ODP - WellBalanced Benefits

Meet Bill

Bill is single. He doesn't use tobacco products and gets his annual physical. He uses in-network doctors and pharmacies, but he's had a tough year.

Let's take a look…

Cost

He gets his free annual physical.

$125 visit x 1

100% paid by the company!

He starts to feel bad and goes to his primary care doctor several times. His doctor gives him some generic medications that he fills at the pharmacy.

$125 visit x 6

$25 generic x 3

His problem gets worse, so he sees a specialist six times. During a few of his visits, he is sent to an outside facility for lab work.

$200 visit x 6

$75 labs x 3

Cost

His condition gets worse and he goes to the ER twice.

$2,500 visit x 2

He ends up having inpatient surgery and staying in the hospital to treat his condition.

$25,000 surgery and hospital stay

He sees a physical therapist eight times to recover from his surgery and fills two new generic prescriptions through mail order.

$115 visit x 8

$70 generic mail order x 2

Bill's total expenses

Bill has incurred a total of $33,435 in expenses from providers and services. Now, let's see which plan would have been better for Him!

$33,435

in total expenses

Wait!

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

Remember, Bill incurred $33,435 in total expenses from providers and services.

Bill pays up to the out-of-pocket max in all three plans, then the rest of his care is covered at 100%.

HSA Basic

HSA Plus

PPO

Costs paid by Bill

$6,000

$5,250

Paycheck contributions

$120

$240

$3,480

Bill's HSA contributions

$250

$500

N/A

Company HSA contributions

($250)

($500)

N/A

And the winner is...

The HSA Basic is the winner for Bill!