ODP - WellBalanced Benefits

Meet Nicole

Nicole's family is usually in good health. She doesn't use tobacco products, and they get their annual physicals. They use in-network doctors and pharmacies. 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 a few rashes that won't go away. Each trip includes a few generic prescriptions.

$125 visit x 8

$25 generic x 10

Cost

Nicole has a condition that's managed through medication, but it requires an expensive preferred brand drug to manage it. She fills her prescription through mail order.

$400 preferred brand mail order x 4

One of the kids has allergies and begins taking a generic medication. Nicole fills it once at the pharmacy then switches to mail order for the rest of the year.

$25 generic x 1

$70 generic mail order x 2

Nicole's total expenses

Nicole has incurred a total of $3,515 in expenses from providers and services. Now, let's see which plan would have been better for Her!

$3,515

in total expenses

Wait!

We also need to remember that Nicole has been paying for medical coverage from Her paycheck too and contributing to her HSA in those plans. We'll add that in.

Remember, Nicole incurred $3,515 in total expenses from providers and services.

In HSA plans, Nicole pays for her care out-of-pocket, while in the PPO, she pays copays and coinsurance.

HSA Basic

HSA Plus

PPO

Costs paid by Nicole

$3,015

$953

Paycheck contributions

$960

$1,800

$4,500

Nicole's HSA contributions

$500

$1,000

N/A

Company HSA contributions

($500)

($1,000)

N/A

And the winner is...

The HSA Basic is the winner for Nicole!