Involuntary Health Plan Switching: Case Study of a Corporate Health Benefits Program

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Abstract
This study examined the extent of health plan switching in one large corporation due to changes in employment, compared it with the extent of voluntary switching among continuously employed individuals, and evaluated the risk mix of health plan stayers, voluntary switchers, and involuntary switchers. Of 14,791 workers enrolled in the firm's fee-for-service plan in 1987, only 5,320 remained in 1990. Of the 11,494 employees enrolled in the large health maintenance organization (HMO) and the 7,677 enrolled in the small HMOs in 1987, only 5,299 and 3,026, respectively, remained in their HMOs and insured by the firm in 1990. These large enrollment losses were offset by large enrollment gains from new employees. Health plan leavers were at a lower risk of using medical services than were health plan stayers. The lowest expected annual expenditures were among newly hired health plan joiners.