ODP - WellBalanced Benefits

Meet Rosa

Rosa and her family get their annual physicals, and she doesn't use tobacco products. They use in-network doctors and pharmacies. But this is a tough year due to serious health conditions and a sports injury.

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!

All the kids get sick a few times. Each time they receive several generic prescriptions to help them get better.

$125 visit x 6

$25 generic x 15

Rosa sees a specialist every month for an ongoing condition. She also fills one generic and one preferred brand prescription by mail order four times to help her manage it.

$200 visit x 12

$70 generic mail order x 4

$400 preferred brand mail order x 4

Cost

Rosa's daughter is rushed to the ER and diagnosed with a serious condition. She's admitted to the hospital for two days of monitoring.

$2,500 visit x 1

$3,000 hospital stay x 2 days

Her daughter is getting worse, so her specialist schedules her for surgery.

$20,000 surgery

Rosa's son is injured playing sports and needs several physical therapy visits to recover.

$115 visit x 8

Rosa gets sick and goes to the ER. She is prescribed a generic prescription to recover. She fills it at the pharmacy twice.

$2,500 visit x 1

$25 generic x 2

Rosa's total expenses

Rosa has incurred a total of $37,875 in expenses from providers and services. Now, let's see which plan would have been better for Her!

$37,875

in total expenses

Wait!

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

Remember, Rosa incurred $37,875 in total expenses from providers and services.

In all three plans, Rosa's daughter reaches her individual out-of-pocket maximum, so the plan covers the rest of her care at 100% for the remainder of the year. In the HSA Basic, Rosa reaches her individual out-of-pocket maximum too.

HSA Basic

HSA Plus

PPO

Costs paid by Rosa

$13,670

$11,734

$9,963

Paycheck contributions

$1,363

$2,520

$5,298

Rosa's HSA contributions

$500

$1,000

N/A

Company HSA contributions

($500)

($1,000)

N/A

And the winner is...

The HSA Plus is the winner for Rosa!