Page 13 - 2015 CBRY Enrollment Guide
P. 13
ASARCO
Option 1—HRA Plan Case Study—
The Allen family elects the HRA Plan and they both complete all four of
the speciic wellness activities to earn $1,500 in HRA incentives. Allen Family
Allowed Member The Allens have three boys with their
Expenses Cost
Annual Physicals (Preventive 100%) $500 $0 oldest getting ready to start college. Mr.
Doctor's Ofice Visit (3 children sick) $255 $60 Copay and Mrs. Allen are very active, enjoy
Emergency Room Visit $400 $150 Copay traveling, and they are looking forward
$250 Deductible to retirement. While they are all very
Back Surgery and Hospital charges $15,000 $1,500 Deductible Met healthy and have their annual physical
$1,500 Coinsurance done each year, the three boys each
Physical Therapy $800 $0 Coinsurance had a sick ofice visit. One child had
Prescription Drugs (12 generic) $150 $120 Copay to go to the emergency room but was
Total Medical Expenses $3,580 released the same day. Mr. John Allen
Total Copays $330 had major back surgery this year and
Total Deductible $1,750 had to complete ten physical therapy
Total Coinsurance $1,500 visits. Let’s take a look at the coverage
Less Deductible & Coinsurance expenses paid from HRA -$1,500 and costs of each plan.
Annual Premium Cost ($71.54 per pay period) $1,860
Total Annual Member Cost $3,940
The Allen family is responsible for copays. They used all the HRA
money and will complete the wellness activities in year two to begin
to build up savings in his HRA for the future.
HRA Rollover to next year $0
Option 2—PPO Plan
Allowed Member
Expenses Cost
Annual Physicals (Preventive 100%) $500 $0
Doctor's Ofice Visit (3 children sick) $255 $255 Deductible
Emergency Room Visit $400 $150 Copay
$250 Deductible
Back Surgery and Hospital charges $15,000 $750 Deductible Met
$1,500 Coinsurance
Physical Therapy $800 $0 Coinsurance
Prescription Drugs (12 generic) $150 $120 Copay
Total Medical Expenses $3,025
Total Copays $270
Total Deductible $1,255 This is an example. Your actual experience may
Total Coinsurance $1,500 vary. All expenses assume the use of in-network
providers. The medical copays, deductible, and
Annual Premium Cost ($149.54 per pay period) $3,888 coinsurance expenses will apply towards the
Total Annual Member Cost $6,913 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.
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Option 1—HRA Plan Case Study—
The Allen family elects the HRA Plan and they both complete all four of
the speciic wellness activities to earn $1,500 in HRA incentives. Allen Family
Allowed Member The Allens have three boys with their
Expenses Cost
Annual Physicals (Preventive 100%) $500 $0 oldest getting ready to start college. Mr.
Doctor's Ofice Visit (3 children sick) $255 $60 Copay and Mrs. Allen are very active, enjoy
Emergency Room Visit $400 $150 Copay traveling, and they are looking forward
$250 Deductible to retirement. While they are all very
Back Surgery and Hospital charges $15,000 $1,500 Deductible Met healthy and have their annual physical
$1,500 Coinsurance done each year, the three boys each
Physical Therapy $800 $0 Coinsurance had a sick ofice visit. One child had
Prescription Drugs (12 generic) $150 $120 Copay to go to the emergency room but was
Total Medical Expenses $3,580 released the same day. Mr. John Allen
Total Copays $330 had major back surgery this year and
Total Deductible $1,750 had to complete ten physical therapy
Total Coinsurance $1,500 visits. Let’s take a look at the coverage
Less Deductible & Coinsurance expenses paid from HRA -$1,500 and costs of each plan.
Annual Premium Cost ($71.54 per pay period) $1,860
Total Annual Member Cost $3,940
The Allen family is responsible for copays. They used all the HRA
money and will complete the wellness activities in year two to begin
to build up savings in his HRA for the future.
HRA Rollover to next year $0
Option 2—PPO Plan
Allowed Member
Expenses Cost
Annual Physicals (Preventive 100%) $500 $0
Doctor's Ofice Visit (3 children sick) $255 $255 Deductible
Emergency Room Visit $400 $150 Copay
$250 Deductible
Back Surgery and Hospital charges $15,000 $750 Deductible Met
$1,500 Coinsurance
Physical Therapy $800 $0 Coinsurance
Prescription Drugs (12 generic) $150 $120 Copay
Total Medical Expenses $3,025
Total Copays $270
Total Deductible $1,255 This is an example. Your actual experience may
Total Coinsurance $1,500 vary. All expenses assume the use of in-network
providers. The medical copays, deductible, and
Annual Premium Cost ($149.54 per pay period) $3,888 coinsurance expenses will apply towards the
Total Annual Member Cost $6,913 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.
13
