ODP - WellBalanced Benefits

Meet Nathan

Nathan has three children. He doesn't use tobacco products. He and his kids get their annual physicals and they use in-network doctors and pharmacies for their care. This is a bumpy year filled with ongoing health conditions, injuries, and medications.

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!

Nathan sees a specialist twice for an ongoing condition. He receives a new preferred brand prescription to help him better manage it. He fills it at the pharmacy, then refills it three times via mail order.

$200 visit x 2

$275 preferred brand x 1

$400 preferred brand mail order x 3

Nathan takes his daughter to the doctor to renew her allergy medication and he uses mail order to fill the prescription.

$125 visit x 1

$70 generic mail order x 1

Cost

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

$125 visit x 6

$25 generic x 12

This is the year of the sports injury at Nathan's house. They rack up three trips to urgent care and get three X-rays at outside facilities.

$250 visit x 3

$300 X-ray x 3

Nathan's son needs surgery to repair a badly injured knee. He is given three generic medications during his recovery.

$7,000 surgery

$25 generic x 3

His son also has to do physical therapy for a few months after the surgery.

$115 visit x 6

Nathan's total expenses

Nathan has incurred a total of $13,035 in expenses from providers and services. Now, let's see which plan would have been better for Him!

$13,035

in total expenses

Wait!

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

Remember, Nathan incurred $13,035 in total expenses from providers and services.

In the HSA Basic, Nathan's son reaches his individual out-of-pocket maximum, so the plan covers the rest of his care at 100% for the remainder of the year. In the HSA Plus, the family meets the deductible, then pays coinsurance for the rest of their care. In the PPO, Nathan pays copays for most of the family's care.

HSA Basic

HSA Plus

PPO

Costs paid by Nathan

$9,870

$7,322

$4,768

Paycheck contributions

$1,363

$2,520

$5,298

Nathan'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 Nathan!