ODP - WellBalanced Benefits

Meet Gabrielle

Gabrielle is married. She and her husband don't use tobacco products and they get their annual physicals. They use in-network doctors and pharmacies; however, this is a rough year for the couple.

Let's take a look…

Cost

They both get their physicals.

$125 visit x 2

100% paid by the company!

Her husband sees his doctor to renew a generic medication he takes for an ongoing condition. He uses mail order to fill it.

$125 visit x 1

$70 generic mail order x 4

Gabrielle has been putting off knee surgery for a while. She goes to the doctor three times for knee pain and fills a generic prescription twice at the pharmacy.

$125 visit x 3

$25 generic x 2

Gabrielle's husband is in a car accident and is taken to the ER.

$2,500 visit x 1

He is sent home from the ER, but a few weeks later, he ends up having surgery due to his injuries.

$20,000 surgery

Cost

Gabrielle's knee continues to bother her, so she goes to see a specialist several times. The specialist prescribes her a generic medication for the pain that she fills at the pharmacy twice.

$200 visit x 4

$25 generic x 2

Gabrielle goes to physical therapy for a few months for her knee issue.

$115 visit x 8

Physical therapy doesn't help, so her doctor schedules her for knee replacement surgery.

$10,000 surgery

After her surgery, Gabrielle sees the specialist two more times and goes to physical therapy for a few months to recover.

$200 visit x 2

$115 visit x 8

Gabrielle's total expenses

Gabrielle has incurred a total of $36,670 in expenses from providers and services. Now, let's see which plan would have been better for Her!

$36,670

in total expenses

Wait!

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

Remember, Gabrielle incurred $36,670 in total expenses from providers and services.

In all three plans, Gabrielle's 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. In the HSA Basic, Gabrielle reaches her individual out-of-pocket maximum too.

HSA Basic

HSA Plus

PPO

Costs paid by Gabrielle

$12,000

$9,053

$9,508

Paycheck contributions

$3,478

$4,416

$8,652

Gabrielle'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 Gabrielle!