ODP - WellBalanced Benefits

Meet Patel

Patel and his family get their annual physicals and they don't use tobacco products. They use in-network doctors and pharmacies. This year he and the family get sick several times, and it turns out to be a bumpy 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!

Patel sees a specialist twice for an ongoing condition. The doctor gives him two generic medications that he fills at the pharmacy. They do not work, so the doctor switches him to a preferred brand medication that he fills at the pharmacy.

$200 visit x 2

$25 generic x 2

$275 preferred brand x 1

Patel's wife and son are prescribed medications for the year. Patel fills the prescriptions at the pharmacy then switches to mail order.

$25 generic x 4

$70 generic mail order x 6

Cost

Everyone gets sick a few times. Each time they receive multiple generic prescriptions to help them get better.

$125 visit x 10

$25 generic x 22

Patel's condition gives him trouble throughout the year and he has three trips to urgent care. He gets three X-rays at outside imaging facilities.

$250 visit x 3

$300 X-ray x 3

Patel's daughter breaks her arm on the playground. The break is serious and requires outpatient surgery. The doctor gives her a generic prescription to manage the pain.

$7,000 outpatient surgery

$25 generic x 1

Patel does physical therapy for a few months to help manage his condition.

$115 visit x 6

Patel's total expenses

Patel has incurred a total of $12,910 in expenses from providers and services. Now, let's see which plan would have been better for Him!

$12,910

in total expenses

Wait!

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

Remember, Patel incurred $12,910 in total expenses from providers and services.

In the HSA Plus, Patel meets the deductible, then pays coinsurance for the rest of his family's care. In the HSA Basic, he pays out of his pocket for care and in the PPO, he pays copays for most of his family's care.

HSA Basic

HSA Plus

PPO

Costs paid by Patel

$10,860

$7,287

$5,675

Paycheck contributions

$2,520

$3,000

$7,320

Patel'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 Patel!