ODP - WellBalanced Benefits

Meet Simone

Simone and her family get their annual physicals, and they don'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 5

100% paid by the company!

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

$125 visit x 9

$25 generic x 18

Simone's husband and her oldest son both see a specialist monthly for ongoing conditions. To manage their conditions, they are each prescribed a preferred brand medication. Simone fills each prescription four times through mail order.

$200 visit x 24

$400 preferred brand mail order x 8

Cost

Simone's infant daughter has a serious case of bronchitis and is taken to the ER. They keep her in the hospital for two days of observation.

$2,500 visit x 1

$2,000 hospital stay x 2 days

Her husband's specialist schedules him for inpatient surgery, as his condition is getting worse. The surgery results in two days in the ICU.

$25,000 surgery

$6,000 ICU x 2 days

Her oldest son is injured badly during a soccer tournament. He goes to physical therapy 12 times for the injury.

$115 visit x 12

Her oldest son is also prescribed a generic pain medication during his recovery. Simone fills it twice at the pharmacy and then twice through mail order.

$25 generic x 2

$70 generic mail order x 2

Simone's total expenses

Simone has incurred a total of $55,270 in expenses from providers and services. Now, let's see which plan would have been better for Her!

$55,270

in total expenses

Wait!

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

Remember, Simone incurred $55,270 in total expenses from providers and services.

In the HSA Basic, Simone's family reaches the $17,400 family out-of-pocket maximum. In the HSA Plus and PPO, her husband reaches his individual out-of-pocket maximum, so the plan covers the rest of his care at 100% for the remainder of the year.

HSA Basic

HSA Plus

PPO

Costs paid by Simone

$17,400

$11,641

$11,403

Paycheck contributions

$3,327

$3,720

$7,800

Simone'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 Simone!