Page 14 - Example
P. 14
Claim Comparison: Choosing the Right Plan (continued)
Claims Example
Jill needs to consider which GLG plan option will be the right it for her and her family. Jill will enroll in family
coverage and her salary is $130K a year. While Jill reviews the medical plan options, she notices that on the
HSA 1350 plan the whole family deductible must be met before beneits begin being paid. Jill, her son and
husband will all receive one preventive annual exam which is covered at 100% on all GLG plans. Jill sees
a specialist three times a year for her back. Her son is rushed to the urgent care with a stomach ache that
turns into appendicitis. He then has an inpatient procedure to remove his appendix. With Jill’s back pain and
her son’s surgery they are prescribed 5 generic medications. She selects the HSA 1350 plan based on low
payroll contributions and GLG’s HSA funding.
Aetna PPO 500 Aetna HSA 1350 Aetna EPO 1500
Total Annual Contribution $6,996 $1,932 $3,864
GLG Contribution to HSA N/A $2,025 N/A
Family deductible to be Satisied $1,000 $2,700 $3,000
Individual deductible $500 N/A* $1,500
*On the HSA only, no one in the family is eligible for beneits until the family coverage deductible is met.
Jill's Services Cost of Care Amount Applied to Cost of Care Amount Applied to Cost of Care Amount Applied to
Deductible
Deductible
Deductible
3 preventive physical exam (in-
network) $0 $0 $0 $0 $0 $0
Assumes $80 ofice visit charge
3 specialist visits 3 copays @ $50 $0 $600 $600 3 copays @ $60 $0
Assumes $200 ofice visit charge = $150 = $180
1 inpatient procedure $500 deductible + $500 $2,100 deductible $2,100 $1,500 deductible $1,500
+ $220
+ $100
Assumes $2,600 charge $210 coinsurance coinsurance coinsurance
1 urgent care visit 1 copay @ $75 1 copay @ $75
Assumes $700 charge = $75 $0 $140 coinsurance $0 = $75 $0
5 generic non-preventive retail drug 5 copay @ $10 5 copay @ $10 5 copay @ $10
purchase = $50 $0 = $50 $0 = $50 $0
(Assumes $40 cost/30-day Rx)
Amount of Amount of Amount of
Cost of Care Deductible Cost of Care Deductible Cost of Care Deductible
Remaining Remaining Remaining
$985 $500 $2,990 $0 $2,025 $1,500
Totals
Jill's Total Annual Cost = Jill's Total Annual Cost = Jill's Total Annual Cost =
Payroll + Cost of Care Payroll + Cost of Care – HSA Funding Payroll + Cost of Care
$2,897
$7,981 ($0 HSA Funds Remaining) $5,889
* On the HSA only, no one in the family is eligible for beneits until the family coverage deductible is met
10
Claims Example
Jill needs to consider which GLG plan option will be the right it for her and her family. Jill will enroll in family
coverage and her salary is $130K a year. While Jill reviews the medical plan options, she notices that on the
HSA 1350 plan the whole family deductible must be met before beneits begin being paid. Jill, her son and
husband will all receive one preventive annual exam which is covered at 100% on all GLG plans. Jill sees
a specialist three times a year for her back. Her son is rushed to the urgent care with a stomach ache that
turns into appendicitis. He then has an inpatient procedure to remove his appendix. With Jill’s back pain and
her son’s surgery they are prescribed 5 generic medications. She selects the HSA 1350 plan based on low
payroll contributions and GLG’s HSA funding.
Aetna PPO 500 Aetna HSA 1350 Aetna EPO 1500
Total Annual Contribution $6,996 $1,932 $3,864
GLG Contribution to HSA N/A $2,025 N/A
Family deductible to be Satisied $1,000 $2,700 $3,000
Individual deductible $500 N/A* $1,500
*On the HSA only, no one in the family is eligible for beneits until the family coverage deductible is met.
Jill's Services Cost of Care Amount Applied to Cost of Care Amount Applied to Cost of Care Amount Applied to
Deductible
Deductible
Deductible
3 preventive physical exam (in-
network) $0 $0 $0 $0 $0 $0
Assumes $80 ofice visit charge
3 specialist visits 3 copays @ $50 $0 $600 $600 3 copays @ $60 $0
Assumes $200 ofice visit charge = $150 = $180
1 inpatient procedure $500 deductible + $500 $2,100 deductible $2,100 $1,500 deductible $1,500
+ $220
+ $100
Assumes $2,600 charge $210 coinsurance coinsurance coinsurance
1 urgent care visit 1 copay @ $75 1 copay @ $75
Assumes $700 charge = $75 $0 $140 coinsurance $0 = $75 $0
5 generic non-preventive retail drug 5 copay @ $10 5 copay @ $10 5 copay @ $10
purchase = $50 $0 = $50 $0 = $50 $0
(Assumes $40 cost/30-day Rx)
Amount of Amount of Amount of
Cost of Care Deductible Cost of Care Deductible Cost of Care Deductible
Remaining Remaining Remaining
$985 $500 $2,990 $0 $2,025 $1,500
Totals
Jill's Total Annual Cost = Jill's Total Annual Cost = Jill's Total Annual Cost =
Payroll + Cost of Care Payroll + Cost of Care – HSA Funding Payroll + Cost of Care
$2,897
$7,981 ($0 HSA Funds Remaining) $5,889
* On the HSA only, no one in the family is eligible for beneits until the family coverage deductible is met
10
