Page 14 - SunWest EE Guide 09-19 Outside CA

CASE STUDIES: PLAN COSTS

Curious how these plans stack up against one another in cost and out of pocket medical
expenses? Below is a side-by-side look at a couple case studies for your review.

Case #1: Single employee in good health | Rarely uses plan

Anthem
Plan Name HRA PPO HSA PPO PPO
Annual Premium Cost
Employee Only $0.00 $1,936.23 $2,176.01

Medical Expenses
Office Visit-Cough (Avg Cost=$100) $100 $100 $25
Total Annual Cost $100 $2,036.23 $2,201.01

Case #2: Employee + Child Coverage | ER Visit & 2 Office Visits, 12 Generic Rx

Anthem
Plan Name HRA PPO HSA PPO PPO
Annual Premium Cost
Employee + Children $3,066.90 $6,557.20 $7,516.79
Medical Expenses
Emergency Room Visit (Avg Cost=$1,300) $1,300 $1,300 $1,300
Office Visits-Cough/Rash (Avg Cost=$200) $200 $200 $50
12 Generic Retail Rx (Avg Cost=$240) $240 $240 $120
Total Annual Cost $4,806.90 $8,317.20 $8,986.79

Case #3: Family Coverage | ER Visit & Surgery, Office Visit, 12 Generic Rx

Anthem
Plan Name HRA PPO HSA PPO PPO
Annual Premium Cost
Employee + Family $8,050.80 $14,066.39 $16,195.45

Medical Expenses
Emergency Room Visit (Avg Cost=$1,300) $1,300 $1,300 $1,300
Knee Surgery (Avg Cost=$20,000) $5,360 $1,700 $4,960

Office Visit-Cough (Avg Cost=$100) $100 $100 $25
12 Generic Retail Rx (Avg Cost=$240) $240 $240 $120
Total Annual Cost $15,050.80 $17,406.39 $22,600.45

NOTE: Each of these case studies is an example of the cost of care that takes into consideration per-member out of pocket
limits, deductibles, copays, and any employer HRA funding. The “Avg Cost” is consideration of what a potential negotiated cost
for care would be in each scenario and would likely differ depending on your region and provider chosen.

Did you know?
An annual preventive care exam is covered at no cost on all of the medical plans.

14 Employee Benefits