How are changes in the health insurance environment affecting the health insurance benefits that employers offer, and how are these changes in insurance offerings affecting employee satisfaction? The goals of the project were to 1) describe the health benefit offerings, and how they have changed, for the 50 largest employers in the Pittsburgh metropolitan area; 2) investigate the decision-making process firms use to select and refine their health insurance offerings; 3) assess the extent to which the changes are influenced by selected firm and environmental characteristics; 4) determine consumer satisfaction with employer-offered health insurance following changes in offerings; and 5) assess and explain consumer selection of insurance plans. The study surveyed large employers (more than 200 employees) in the Pittsburgh metropolitan area. The researchers also conducted structured interviews with benefits officers or union officials. The objective of the study was to help policymakers understand and predict how changes in the marketplace will affect what health insurance employers offer, how satisfied employees will be with the new offerings, and to what extent employers are really acting as "agents" of their employees.