Page 45 - 2020 Barrister Employee Benefits Book

copayments and plans. Please $3,500 30% 30% 30% (including medical supplies) (crutches) (physical therapy) $1,900 $1,600 $100 $0 $0 $1,700 6 of 6

plan. Use this information to compare the portion of costs you might pay under different health
cost sharing amounts (deductibles, plan might cover medical care. Your actual costs will be different depending Mia’s Simple Fracture (in-network emergency room visit and follow up care) deductible plan's overall The coinsurance Emergency room coinsurance Hospital (facility) coinsurance Other This EXAMPLE event includes services like: Emergency room care (x-ray) Diagnostic test Durable medical equipment Rehabilitation services Total Example Cost In this

providers charge, and many other factors. Focus on the

$3,500 $60 30% 30% $7,400 $1,900 $1,400 $0 $60 $3,360

Managing Joe’s type 2 Diabetes (a year of routine in-network care of a well-controlled condition) deductible copayment coinsurance This EXAMPLE event includes services like: Primary care physician office visits (including disease (blood work) (glucose meter) Cost Sharing What isn't covered plan would be responsible for the other costs of these EXAMPLE covered services.

Treatments shown are just examples of how this

The plan's overall Specialist Hospital (facility) coinsurance Other education) Diagnostic tests Prescription drugs Durable medical equipment Total Example Cost In this example, Joe would pay: Deductibles Copayments Coinsurance Limits or exclusions The total Joe would pay is
excluded services under the on the actual care you receive, the prices your note these coverage examples are based on self-only coverage. $3,500 $60 30% 30% $12,700 $3,500 $100 $2,700 $60 $6,360 The

About these Coverage Examples: This is not a cost estimator. coinsurance) and Peg is Having a Baby (9 months of in-network pre-natal care and a hospital delivery) deductible plan's overall The copayment Specialist coinsurance Hospital (facility) coinsurance Other This EXAMPLE event includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood