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What plan is right for you?

We hope one of these examples will help you in selecting the medical plan that's best for you. View the scenarios below to see possible costs.

Final costs equal premiums plus medical costs minus company HSA contribution (if applicable). These scenarios are for illustration only. Your actual costs my vary.

 
John and Janeen

 

SCENARIO 1
John and Janeen have 2 children
, and their trips to the doctor include well child visits, annual physicals for both of them, and three or four prescriptions throughout the year for various minor ailments. Costs for this scenario include: two well child visits (covered 100%), two annual physicals, one office visit, one minute clinic visit and four generic prescriptions.
Plan Bronze Gold
Medical Care Received

Two well child visits (coverage at 100%), two annual physicals (coverage at 100%), one office visit ($114 applies toward deductible), one Minute Clinic ($74 applies toward deductible) and four generic prescriptions ($16 - $4 generics, less than the copay)

Two well child visits (covered at 100%), two annual physicals (covered at 100%), one office visit ($114 applies toward deductible), one Minute Clinic ($74 applies toward deductible) and four generic prescriptions ($16 - $4 generics)

Annual Premium
(2 Challengers)

$2,628 $1,716
Medical Costs Paid by Member $204 $204
Company HSA Contribution NA -$500
Final Costs Paid by Member $2,832 $1,420

 

 

Alex

 

SCENARIO 2
Alex is a healthy 28-year-old single man who sees his doctor once a year for an annual physical. He recently suffered a back injury from a fall while inline skating near his home. Costs for this scenario include: one annual physical and back surgery
Plan Bronze Gold
Medical Care Received

Annual physical (coverage at 100%) and back surgery ($3,000 - deductible and out-of-pocket max met)

Annual physical (covered at 100%) and back surgery ($3,000 - deductible and out-of-pocket max met)
Annual Premium
(Challenger)
$900 $636
Medical Costs Paid by Member $3,000 $3,000
Company HSA Contribution NA -$500
Final Costs Paid by Member $3,900 $3,136
Jose

 

SCENARIO 3
Jose is a single 30-year-old
who is active in a number of sports. He frequents his chiropractor and has also been undertaking physical therapy to rehab from a softball injury. Costs for this scenario include: 12 chiropractic visits and physical therapy
Plan Bronze Gold
Medical Care Received

Twelve chiropractic visits ($600 - applies toward deductible, deductible met) and physical therapy ($140 - applies toward deductible, deductible met)

Twelve chiropractic visits ($600 - applies toward deductible) and physical therapy ($140 - applies toward deductible)
Annual Premium
(Champion)
$696 $432
Medical Costs Paid by Member $548 ($500 deductible, $48 in coinsurance) $740
Company HSA Contribution NA -$500
Final Costs Paid by Member $1,244 $672

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Allison and Andy
SCENARIO 4
Allison and Andy are a young married couple with no children.
Both are relatively healthy, although Allison is on maintenance drugs for allergies and birth control pills. Costs for this scenario include: one annual physical, allergy medication (brand formulary) and birth control pills
Plan Bronze Gold
Medical Care Received

Annual physical (coverage at 100%), allergy medication - brand formulary $240 ($30 copay), and birth control ($48 - $4 generics, less than copay)

Annual physical (covered at 100%), allergy medication - brand formulary ($2,300 towards IRS Individual on Family Plan deductible, then the deductible is met), and birth control (covered at 100% once deductible is met)

Annual Premium
(2 Challengers)

$1,668 $1,116
Medical Costs Paid by Member $288 $2,300
Company HSA Contribution NA -$500
Final Costs Paid by Member $1,956 $2,916

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Tom
SCENARIO 5
Tom is a 40-year-old single man with diabetes.
Tom is moderately compliant with his doctor's plan for keeping his diabetes under control. Costs for this scenario include: prescriptions and three doctor visits
Plan Bronze Gold
Medical Care Received

Prescriptions $240 (eight at a $30 copay) and three doctor visits ($405 applies toward deductible)

Prescriptions $1,500 (applies toward deductible) and three doctor visits ($405 applies toward deductible)
Annual Premium
(Contender)
$1,116 $840
Medical Costs Paid by Member $645 $1,905
Company HSA Contribution NA -$500
Final Costs Paid by Member $1,761 $2,245

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Brittney
SCENARIO 6
Brittney is a single 24-year-old woman
who decided not to be on the company medical plan, and who recently broke her leg in a biking accident and had to be taken to the Emergency Room. Costs for this scenario include: no annual physical, emergency room, surgery and hospital fees
Plan No Coverage
Medical Care Received

No annual physicals, emergency room, surgery and hospital fees

Annual Premium NA
Medical Costs Paid by Member $14,867
Company HSA Contribution NA
Final Costs Paid by Member $14,867

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mary and michael

SCENARIO 7
Michael and Mary are a healthy young couple. Mary is pregnant with their first child, who is born halfway through the plan year. There are no complications to the delivery, and baby is discharged with mother. Note: deductible, out-of-pocket and premiums all increase to family coverage after the baby is added to the plan. Costs for this scenario include: total pregnancy cost

Plan Bronze Gold
Medical Care Received

Total Pregnancy Costs $3,000 (deductible and out-of-pocket max are met)

Total Pregnancy Costs $3,000 (deductible and out-of-pocket max are met)

Annual Premium
(2 Challengers)

Changes to family coverage

$2,148 $1,416
Medical Costs Paid by Member $3,000 $3,000
Company HSA Contribution NA -$500
Final Costs Paid by Member $5,148 $3,916

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Tina
SCENARIO 8
Tina is an active, healthy 35-year-old single woman whose only trip to the doctor is for her annual physical.
Plan Bronze Gold
Medical Care Received

Annual physical (coverage at 100%)

Annual physical (covered at 100%)
Annual Premium
(Contender)
$1,116 $840
Medical Costs Paid by Member $0 $0
Company HSA Contribution NA -$500
Final Costs Paid by Member $1,116

$340

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Alan

SCENARIO 9
Alan is a healthy 22-year-old
who visited the doctor for his annual physical and also had strep throat. Costs for this scenario include: annual physical, one office visit, one lab (throat culture) and one prescription

Plan Bronze Gold
Medical Care Received

Annual physical (coverage at 100%), an office visit for strep throat ($30 copay), lab - throat culture ($28 applies toward deductible) and Rx - antibiotic ($4 generic, less than the copay)

Annual physical (covered at 100%), an office visit for strep throat ($114 applies toward deductible), lab - throat culture ($28 applies toward deductible) and Rx - antibiotic ($4 generic)
Annual Premium
(Champion)
$696 $432
Medical Costs Paid by Member $62 $146
Company HSA Contribution NA -$500
Final Costs Paid by Member $758

$78

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