Page 10 - S & S Die Company 2020 Renewal Presentation

S & S Die Company Renewal

November 2020

Current Renewal Alt # 1 Alt # 2 Alt # 3 Alt # 4
BCN HMO Platinum BCN HMO Platinum PHP POS Platinum PHP PPO Platinum PHP POS Gold PHP PPO Gold
$500 $500 $500 $500 $1000 $1000
36 employees
Member Member Member Member Member Member
Level Level Level Level Level Level
Rating Rating Rating Rating Rating Rating

Est. Monthly Premium $38,587.85 $41,547.72 $43,144.78 $47,705.27 $36,662.08 $40,720.07
Est. Annual Premium $463,054.20 $498,572.64 $517,737.36 $572,463.24 $439,944.96 $488,640.84
Includes Taxes and Fees
Change in Premium 7.67% INCREASE 11.8% INCREASE 23.6% INCREASE SAVE 5% 5.4% INCREASE
Benefits
Deductible
In network $500/$1000 $500/$1000 $500/$1000 $500/$1000 $500/$1000 $500/$1000
Out Network No Benefit No Benefit $1500/$3000 $1500/$3000 $3000/$6000 $3000/$6000

Prescription drug copay $4/$15/$40/$80/20%/20% $4/$15/$40/$80/20%/20% $10/$40/$80/20% ($300) $10/$40/$80/20% ($300) $20/$50/$80/20%($300) $20/$50/$80/20%($300)

Office visit copay $20 PCP/$30 Spec $20 PCP/$30 Spec $20 PCP/$40 SPEC $20 PCP/$40 SPEC $25 PCP/$50 SPEC $25 PCP/$50 SPEC

Urgent care copay $35 $35 $50 $50 $60 $60

Emergency Room Copay $150 after deductible $150 after deductible $150 after deductible $150 after deductible 80% after deductible 80% after deductible

Hospitalization
In patient 100% after deductible 100% after deductible 90% after deductible 90% after deductible 80% after deductible 80% after deductible
Out patient 100% after deductible 100% after deductible 90% after deductible 90% after deductible 80% after deductible 80% after deductible

Lab & X-ray 100% after deductible 100% after deductible 90% after deductible 90% after deductible 80% after deductible 80% after deductible

Ded. & Coinsurance Max. N/A N/A $500/$1000 $500/$1000 $5000/$10,000 $5000/$10,000

Maximum copayment
In network $1500/$3000 $1500/$3000 $3000/$6000 $3000/$6000 $8000/$16,000 $8000/$16,000
Out network No Benefit No Benefit $5000/$10,000 $5000/$10,000 $15,000/$30,000 $15,000/$30,000

If the group were to enroll with McLaren, there is one employee outside of their network. The member would need to sign a form indicating they would seek
services from an in network physician.

Prepared August 2019