Page 8 - Dentsu 2022 Annual Enrollment Flyer
P. 8
Medical Plan Highlights










Enhanced PPO Standard PPO Classic HDHP Value HDHP
Out-of-
Out-of-
Out-of-
Out-of-
Plan Feature* In-Network Network In-Network Network In-Network Network In-Network Network
Contributions Per Semi Monthly Pay Period
Employee $114.00 $74.50 $45.00 $32.00
Employee + $263.00 $191.00 $130.00 $99.50
Spouse/DP
Employee + $222.50 $146.00 $99.00 $75.50
Child(ren)
Family $409.50 $295.00 $199.50 $143.00

Deductible
Individual $500 $2,000 $1,000 $3,000 $2,000 $6,000 $4,000 $12,000
Family $1,000 $4,000 $2,000 $6,000 $4,000 $12,000 $8,000 $24,000

Company HSA Contribution
Individual/Family N/A N/A $500/$1,000 $750/$1,500

Out of Pocket Maximum
Individual $4,500 $9,000 $4,500 $13,500 $4,500 $13,500 $6,900 $20,700
Family $9,000 $18,000 $9,000 $27,000 $7,000 $21,000 $13,800 $41,400

Plan Feature
Plan Coinsurance 90% 70% 80% 60% 80% 60% 80% 60%

Preventive 100% Ded & Coin 100% Ded & Coin 100% Ded & Coin 100% Ded & Coin
Not
Not
Not
Not
Virtual Visits $0 Covered $0 Covered $0 after Ded Covered $0 after Ded Covered
Primary Care $30 Ded & Coin $30 Ded & Coin Ded & Coin Ded & Coin Ded & Coin Ded & Coin
Specialist $50 Ded & Coin $50 Ded & Coin Ded & Coin Ded & Coin Ded & Coin Ded & Coin
Inpatient Ded & Coin Ded & Coin Ded & Coin Ded & Coin Ded & Coin Ded & Coin Ded & Coin Ded & Coin
Outpatient Ded & Coin Ded & Coin Ded & Coin Ded & Coin Ded & Coin Ded & Coin Ded & Coin Ded & Coin
Emergency Room $250 $250 Ded & Coin Ded & Coin
Copay

















8 2022 Benefits Enrollment
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