ICMA in collaboration with Cigna, an ICMA Strategic Partner, launched a national survey in the summer of 2016 to learn about the current state of local government employee health insurance programs. ICMA and Cigna conducted this research in follow-up to a similar survey conducted in 2011. The 2016 survey was sent via postal mail to a sample of 3,110 local governments. An online submission option was also made available. The sampling frame for the survey included all U.S. local governments with populations of 10,000 or higher. A 1 in 2.2 sample was selected at random among all local governments with populations less than 250,000; and all local governments with populations of 250,000 or higher were included in the survey sample. The survey was addressed to the Human Resources Director of each selected local government. The response rate was 23.0%, with 714 local governments responding. With this response, the margin of error is +/- 3.5% at the 95% confidence level.