Page 8 - Mersen Benefit Guide Local 502
P. 8
Here’s an example of your medical expenses shown through all the plans that are offered for the 2023 plan year.
Mersen CHOICE
Employee ONLY Union BASE PLAN Union CHOICE PLAN PLAN Mersen KEY PLAN
Annual Physical covered at
100% $0 $0 $0 $0
Two PCP Office visits ($150
each) $50 $50 $50 $300
Four preferred brand
prescriptions ($500) $100 $100 $100 $500
Total medical out of pocket
expenses (Deductibles or
Copays) $150 $150 $150 $800
Mersen HSA contributions $0 $0 $0 $750
HSA pays portion of out-of-
pocket costs $0 $0 $0 ($750)
Total Expenses to be paid by
employee (calculation
includes HSA Savings) $150 $150 $150 $50
Annual Premium Employee
Only Rate $3,535 $2,595 $2,035 $983
Total Employee cost
(Expenses + Premiums) $3,685 $2,745 $2,185 $1,032
HSA Rollover for following
year $0 $0 $0 $0
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