Meet Sanjay

Sanjay's family is usually in good health. They don't smoke, and they get their annual physicals. They use in-network doctors and pharmacies. Except for a few expensive medications, they have a pretty smooth year.  

Let's take a look…

Cost

All of the family members get their physicals and the kids get their immunizations.

$125 visit x 4

100% paid by the company!

A few of them go to the doctor for the flu. The kids also go to the doctor a few times for sinus infections and some rashes that won't go away. Each trip includes a few generic prescriptions.

$125 visit x 8

$25 generic x 16

Cost

Sanjay develops a condition that requires a preferred brand medication. Sanjay fills it twice at the pharmacy and then switches to mail order.

$275 preferred brand retail x 2

$400 preferred brand mail order x 3

His wife starts feeling ill, so she goes to the doctor. After testing, the doctor prescribes her a generic medication. She fills it twice at the pharmacy then switches to mail order for the rest of the year.

$125 visit x 1

$75 labs x 1

$25 generic retail x 2

$70 generic mail order x 3

Sanjay's total expenses:

Sanjay has incurred a total of $4,135 in expenses from providers and services. Now, let’s see which plan would have been better for Him!

$4,135

in total expenses

Wait!
We also need to remember that Sanjay has been paying for medical coverage from His paycheck too. We'll add that in.
Remember, Sanjay incurred $4,135 in total expenses from providers and services.

In the HSA plan, Sanjay pays for His care out-of-pocket, while in the PPO plan, He pays copays for most of His care.

PPO
HSA
Costs paid by
 
Sanjay
$1,011
$3,115
Paycheck contributions
$9,864
$6,852
Company contributions
N/A
($500)

And the winner is...

The PPO plan is the winner for Sanjay!

In the HSA plan, Sanjay pays for His care out-of-pocket, while in the PPO plan, He pays copays for most of His care.

PPO
HSA
Costs paid by
 
Sanjay
$1,011
$3,115
Paycheck contributions
$9,864
$6,852
Company contributions
N/A
($500)
Sanjay
's
 total cost
$10,875
$8,967