Page 7 - 2017 Benefits Enrollment

Dentsu Aegis Network (DAN)

Medical Plan Highlights

You will have four plan opions through United Healthcare, the High Deducible Health Plan w/HSA
provides you with the lowest premium cost. For a more detailed comparison of the medical plans visit
the beneitsPLUS website (where you can also access a link to UHC’s pre-enrollment site, Healthcare
Lane, and more comprehensive medical plan summaries).

High Deducible
Standard Plan Enhanced Plan Premium Plan Health Plan (HDHP)
with HSA ****
Out-of-
Out-of-
Out-of-
Out-of-
Plan Feature* In-Network Network In-Network Network In-Network Network In-Network Network
Employee Contribuions Per Pay Period
Employee $55.09 $92.05 $126.12 $29.14
Employee + $124.24 $213.13 $313.51 $77.90
Spouse
Employee + $110.78 $190.89 $278.41 $69.04
Child(ren)
Family $207.48 $355.21 $522.31 $129.84
Deducible
Individual $1,000 $2,000 $500 $1,000 $350 $700 $2,000 $4,000
Family $2,000 $4,000 $1,000 $2,000 $700 $1,400 $4,000 $8,000
HSA Account Funding
Individual/
Family N/A N/A N/A $500/$1,000
Out-of-Pocket Max**
Individual $4,000 $8,000 $4,000 $8,000 $3,000 $6,000 $4,000 $12,000
Family $8,000 $16,000 $8,000 $16,000 $6,000 $12,000 $6,850 $24,000
Plan
Coinsurance 80% 60% 90% 80% 100% 80% 80% 60%
Oice Visit Copay

Prevenive Free Ded. and Free Ded. and Free Ded. and Free Ded. and
Coin.
Coin.
Coin.
Coin.
Virtual Visits $15 Not Covered $15 Not Covered $15 Not Covered Ded. and Not Covered
Coin.
Primary Care $30 Ded. and $30 Ded. and $30 Ded. and Ded. and Ded. and
Coin.
Coin.
Coin.
Coin.
Coin.
Specialist $50 Ded. and $50 Ded. and $50 Ded. and Ded. and Ded. and
Coin.
Coin.
Coin.
Coin.
Coin.
Hospital Facility
Inpaient Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and
Coin.
Coin.
Coin.
Coin.
Coin.
Coin.
Coin.
Coin.
Outpaient Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and
Coin.
Coin.
Coin.
Coin.
Coin.
Coin.
Coin.
Coin.
Emergency
Room Copay $250 $250 $250 Ded. and Coin.
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