Page 6 - 2016 Enrollment
P. 6
Medical Plan Cost Example
How Much Could it Cost?
To the right you will find an Dr. Smith’s Ofice
example of a bill you could 123 Parkway Dr
receive for a visit to your St Louis, MO 63123
doctor. This bill illustrates
how much you would pay in Total Charges $200
various scenarios under all
three medical plans. Insurance Discount $75
Your Responsibility $125
NOTE: all wellness and preventative visits will be covered at 100%
with NO deductible or coinsurance.
These visits include immunizations, health screenings, physicals, and more
Gold Plan Silver Plan Bronze Plan
Individual deductible $1,500 $2,500 $3,000
Out-of-pocket max $1,500 $4,500 $6,000
Plan pays after the 100% 90% 70%
deductible has been met
Member responsibility if the
deductible has NOT been $125 $125 $125
met
Member responsibility if the
deductible has been met $0 $12.50 $37.50
(coinsurance)
Member responsibility if the $0 $0 $0
out-of-pocket is met
How Much Could it Cost?
To the right you will find an Dr. Smith’s Ofice
example of a bill you could 123 Parkway Dr
receive for a visit to your St Louis, MO 63123
doctor. This bill illustrates
how much you would pay in Total Charges $200
various scenarios under all
three medical plans. Insurance Discount $75
Your Responsibility $125
NOTE: all wellness and preventative visits will be covered at 100%
with NO deductible or coinsurance.
These visits include immunizations, health screenings, physicals, and more
Gold Plan Silver Plan Bronze Plan
Individual deductible $1,500 $2,500 $3,000
Out-of-pocket max $1,500 $4,500 $6,000
Plan pays after the 100% 90% 70%
deductible has been met
Member responsibility if the
deductible has NOT been $125 $125 $125
met
Member responsibility if the
deductible has been met $0 $12.50 $37.50
(coinsurance)
Member responsibility if the $0 $0 $0
out-of-pocket is met
