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Plug and play: plan design changes sample

Plug and Play: Plan Design Changes Sample
Sample client

2019 2020
HSA Core HSA Plus PPO HSA Core HSA Plus PPO
Summary of Plan Design
Coinsurance
In-Network 20% 20% 20% 20% 20% 20%
Deductible
In-Network Single $5,000 $2,400 $1,200 $5,000 $2,400 $1,200
Family 2x 2x 2x 2x 2x 2x
Embedded/Non-Embedded* Emb / Emb Non / Non Emb / Emb Emb / Emb Non / Non Emb / Emb
Plan design
OOP Max (includes Ded) options
In-Network Single $6,600 $5,000 $6,000 $6,600 $5,000 $6,000 allow you
Family 2x 2x 2x 2x 2x 2x to choose
Office Visit from a
PCP ded/coins ded/coins $35 ded/coins ded/coins $35 variety of
Specialist ded/coins ded/coins $50 ded/coins ded/coins $50 inputs to
Inpatient Hospital ded/coins ded/coins ded/coins ded/coins ded/coins ded/coins modify your
Emergency Room ded/coins ded/coins ded/coins ded/coins ded/coins ded/coins plan.
Urgent Care ded/coins ded/coins $40 ded/coins ded/coins $40
Rx Deductible N/A N/A N/A N/A N/A N/A
Prescription Drugs Tier 1 ded/coins ded/coins $10 ded/coins ded/coins $10
Tier 2 ded/coins ded/coins $30 ded/coins ded/coins $30
Tier 3 ded/coins ded/coins $50 ded/coins ded/coins $50
Tier 4 ded/coins ded/coins $150 ded/coins ded/coins $150
Note: *Embedded/ Embedded is the only current option for 3x Family
CDHP Contributions Account Type HSA HSA None HSA HSA None
Usage % 100% 100% 100% 100%
Add funding in addition Yes Yes Yes Yes If you plan on adding a
to premiums? Health Account for a
EE $500 $250 $500 $250 consumer driven option,
ES $1,000 $500 $1,000 $500 you can input values and
EE+ Child(ren) $1,000 $500 $1,000 $500 estimate cost here.
Family $1,000 $500 $1,000 $500
Total $134,000 $44,750 $0 $134,000 $44,750 $0
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49 Lockton Companies