Page 13 - 2015 DAN Benefits Guide

Dentsu Aegis Network (DAN)

Moderate User
Ralph, age 37, covers himself and his children and seeks healthcare
services moderately. His 2015 medical expenses might look like this.

Premium PPO Enhanced PPO Standard PPO HSA PPO
Total Cost Out-of-Pocket Expenses by Plan
(In-Network) 1
Annual physical Free Free Free Free
& well child
visits: $426
4 Primary Care $30 copay $30 copay $30 copay $480
Visits ($120/ ($120 total) ($120 total) ($120 total) (deducible)
visit)
1 Emergency $250 copay $250 copay $250 copay $1,000
Room Visits: (deducible)
$1,000
Hospital Stay $250 to saisfy $500 to saisfy $1,000 $2,520
for one family deducible; deducible; to saisfy to saisfy
member : then 0% of then 10% of deducible; deducible;
2
$15,000 $14,750 remaining then 20% of then 20% of
$14,500 remaining remaining
$14,000 $12,480
Total Employee Responsibility
Total Out $620 $2,320 $4,170 $6,496
of Pocket
Expenses:
Annual Payroll $5,841 $4,079 $2,389 $1,517
Deducion (EE +
Child)
Company HSA N/A N/A N/A ($1,000)
Contribuion
Ralph’s Total $6,461 $6,399 $6,559 $7,013
Cost

The best opion for Ralph is the Enhanced Plan.

Notes:
1 Please note the costs for the various services used to create the preceding scenarios are for
illustraive purposes only. Actual costs may difer the type of care or services provided.
2 Hospital Stay—cost assumed as total of all inpaient, outpaient, and surgical expenses; therefore,
applying directly to deducible and coinsurance for all modeled plan

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