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6
MEDICAL PLANS
How do I know which medical plan is right for me?
Unsure which medical plan option is the best fit for your needs? Take a moment to review the utilization
scenarios below. The top scenario represents a low to average utilizer and the bottom scenario represents a
high utilizer. While the examples below represent an employee with single coverage, the impact would be
similar at other tiers of coverage (employee + spouse, employee + child(ren) or family). The charts below
illustrate projected total annual cost under each plan option.
Employee Only
Claim Activity
Fund Your Cost
Fund Your Cost
Fund Your Cost
PCT Fund Your Cost
PCT Annual Contribution
$1,000
6 Regular Office Visits
(estimated $70 each)
$150
$150
$180
($420)
$0
Preventive Office Visits
$0
$0
$0
$0
$0
1 Specialty Office Visits
(estimated $100 cost)
$25
$40
$30
($100)
$0
4 Mail Order Prescriptions
(Tier 2; estimated $125 each)
$240
$250 Rx ded +
$240 copay
$360
($480) max
$20
1 Emergency Room Visit
(estimated $500)
$100
$150 copay +
$500 ded
$150 copay +
$100 coins
$0
$500 ded
TOTALS
$515
$1,330
$820
($1,000)
$520
Employee Annual Contributions N/A $2,907
N/A $5,057
N/A $7,421
N/A
$6,546
$3,422
$6,387
$8,241
$7,066
Claim Activity
Fund Your Cost
Fund Your Cost
Fund Your Cost
PCT Fund Your Cost
PCT Annual Contribution
$1,000
6 Regular Office Visits
(estimated $70 each)
$150
$150
$180
($420)
$0
Preventive Office Visits
$0
$0
$0
$0
$0
1 Specialty Office Visits
(estimated $100 cost)
$25
$40
$30
($100)
$0
4 Mail Order Prescriptions
(Tier 2; estimated $125 each)
$240
$250 Rx ded +
$240 copay
$360
($480) max
$20
1 Inpatient Hospitalization
(estimated $20,000)
$250 copay
$1,500 ded +
$820 coins max
$750 ded +
$3,680 coins max
Fund
exhausted
$1,000 ded +
$2,980 coins max
TOTALS
$665
$3,000
$5,000
($1,000)
$4,000
Employee Annual Contributions N/A $2,907
N/A $5,057
N/A $7,421
N/A
$6,546
$3,572
$8,057
$12,421
$10,546
Employee Only
HMO
PPO
HIA
Anthem BCBS
Anthem BCBS
Anthem BCBS
PPO
HIA
Anthem BCBS
Anthem BCBS
Anthem BCBS
HMO
Kaiser
HMO
Kaiser
HMO