Page 15 - SunWest EE Guide 09-19 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 Priority Select Full Network
Plan Name HMO HMO HSA PPO PPO
Annual Premium Cost
Employee Only $434.51 $1,662.76 $1,936.23 $2,176.01

Medical Expenses
Office Visit-Cough (Avg Cost=$100) $30 $30 $100 $25
Total Annual Cost $464.51 $1,692.76 $2,036.23 $2,201.01

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

Anthem Priority Select Full Network
Plan Name HMO HMO HSA PPO PPO
Annual Premium Cost
Employee + Children $3,278.16 $5,488.83 $6,557.20 $7,516.79
Medical Expenses
Emergency Room Visit (Avg Cost=$1,300) $200 $200 $1,300 $1,300
Office Visits-Cough/Rash (Avg Cost=$200) $60 $60 $200 $50
12 Generic Retail Rx (Avg Cost=$240) $120 $120 $240 $120
Total Annual Cost $3,658.16 $5,868.83 $8,317.20 $8,986.79

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

Anthem Priority Select Full Network
Plan Name HMO HMO HSA PPO PPO
Annual Premium Cost
Employee + Family $7,899.12 $11,706.45 $14,066.39 $16,195.45

Medical Expenses
Emergency Room Visit (Avg Cost=$1,300) $200 $200 $1,300 $1,300
Knee Surgery (Avg Cost=$20,000) $4,800 $4,800 $1,700 $4,960

Office Visit-Cough (Avg Cost=$100) $30 $30 $100 $25
12 Generic Retail Rx (Avg Cost=$240) $120 $120 $240 $120
Total Annual Cost $13,049.12 $16,856.45 $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 and copays. 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.

Employee Benefits 15