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.

$150 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. They fill each prescription at the pharmacy.

$150 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.

$250 visit x 24
$500 preferred brand mail order x 2 x 4

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.

$2,000 visit x 1
$20,000 hospital stay

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

$50,000 surgery and ICU stay

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

$150 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 though mail order.

$25 generic x 2
$20 generic mail order x 2

Simone’s total expenses

Simone has incurred a total of $86,440 in expenses. Now, let’s see which plan would have been better for Her.

$86,440

in total expenses

Wait!

Simone has also been paying for medical coverage from Her paycheck and contributing to Her HSA. We’ll add that in.

Remember, Simone incurred $86,440 in total expenses.

In all the plans, Simone pays up to the family out-of-pocket maximum, then the rest of her family’s care is covered at 100% for the remainder of the year.

HSA Core
HSA Value
Copay PPO
Costs paid by
 
Simone
$14,000
$10,000
$13,000
Paycheck deductions
$4,045
$5,451
$8,176
Employee HSA contributions
$1,000
$1,000
N/A
Company-provided HSA contributions
($1,000)
($1,000)
N/A

And the winner is...

The HSA Value is the winner for Simone!
HSA Core
HSA Value
Copay PPO
Costs paid by
 
Simone
$14,000
$10,000
$13,000
Paycheck deductions
$4,045
$5,451
$8,176
Employee HSA contributions
$1,000
$1,000
N/A
Company-provided HSA contributions
($1,000)
($1,000)
N/A
Simone
’s
 total cost
$18,045
$15,451
$21,176

For more information about the LSC Medical Plans, review the Benefits eGuide. Remember, this is an example and your actual costs may vary.