Page 7 - 2017 Benefits Enrollment
P. 7
Dentsu Aegis Network (DAN)
Medical Plan Highlights
In 2017, you will coninue to have four plan opions through United Healthcare, the High Deducible
Health Plan w/HSA provides you with the lowest premium cost. For a more detailed comparison of the
medical plans visit DAN beneitsPLUS website (where you can also access a link to UHC’s pre-enrollment
site, Healthcare Lane, and more comprehensive medical plan summaries).
High Deducible
Standard Plan Enhanced Plan Premium Plan Health Plan (HDHP) ****
Out-of-
Out-of-
Out-of-
Out-of-
Plan Feature* In-Network Network In-Network Network In-Network Network In-Network Network
Employee Contribuions Per Pay Period
Employee $55.09 $92.05 $126.12 $29.14
Employee + $124.24 $213.13 $313.51 $77.90
Spouse
Employee + $110.78 $190.89 $278.41 $69.04
Child(ren)
Family $207.48 $355.21 $522.31 $129.84
Deducible
Individual $1,000 $2,000 $500 $1,000 $350 $700 $2,000 $4,000
Family $2,000 $4,000 $1,000 $2,000 $700 $1,400 $4,000 $8,000
HSA Account Funding
Individual/
Family N/A N/A N/A $500/$1,000
Out-of-Pocket Max**
Individual $4,000 $8,000 $4,000 $8,000 $3,000 $6,000 $4,000 $12,000
Family $8,000 $16,000 $8,000 $16,000 $6,000 $12,000 $6,850 $24,000
Plan
Coinsurance 80% 60% 90% 80% 100% 80% 80% 60%
Oice Visit Copay
Prevenive Free Ded. and Free Ded. and Free Ded. and Free Ded. and
Coin.
Coin.
Coin.
Coin.
Virtual Visits $15 Not Covered $15 Not Covered $15 Not Covered Ded. and Not Covered
Coin.
Primary Care $30 Ded. and $30 Ded. and $30 Ded. and Ded. and Ded. and
Coin.
Coin.
Coin.
Coin.
Coin.
Specialist $50 Ded. and $50 Ded. and $50 Ded. and Ded. and Ded. and
Coin. Coin. Coin. Coin. Coin.
Hospital Facility
Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and
Inpaient Coin. Coin. Coin. Coin. Coin. Coin. Coin. Coin.
Outpaient Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and
Coin.
Coin.
Coin.
Coin.
Coin.
Coin.
Coin.
Coin.
Emergency
Room Copay $250 $250 $250 Ded. and Coin.
7
Medical Plan Highlights
In 2017, you will coninue to have four plan opions through United Healthcare, the High Deducible
Health Plan w/HSA provides you with the lowest premium cost. For a more detailed comparison of the
medical plans visit DAN beneitsPLUS website (where you can also access a link to UHC’s pre-enrollment
site, Healthcare Lane, and more comprehensive medical plan summaries).
High Deducible
Standard Plan Enhanced Plan Premium Plan Health Plan (HDHP) ****
Out-of-
Out-of-
Out-of-
Out-of-
Plan Feature* In-Network Network In-Network Network In-Network Network In-Network Network
Employee Contribuions Per Pay Period
Employee $55.09 $92.05 $126.12 $29.14
Employee + $124.24 $213.13 $313.51 $77.90
Spouse
Employee + $110.78 $190.89 $278.41 $69.04
Child(ren)
Family $207.48 $355.21 $522.31 $129.84
Deducible
Individual $1,000 $2,000 $500 $1,000 $350 $700 $2,000 $4,000
Family $2,000 $4,000 $1,000 $2,000 $700 $1,400 $4,000 $8,000
HSA Account Funding
Individual/
Family N/A N/A N/A $500/$1,000
Out-of-Pocket Max**
Individual $4,000 $8,000 $4,000 $8,000 $3,000 $6,000 $4,000 $12,000
Family $8,000 $16,000 $8,000 $16,000 $6,000 $12,000 $6,850 $24,000
Plan
Coinsurance 80% 60% 90% 80% 100% 80% 80% 60%
Oice Visit Copay
Prevenive Free Ded. and Free Ded. and Free Ded. and Free Ded. and
Coin.
Coin.
Coin.
Coin.
Virtual Visits $15 Not Covered $15 Not Covered $15 Not Covered Ded. and Not Covered
Coin.
Primary Care $30 Ded. and $30 Ded. and $30 Ded. and Ded. and Ded. and
Coin.
Coin.
Coin.
Coin.
Coin.
Specialist $50 Ded. and $50 Ded. and $50 Ded. and Ded. and Ded. and
Coin. Coin. Coin. Coin. Coin.
Hospital Facility
Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and
Inpaient Coin. Coin. Coin. Coin. Coin. Coin. Coin. Coin.
Outpaient Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and Ded. and
Coin.
Coin.
Coin.
Coin.
Coin.
Coin.
Coin.
Coin.
Emergency
Room Copay $250 $250 $250 Ded. and Coin.
7
