global
                                                                                    4% 5%           30%                                                      47%                                    14%                Asia
                                                                 Mental health       5%      20%                                   33%                            22%                             20%                  Europe
                                                                                            27%                                                46%                                             27%                     MEA
                                                                                    5%          27%                                18%                                 36%                           14%               LATAM

                                                                                          15%                      27%                               27%                           16%          15%                    Global
                                                                                        9%                         38%                                           34%                       12%      7%                 Asia
                                                    Prenatal and maternity care          11%              21%                            26%                           20%                   22%                       Europe
                                                                                                  27%                                    36%                                       28%             9%                  MEA
                                                                                                        37%                              18%                     18%                   18%         9%                  LATAM

                                                                                    5%   9%                   21%                        22%                                       43%                                 Global
                                                                                    4%    12%                      27%                                     32%                                  25%                    Asia
                                                                      HIV/AIDS     3% 4%     14%                  17%                                                  62%                                             Europe
                                                                                         18%                         27%                    9%                                   46%                                   MEA
                                                                                         18%                   14%                        32%                                  23%                    13%              LATAM

                                                                                    5%        15%                         26%                          23%                               31%                           Global
                                                                                    4%      12%                          32%                                 27%                            25%                        Asia
                                                        Women’s care program        4%         19%                       20%                    20%                                   37%                              Europe
                                                                                           18%                     18%                            37%                                      27%                         MEA
                                                                                         14%       9%                              36%                                   23%                   18%                     LATAM

                                                                                12%1%       17%                                                                70%                                                     Global
                                                                                 18%           14%                                                              68%                                                    Asia
                                             Gender reassignment procedure 1% 8%        16%                                                                  75%                                                       Europe
                                                                              9%      9%         18%                                                              64%                                                  MEA
                                                                                  18%              23%                                                              59%                                                LATAM

                                Very large extent                  Large extent                           Some extent                                 Modest extent                                   No extent at all
26
We acknowledge the importance of diversity in
benefit design; employers are under increased
scrutiny to define and uphold standards that
sustain a healthy and tolerant environment, and
diversity promotes increased performance and
productivity. In our experience, organizations are
interested in implementing adequate benefits,
but employers should consider expanding
benefits offerings to address the concerns of the
increasingly diverse workforce in order to attract
and retain key talent. This likely means straying
from common market practice.

Occupational risks can be largely contained and
influenced by corporate leaders. We see the
most potential here to influence downstream
medical conditions that stem from occupational
risks, namely stress-management and wellness
programs designed with a preventative
strategy. The role of the work environment in
employee health and wellbeing should not be
underestimated. The burden of cost will continue
to affect employers through lost productivity
and the lower performance levels of an
unhealthy workforce.

                                                     27
To what extent do                                      0%                  10%            20%            30%             40%                      50%

                   government(s) or                                  8%
                                                                    25%
                   professional bodies                    Global    37%
                                                                    23%
                   control the cost                                  7%

                   and quality of                                    4%
                                                                    25%
                                                             Asia   41%
                   medical care                                     27%
                                                                     4%
                   (e.g. treatment
                                                                     9%
                   protocols)?                                      28%
                                                          Europe    38%
                                                                    19%
                                                                     8%
                                                                     0%
                                                                    18%
                                         Middle East/Africa (MEA)   18%
                                                                    27%
                                                                    36%

                                                                    14%
                                                                    14%
                                           Latin America (LATAM)    41%
                                                                    32%
                                                                     0%

5
                                               Very large extent               Large extent         Some extent            Modest extent          No extent at all

                                         Insurers reported an increase in organizations                      In Latin America, government control has been
                                         considering or attempting to influence healthcare                   used to increase coverage or transfer more of
                                         legislative change and reform. As we noted earlier,                 the healthcare burden to employer-sponsored
                                         insurers continue to voice concerns about how                       plans, causing uncertainty in expectations about
                                         changes to public/government social security                        future costs. Social security systems in this
                                         schemes and/or health reform could affect the                       region are also transferring costs by reducing the
                                         overall cost of healthcare.                                         integration of services between private plans and
The Role of Government                                                                                       social security, or by preventing access to social

and/or Industry                          Compared to last year’s data, the responses to
                                         this year’s survey suggest more consistently
                                                                                                             security until private-plan coverage options are
                                                                                                             exhausted. Employers are looking for alternative
Associations in                          that governments or professional bodies will                        paths that provide more predictable benefits

Influencing Health                       evidently have “some control” over the cost and
                                         quality of medical care. This is particularly true
                                                                                                             costs, including through the addition of choice.

                                         in Latin America and Europe, whereas in the
Insurers and Employers Can Play a
                                         Middle East, government is not seen as much
Role in Health Reform                    of a player in healthcare.
In the US, for example, controlling health benefit
cost growth has taken on new urgency in recent                                        Do you track and report paid claims by ICD10 or another diagnostic category? If your response is “no,”
years as employers have ramped up cost-saving                                         which classification system do you use?
measures in anticipation of the excise or
                                                                                                                                           0%    5%      10%                    15%                       20%
“Cadillac” tax, one of the Affordable Care Act’s
                                                                                                                                     7%
(ACA’s) final provisions.7 Originally slated to                                                                                     11%
                                                                                                                            ICD9     8%
go into effect in 2018, in December 2015 the                                                                                         0%
                                                                                                                                     0%
government announced that implementation                                                                                                                                         Global Use of ICD 10
                                                                                                                                     2%
would be delayed until 2020. Still, employer actions                                                                                 5%
                                                                                      Current Procedural Terminology category        0%
to reduce their exposure to the 40% excise tax                                                                                       0%                                           Yes             No
                                                                                                                                     0%                                           63%             37%
helped hold growth in health benefits cost per
employee to just 3.8% in 2015, for a third straight                                                                                  3%
                                                                                                                                     2%
year of increases below 4%. Enrollment in high-                                                       Local government catalog       1%
                                                                                                                                     0%
                                                                                                                                    14%
deductible, consumer-directed health plans,
which grown steadily during this period, reached                                                                                     3%
                                                                                                                                     4%
a milestone 25% of all covered employees in 2015                                                    Local social security catalog    4%
                                                                                                                                     0%
as the percentage of large employers offering                                                                                        0%

these lower-cost plans jumped from 48% to 59%.                                                                                       1%
                                                                                                                                     0%
                                                                                        National Insurance Association catalog       1%
                                                                                                                                     0%
What Can Be Done With the Data                                                                                                       0%

                                                                                                                                    15%
                                                                                                                                    14%
Global data-tracking tools used by the survey                                                                  Your own catalog     18%
                                                                                                                                     9%
respondents have remained largely the same                                                                                           5%

as last year, with more than half of all insurers                                                                                    5%
                                                                                                                                     4%
surveyed tracking the diagnoses of paid claims                                                       Other classification system     6%
                                                                                                                                     9%
using the International Classification of Disease                                                                                    0%

version 10 (ICD10).                                                                                                                  2%
                                                                                                                                     0%
                                                                                                                      None used      4%
                                                                                                                                     9%
                                                                                                                                     0%

                                                                                           Global                                   Asia        Europe         M iddle East/             Latin America
                                                                                                                                                                Africa (MEA)              (LATAM)

7
    For information on US trends, refer to Mercer’s National Survey of Employer-sponsored Health Plans 2015 report.
                                                                                                                                                                                                          29
General Conclusions

                           The results of the survey reflected that most
                           governments today are not providing adequate
                           healthcare systems to cope with growing demand.
                           Insurers are doing what they can to control costs,
                           but employers must also do their part. Unless
                           employers act to address certain endemic health
                           concerns in their workforces, they face lowered
                           levels of productivity and performance.

                           The role of the employer must continue to
                           evolve. Organizations worldwide must attempt to
                           influence government provision of appropriate
                           healthcare services and fill the gaps by offering
                           employer-sponsored health improvement
                           programs and changing the work environment in
                           support of health and well-being. Designing benefit
                           offerings that address individual needs, provide
                           portability, and offer access to transparent
                           healthcare are challenges faced by many
                           employers as they endeavor to attract, retain and

6
                           maintain a healthy, high-performing workforce.

Conclusion
Change Is on the Horizon
Insurers from
                                     Region                 Country              Region   Country
              49 countries
                                     Asia                   China                Europe   Belgium
              participated in this
                                                            Hong Kong                     Denmark
              year’s survey.
                                                            India                         France
                                                            Indonesia                     Greece
                                                            Malaysia                      Hungary
                                                            Philippines                   Ireland
                                                            Singapore                     Italy
                                                            South Korea                   Latvia
                                                            Taiwan                        Lithuania
                                                            Thailand                      Netherlands
                                                            Vietnam                       Norway
                                     Americas               Argentina                     Poland
                                                            Brazil                        Portugal
                                                            Canada                        Romania
                                                            Chile                         Russia
                                                            Colombia                      Serbia
                                                            Dominican Republic            Spain
                                                            Mexico                        Sweden
                                                            Panama                        Switzerland
                                                            Peru                          Turkey
                                     Middle East & Africa   Egypt                         Ukraine
                                                            Burkina Faso                  United Kingdom
                                                            Ghana
                                                            Malawi
                                                            Mali
                                                            Qatar
                                                            Saudi Arabia

About This Survey
Appendix

                                                                                                           31
The following         Country     Insurance company                                             Country       Insurance company
     insurers agreed       Africa      Metropolitan Health Insurance Ghana Limited                   Hong Kong     Manulife (International) Limited
     to having their       Africa      Metropolitan Malawi                                           Hong Kong     MassMutual Asia Ltd
     names published       Argentina   Grupo Sancor Seguros                                          Hong Kong     Sun Life Hong Kong Limited
     as participants       Argentina   MEDIFE A.C.                                                   Hungary       Vienna Life Vienna Insurance Group Biztosító Zrt.

     in the survey,        Belgium     AXA Belgium                                                   Indonesia     Aetna

     whereas 81 insurers   Belgium     DKV Belgium SA/NV                                             Indonesia     PT Asuransi Reliance Indonesia

     participated on a     Brazil      Allianz Saúde                                                 Indonesia     PT FWD Life Indonesia

     confidential basis.   Brazil      Care Plus Medicina Assistencial LTDA                          Ireland       Laya Healthcare

                           Brazil      SulAmérica Seguros SA                                         Italy         Reale Mutua di Assicurazioni

                           Canada      Green Shield Canada                                           Latvia        BTA Baltic Insurance Company AAS

                           Canada      Sun Life Assurance Company of Canada                          Lithuania     Gjensidige

                           Chile       Chilena Consolidada                                           Malaysia      AIA Bhd

                           China       友邦保险有限公司上海分公司 (American International                         Malaysia      TOKIO MARINE INSURANS BERHAD
                                       Assurance Company Limited, Shanghai Branch)                   Norway        Gjensidige Forsikring
                           China       Generali China Life Insurance Company, Ltd.                   Norway        If Skadeforsikring NUF
                           China       MHS China (Shanghai) Enterprise Services Co., Ltd.            Norway        Storebrand Helseforsikring AS
                           China       Ping An Annuity Insurance Company, Shanghai Branch            Norway        Vertikal Helseassistanse AS
                           Colombia    Allianz Seguros                                               Panama        MAPFRE PANAMÁ
                           Colombia    AXA COLPATRIA Medicina Prepagada                              Panama        Pan-American Life Insurance Group
                           Denmark     Codan                                                         Peru          Rimac S.A. EPS
                           Denmark     Dansk Sundhedssikring A/S                                     Philippines   Avega Managed Care, Inc.
                           Denmark     Mølholm Forsikring A/S                                        Philippines   MEDICARD PHILIPPINES INC.
                           Denmark     Skandia                                                       Philippines   The Philippine American Life and General Insurance Company
                           Greece      Allianz Hellas SA                                             Philippines   United Coconut Planters Life Assurance Corporation
                           Greece      Generali Hellas                                               Poland        Compensa TU SA Vienna Insurance Group
                           Greece      International Life                                            Poland        LMG Försäkrings AB
                           Greece      MetLife                                                       Poland        PZU Życie S.A.
                           Hong Kong   Aetna Global Benefits (Asia Pacific) Limited [in Hong Kong:   Portugal      Allianz Portugal
                                       Starr International Insurance (Asia) Ltd.]
                                                                                                     Portugal      Companhia de Seguros Tranquilidade
                           Hong Kong   Assicurazioni Generali S.p.A. Hong Kong Branch
                                                                                                     Portugal      Generali-Companhia de Seguros, S.A.
                           Hong Kong   AXA Hong Kong
                                                                                                     Portugal      Groupama Seguros S.A.
                           Hong Kong   Blue Cross (Asia-Pacific) Insurance Limited
                                                                                                     Portugal      Multicare — Seguros de Saúde, S. A
                           Hong Kong   Bupa (Asia) Limited
                                                                                                     Portugal      VICTORIA Seguros
                           Hong Kong   Federal Insurance Company
                                                                                                     Russia        Allianz Life
                           Hong Kong   Liberty International Insurance Limited
                                                                                                     Russia        Ingosstrakh Insurance Company

32
Country         Insurance company
                                                                       About Mercer Marsh Benefits
Russia          OJSC Alfa Strakhovanie
                                                                       The Mercer Marsh Benefits network is a combination of
Russia          RESO-GARANTIA
                                                                       Mercer and Marsh local offices around the world, plus country
Russia          VTB Insurance
                                                                       correspondents who have been selected based on specific
Saudi Arabia    Allianz Saudi Fransi Cooperative Insurance Company
                                                                       criteria. Through our locally established businesses, we have
Singapore       Aetna International Singapore
                                                                       a unique common platform that allows us to serve clients with
Singapore       Aviva Ltd.
                                                                       global consistency and locally unique solutions.
Singapore       AXA Life Insurance Singapore Pte Ltd / AXA Insurance
                Singapore Pte Ltd
                                                                       Mercer and Marsh are two of the Marsh & McLennan
Sweden          Euro Accident Health & Care Insurance AB
                                                                       Companies, together with Guy Carpenter and Oliver Wyman.
Sweden          Länsförsäkringar

Sweden          Skandia
                                                                       This information is not intended to be taken as advice
Switzerland     Helsana Versicherungen AG                              regarding any individual situation and should not be relied
Switzerland     Sanitas                                                upon as such. Statements concerning tax, accounting and/
Switzerland     Sympany                                                or legal matters are general observations based solely on our
Taiwan          China Life Insurance Co., Ltd                          experience as insurance brokers and risk consultants and
Taiwan          Fubon Life Insurance Co., Ltd                          should not be relied on as legal, tax or accounting advice. You
Taiwan          Nan Shan Life Insurance Co., Ltd
                                                                       should contact your legal, accounting, tax and other advisors
                                                                       regarding specific coverage and other issues. The information
Taiwan          Shin Kong Life Insurance Company
                                                                       contained in this publication is based on sources we believe
Thailand        Krungthai-AXA Life Insurance Public Company Limited
                                                                       are reliable, but we make no representation or warranty
Thailand        Tokio Marine Life Insurance (Thailand) PCL
                                                                       as to its accuracy. All insurance coverage is subject to the
Ukraine         AXA Insurance (Ukraine)
                                                                       terms, conditions and exclusions of the applicable individual
Ukraine         The European Insurance Alliance, Private Joint Stock   policies. Marsh and Mercer cannot provide any assurance that
                Company
                                                                       insurance can be obtained for any particular client or for any
Ukraine         INGO Ukraine                                           particular risk. Marsh and Mercer make no representations or
Ukraine         JSIC "Illichivske"                                     warranties, expressed or implied, concerning the application
Ukraine         PROVIDNA, Ins. Co. Ukraine                             of policy wordings or the financial condition or solvency of
Ukraine         PZU Ukraine                                            insurers or reinsurers.
United Kingdom Aviva Health UK Limited

United Kingdom AXA PPP Healthcare

United Kingdom Cigna UK HealthCare Benefits

United Kingdom VitalityHealth

Vietnam         Bao Viet Saigon Insurance

Vietnam         Petro Vietnam Insurance Corporation

                                                                                                                                   33
For further information, please contact your local
Mercer Marsh Benefits office.

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