ODP - WellBalanced Benefits

Meet Sanjay

Sanjay's family is usually in good health. They don't use tobacco products, 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 $4,110 in expenses from providers and services. Now, let's see which plan would have been better for Him!

$4,110

in total expenses

Wait!

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

Remember, Sanjay incurred $4,110 in total expenses from providers and services.

In the HSA plans, Sanjay pays for his care out-of-pocket, while in the PPO, he pays copays.

HSA Basic

HSA Plus

PPO

Costs paid by Sanjay

$3,610

$1,198

Paycheck contributions

$3,327

$3,720

$7,800

Sanjay'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 Sanjay!