Meet Simone

Simone's 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 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.

$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 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.

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

Her husband's specialist schedules him for in-patient surgery given his condition is getting worse. The surgery results two days in the ICU.

$50,000 surgery with two days in the ICU

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

$150 visits 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 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 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 $86,440 in total expenses.

In all the plans Simone pays up to the family out-of-pocket max, 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
$5,888
$7,360
$11,040
Employee HSA contributions
$1,000
$1,000
N/A
Company-provided 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
$5,888
$7,360
$11,040
Employee HSA contributions
$1,000
$1,000
N/A
Company-provided contributions
($1,000)
($1,000)
N/A
Simone
's
 total cost
$19,888
$17,360
$24,040

For more information about the medical plans, review the Benefits Guide. Remember, this is an example, your actual costs may vary.