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Benchmarking │ Plan Design
Single
Single Out-of-Pocket
In-Network Deductible
Max (Includes Deductible)
$0
10%
< $2,000
15%
$1 - $499
18%
$2,000 - $2,999
25%
$500 - $999
23%
$3,000 - $4,999
40%
$1000 - $1999
29%
$5,000 +
20%
$2,000 +
20%
Unlimited
0%
Primary Care Office Visit
Employee Coinsurance (for most
services)
Specialist Office Visit
<$19 Copay
8%
< $30 Copay
11%
$20 - $24 Copay
17%
0%
17%
$30 - $39 Copay
15%
$25 - $29 Copay
19%
1% - 19%
28%
$40 - $49 Copay
18%
$30 - $34 Copay
12%
20% - 29%
49%
$50 +
17%
$35 +
7%
30% +
6%
Coinsurance
39%
Coinsurance
37%
Average Retail Prescription
Drug Copays (30 day Supply)
Average Mail Order Prescription Drug
Copays (90 day Supply)
Preferred Generic
$11
Source: Health and Well-Being Touchstone
Survey Results PwC (PricewaterhouseCoopers)
2016
Preferred Generic
$21
Non-Pref. Generic
$16
Non-Pref. Generic
$29
Brand (Formulary)
$35
Brand (Formulary)
$63
Brand (Non-Form.)
$48
Brand (Non-Form.)
$98
Preferred Specialty
$58
Preferred Specialty
$93
Non-Pref. Specialty
$64
Non-Pref. Specialty
$113