Page 11 - 2015 CBRY Enrollment Guide
P. 11
ASARCO
Option 1—HRA Plan Case Study—
Oscar elects the HRA Plan and completes all four of the speciic
wellness activities to earn $750 in HRA incentives. Oscar
Allowed Member Oscar is an active, athletic, and healthy
Expenses Cost 33 year old. Being healthy has always
Annual Physical (Preventive 100%) $100 $0 been important to him, but he has
Arthroscopic Knee Surgery $4,200 $1,500 Deductible never put much thought into it. While
$540 Coinsurance playing lag football, he took a nasty
Specialist Doctor's Ofice Visit—Post Surgery $250 $50 Copay spill and had to have knee surgery
Prescription Drugs (2 non-formulary brand) $200 $80 Copay later in the year. Due to the cost of
Total Medical Expenses $2,170 the surgery, Oscar’s expenses were
Total Copays $130 abnormally high, and he was faced with
Total Deductible $1,500 some out-of-pocket expenses in his irst
Total Coinsurance $540 year on the plan. In the second year,
Less Deductible & Coinsurance expenses paid from HRA -$750 Oscar did not experience as many out
Annual Premium Cost ($23.08 per pay period) $600 of pocket expenses then he was able
Total Annual Member Cost $2,020 to begin to build up savings in his HRA
Oscar is responsible for copays. Oscar used all of his HRA money and will
complete the wellness activities in year two to begin to build up savings for the future. Let’s take a look at the
in his HRA for the future. coverage and costs of each plan.
HRA Rollover to next year $0
Option 2—PPO Plan
Allowed Member
Expenses Cost
Annual Physical (Preventive 100%) $100 $0
Arthroscopic Knee Surgery $4,200 $750 Deductible
$690 Coinsurance
Specialist Doctor's Ofice Visit—Post Surgery $250 $0 Coinsurance
Prescription Drugs (2 non-formulary brand) $200 $80 Copay
Total Medical Expenses $1,570
Total Copays $80
Total Deductible $750
Total Coinsurance $690
Annual Premium Cost ($44.77 per pay period) $1,164
Total Annual Member Cost $2,734
This is an example. Your actual experience may
vary. All expenses assume the use of in-network
providers. The medical copays, deductible, and
coinsurance expenses will apply towards the
medical out-of-pocket maximum. The prescription
drug copays will apply towards the prescription
out-of-pocket maximum. Refer to the Summary
Plan Description for the individual and family
deductibles and out-of-pocket maximums.
11
Option 1—HRA Plan Case Study—
Oscar elects the HRA Plan and completes all four of the speciic
wellness activities to earn $750 in HRA incentives. Oscar
Allowed Member Oscar is an active, athletic, and healthy
Expenses Cost 33 year old. Being healthy has always
Annual Physical (Preventive 100%) $100 $0 been important to him, but he has
Arthroscopic Knee Surgery $4,200 $1,500 Deductible never put much thought into it. While
$540 Coinsurance playing lag football, he took a nasty
Specialist Doctor's Ofice Visit—Post Surgery $250 $50 Copay spill and had to have knee surgery
Prescription Drugs (2 non-formulary brand) $200 $80 Copay later in the year. Due to the cost of
Total Medical Expenses $2,170 the surgery, Oscar’s expenses were
Total Copays $130 abnormally high, and he was faced with
Total Deductible $1,500 some out-of-pocket expenses in his irst
Total Coinsurance $540 year on the plan. In the second year,
Less Deductible & Coinsurance expenses paid from HRA -$750 Oscar did not experience as many out
Annual Premium Cost ($23.08 per pay period) $600 of pocket expenses then he was able
Total Annual Member Cost $2,020 to begin to build up savings in his HRA
Oscar is responsible for copays. Oscar used all of his HRA money and will
complete the wellness activities in year two to begin to build up savings for the future. Let’s take a look at the
in his HRA for the future. coverage and costs of each plan.
HRA Rollover to next year $0
Option 2—PPO Plan
Allowed Member
Expenses Cost
Annual Physical (Preventive 100%) $100 $0
Arthroscopic Knee Surgery $4,200 $750 Deductible
$690 Coinsurance
Specialist Doctor's Ofice Visit—Post Surgery $250 $0 Coinsurance
Prescription Drugs (2 non-formulary brand) $200 $80 Copay
Total Medical Expenses $1,570
Total Copays $80
Total Deductible $750
Total Coinsurance $690
Annual Premium Cost ($44.77 per pay period) $1,164
Total Annual Member Cost $2,734
This is an example. Your actual experience may
vary. All expenses assume the use of in-network
providers. The medical copays, deductible, and
coinsurance expenses will apply towards the
medical out-of-pocket maximum. The prescription
drug copays will apply towards the prescription
out-of-pocket maximum. Refer to the Summary
Plan Description for the individual and family
deductibles and out-of-pocket maximums.
11
