Page 12 - 2015 OE Sample Guidebook
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Example 2—FAMILY Coverage
John is married with two children, and elected Family coverage at [Client]. Both
John and his wife took advantage of earning Activity Based Wellness Dollars by
completing a health risk assessment, a biometric screen, a dental checkup, and an
annual physical. They also received a lu shot, completed a health improvement
program and did not use tobacco products. In doing so John and his wife each
earned $700 Wellness Dollars, for a total of $1,400 to use in offsetting any family
deductible medical costs they might experience. The children also had their well
child exams, with charges paid at 100% and no out-of-pocket costs.
John and his family ended up having 12 ofice visits for the following:
Various colds, sore throats, and some minor cuts/bruises
There were two situations during the year that required emergency care, resulting
in an emergency room visit both times.
The whole family had to ill various prescriptions, resulting in 48 ills for the year.
36 of the prescriptions were illed at the generic copay, which helped the family
budget. The remaining 12 prescriptions were Brand Formulary.
The family had various outpatient tests and services that resulted in approximately
$12,000 that were not covered by an ofice visit copay and were outside a wellness
beneit.
Let’s compare John’s out-of-pocket expenses for the year under the two [Client]
health 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.)
Emergency Room Visit $200 copay $500 (assumes an ER visit cost of $500, there is no copay)
Generic Prescription $10 copay $25 (assumes script is $25, there is no copay)
Brand Name Formulary Prescription $25 copay $150 (assumes script is $150, there is no copay)
(Generic Not Available)
John and Family’s Activity and out-of-pocket costs
12 Doctor Ofice Visits $300 $1,200
2 Emergency Room Visits $500 $1,000
36 Prescriptions Filled—Generic $360 $900
12 Prescriptions Filled—Brand Name Formulary $300 $1,480*
$12,000 In Additional Medical Expenses $4,200 $2,400*
EMPLOYEE’S ANNUAL PREMIUM $6,204 $3,324
[CLIENT] ACTIVITY BASED WELLNESS ($1,400) ($1,400)
DOLLARS CONTRIBUTION
NET EMPLOYEE OUT-OF-POCKET EXPENSES $10,464 $8,904
In this example, John’s family annual out-of-pocket costs under the HSA plan were less for the same services covered by the HRA
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 $4,500 satisied, coinsurance applies
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John is married with two children, and elected Family coverage at [Client]. Both
John and his wife took advantage of earning Activity Based Wellness Dollars by
completing a health risk assessment, a biometric screen, a dental checkup, and an
annual physical. They also received a lu shot, completed a health improvement
program and did not use tobacco products. In doing so John and his wife each
earned $700 Wellness Dollars, for a total of $1,400 to use in offsetting any family
deductible medical costs they might experience. The children also had their well
child exams, with charges paid at 100% and no out-of-pocket costs.
John and his family ended up having 12 ofice visits for the following:
Various colds, sore throats, and some minor cuts/bruises
There were two situations during the year that required emergency care, resulting
in an emergency room visit both times.
The whole family had to ill various prescriptions, resulting in 48 ills for the year.
36 of the prescriptions were illed at the generic copay, which helped the family
budget. The remaining 12 prescriptions were Brand Formulary.
The family had various outpatient tests and services that resulted in approximately
$12,000 that were not covered by an ofice visit copay and were outside a wellness
beneit.
Let’s compare John’s out-of-pocket expenses for the year under the two [Client]
health 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.)
Emergency Room Visit $200 copay $500 (assumes an ER visit cost of $500, there is no copay)
Generic Prescription $10 copay $25 (assumes script is $25, there is no copay)
Brand Name Formulary Prescription $25 copay $150 (assumes script is $150, there is no copay)
(Generic Not Available)
John and Family’s Activity and out-of-pocket costs
12 Doctor Ofice Visits $300 $1,200
2 Emergency Room Visits $500 $1,000
36 Prescriptions Filled—Generic $360 $900
12 Prescriptions Filled—Brand Name Formulary $300 $1,480*
$12,000 In Additional Medical Expenses $4,200 $2,400*
EMPLOYEE’S ANNUAL PREMIUM $6,204 $3,324
[CLIENT] ACTIVITY BASED WELLNESS ($1,400) ($1,400)
DOLLARS CONTRIBUTION
NET EMPLOYEE OUT-OF-POCKET EXPENSES $10,464 $8,904
In this example, John’s family annual out-of-pocket costs under the HSA plan were less for the same services covered by the HRA
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 $4,500 satisied, coinsurance applies
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