Page 8 - 2015 Four Seasons Sante Fe/Vail Enrollment Guide
P. 8
The following examples help you compare costs under the different medical plans options. For a detailed, side-by-
side comparison of your medical plan options, refer to the 2015 Medical Plan Beneits Comparison included with
this kit.
Example of Annual Cost—Without Hospital Stay
As you can see in the illustration below, if you are generally healthy, the HSA is a lower cost option than the OAPIN.
However, when choosing a plan, you need to think about your medical needs for the next year.
Features HSA OAPIN
Single Family 1 Single Family 1
How much you pay per
year from your paycheck 2 $966 $3,352 $1,506 $4,746
4 visits to PCP 3 $520 $1,560 $100 $300
(Ded/Coinsurance) ($25 each visit)
1 visit to specialist 3 $200 $600 $50 $150
(Ded/Coinsurance) ($50 each visit)
HSA Funds ($500) ($1,000) N/A
Total for year $1,186 $4,512 $1,656 $5,196
1 Assuming three family members using the plan.
2 For illustrative purposes only. For actual paycheck contribution rates, log on to the My Four Seasons Beneits Center at
https://fsbeneits.fourseasons.com.
3 Assuming PCP is $130 and Specialist is $200 per visit.
Example of Annual Costs—With a Hospital Stay for One Family Member
In this illustration, an inpatient hospital stay will cost you less under the HSA Plan.
Features HSA OAPIN
Single Family Single Family
How much you pay per
year from your paycheck 1 $966 $3,352 $1,506 $4,746
Annual Deductible (In-Network) $1,500 $3,000 $300 $600
Coinsurance 20% 15%
Coinsurance for a $50,000 hospital stay $2,000 $4,000 $2,700 $5,400
(capped at (capped at (capped at (capped at
$3,500) $7,000) $3,000) $6,000)
HSA Funds ($500) ($1,000) N/A
Total for year $3,966 $9,352 $4,506 $10,746
Colour Elements
1 For illustrative purposes only. For actual paycheck contribution rates, log on to the My Four Seasons Beneits Center at
https://fsbeneits.fourseasons.com.
Logo & Logo Variations
My Four Seasons BENEFITS My Four Seasons 8
BENEFITS
Icon Image Elements Font Elements
Tandelle
Century Gothic
side comparison of your medical plan options, refer to the 2015 Medical Plan Beneits Comparison included with
this kit.
Example of Annual Cost—Without Hospital Stay
As you can see in the illustration below, if you are generally healthy, the HSA is a lower cost option than the OAPIN.
However, when choosing a plan, you need to think about your medical needs for the next year.
Features HSA OAPIN
Single Family 1 Single Family 1
How much you pay per
year from your paycheck 2 $966 $3,352 $1,506 $4,746
4 visits to PCP 3 $520 $1,560 $100 $300
(Ded/Coinsurance) ($25 each visit)
1 visit to specialist 3 $200 $600 $50 $150
(Ded/Coinsurance) ($50 each visit)
HSA Funds ($500) ($1,000) N/A
Total for year $1,186 $4,512 $1,656 $5,196
1 Assuming three family members using the plan.
2 For illustrative purposes only. For actual paycheck contribution rates, log on to the My Four Seasons Beneits Center at
https://fsbeneits.fourseasons.com.
3 Assuming PCP is $130 and Specialist is $200 per visit.
Example of Annual Costs—With a Hospital Stay for One Family Member
In this illustration, an inpatient hospital stay will cost you less under the HSA Plan.
Features HSA OAPIN
Single Family Single Family
How much you pay per
year from your paycheck 1 $966 $3,352 $1,506 $4,746
Annual Deductible (In-Network) $1,500 $3,000 $300 $600
Coinsurance 20% 15%
Coinsurance for a $50,000 hospital stay $2,000 $4,000 $2,700 $5,400
(capped at (capped at (capped at (capped at
$3,500) $7,000) $3,000) $6,000)
HSA Funds ($500) ($1,000) N/A
Total for year $3,966 $9,352 $4,506 $10,746
Colour Elements
1 For illustrative purposes only. For actual paycheck contribution rates, log on to the My Four Seasons Beneits Center at
https://fsbeneits.fourseasons.com.
Logo & Logo Variations
My Four Seasons BENEFITS My Four Seasons 8
BENEFITS
Icon Image Elements Font Elements
Tandelle
Century Gothic
