Page 11 - 2015 OE Sample Guidebook
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COMPARING PLANS: OUT-OF-POCKET COST EXAMPLES
Example 1—SINGLE Coverage
Chris elected Single coverage at [Client]. Chris took advantage of earning Activity Based
Wellness Dollars by completing a health risk assessment, a biometric screening, a dental On the following pages are
check up, and an annual physical. He also received a lu shot, and completed a health
improvement program, which enabled him to reduce his cholesterol to a recommended hypothetical examples of
level, and did not use tobacco products. This provided Chris $700 of earned Wellness Medical coverage chosen for
Dollars to use to offset any deductible medical costs that he might experience. either the HRA Plan or the HSA
Chris ended up having four ofice visits for the following: Plan. Frequency of ofice visits
He developed an ear infection and was treated once by his family physician and Rx ills may vary. Only
He developed migraine headaches and saw his family physician twice refer to these examples as
general guidelines to assist you
Months later he had a bad sore throat, and knowing it wasn't an emergency, he didn't in understanding your potential
go to the Emergency Room, but back to his family doctor, which saved him the higher out-of-pocket costs for the
cost and expense at the Emergency Room Medical and Rx coverage for
In addition to his ofice visits Chris had to ill various prescriptions resulting in 24 ills for 2014.
the year. Most scripts were due to the illness listed above and another for his cholesterol
maintenance drug which he takes regularly. Chris spoke with his doctor and requested a All examples are based on the
generic script when available, which ended up being half of the time. assumption that the services
Chris also had outpatient tests, which resulted in approximately $500 in charges that were listed, including the pharmacy,
not covered by an ofice visit copay and were not covered under the wellness beneit. are from In-Network,
Let’s compare Chris’ out-of-pocket expenses for the year under the two [Client] health participating providers only.
plans. All services listed, including the pharmacy, are from in-network participating providers
only.
Cost Examples Option 1— Option 2—HSA Plan
HRA Plan
Ofice Visit (Family Practice Physician) $25 copay $100 (assumes ofice visit cost of $100, there is no copay)
Generic Prescription $10 copay $25 (assumes Rx is $25, there is no copay)
Brand Name Formulary Prescription $25 copay $150 (assumes Rx is $150, there is no copay)
(Generic Not Available)
Chris’ Activity and out-of-pocket costs
Four Doctor ofice visits $100 $400
12 Prescriptions illed—Generic $120 $300
12 Prescriptions illed—Brand Name Formulary $300 $1,600*
$500 in additional medical expenses $500 $100*
EMPLOYEE’S ANNUAL PREMIUM $2,088 $1,032
[CLIENT] ACTIVITY BASED WELLNESS ($700) ($700)
DOLLARS CONTRIBUTION
NET EMPLOYEE OUT-OF-POCKET EXPENSES $2,408 $2,732
In this example, Chris’ annual out-of-pocket costs under the HRA Plan were less for the same services covered by the HSA Plan.
This is an example. Your actual experience will vary depending on your frequency of ofice visits, prescription ills, and other medical
expenses.
* Deductible of $2,250 satisied, coinsurance applies
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Example 1—SINGLE Coverage
Chris elected Single coverage at [Client]. Chris took advantage of earning Activity Based
Wellness Dollars by completing a health risk assessment, a biometric screening, a dental On the following pages are
check up, and an annual physical. He also received a lu shot, and completed a health
improvement program, which enabled him to reduce his cholesterol to a recommended hypothetical examples of
level, and did not use tobacco products. This provided Chris $700 of earned Wellness Medical coverage chosen for
Dollars to use to offset any deductible medical costs that he might experience. either the HRA Plan or the HSA
Chris ended up having four ofice visits for the following: Plan. Frequency of ofice visits
He developed an ear infection and was treated once by his family physician and Rx ills may vary. Only
He developed migraine headaches and saw his family physician twice refer to these examples as
general guidelines to assist you
Months later he had a bad sore throat, and knowing it wasn't an emergency, he didn't in understanding your potential
go to the Emergency Room, but back to his family doctor, which saved him the higher out-of-pocket costs for the
cost and expense at the Emergency Room Medical and Rx coverage for
In addition to his ofice visits Chris had to ill various prescriptions resulting in 24 ills for 2014.
the year. Most scripts were due to the illness listed above and another for his cholesterol
maintenance drug which he takes regularly. Chris spoke with his doctor and requested a All examples are based on the
generic script when available, which ended up being half of the time. assumption that the services
Chris also had outpatient tests, which resulted in approximately $500 in charges that were listed, including the pharmacy,
not covered by an ofice visit copay and were not covered under the wellness beneit. are from In-Network,
Let’s compare Chris’ out-of-pocket expenses for the year under the two [Client] health participating providers only.
plans. All services listed, including the pharmacy, are from in-network participating providers
only.
Cost Examples Option 1— Option 2—HSA Plan
HRA Plan
Ofice Visit (Family Practice Physician) $25 copay $100 (assumes ofice visit cost of $100, there is no copay)
Generic Prescription $10 copay $25 (assumes Rx is $25, there is no copay)
Brand Name Formulary Prescription $25 copay $150 (assumes Rx is $150, there is no copay)
(Generic Not Available)
Chris’ Activity and out-of-pocket costs
Four Doctor ofice visits $100 $400
12 Prescriptions illed—Generic $120 $300
12 Prescriptions illed—Brand Name Formulary $300 $1,600*
$500 in additional medical expenses $500 $100*
EMPLOYEE’S ANNUAL PREMIUM $2,088 $1,032
[CLIENT] ACTIVITY BASED WELLNESS ($700) ($700)
DOLLARS CONTRIBUTION
NET EMPLOYEE OUT-OF-POCKET EXPENSES $2,408 $2,732
In this example, Chris’ annual out-of-pocket costs under the HRA Plan were less for the same services covered by the HSA Plan.
This is an example. Your actual experience will vary depending on your frequency of ofice visits, prescription ills, and other medical
expenses.
* Deductible of $2,250 satisied, coinsurance applies
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