Sofia and Ricardo


Sofia doesn’t go to the doctor that often, but Ricardo is monitored for a chronic condition. They both get annual physicals, which are covered in full. Ricardo goes to the doctor for frequent check-ups to monitor his high blood pressure, and his doctor expects that medication will be needed in the near future. Let’s take a look at how the plans compare for Sofia and Ricardo based on their usage:

ServiceUMR Average Approved AmountPreferred PlanPOSHSA*
Annual Physical – 2 visits (employee and spouse)$380.00$0$0$0
Primary Care Office visit – 1 visit (spouse)$78.00$10.00
Specialist Office Visit – 2 visits (employee and spouse)$200.00$40.00
Tier 1 Prescription – 12 Preventive Prescriptions (spouse)$220.92
($18.41 x 12)*
Total Medical Expense Out of Pocket$50.00
Employee Annual Premium$3,510.00$5,590.00$2,292.52
TOTAL ANNUAL COST$3,560.00$5,770.00$2,570.52

* Preferred and HSA enrolled employees purchase preventive Rx at an MIHS pharmacy to take advantage of $0 generic preventive Rx program
** Employee can use Health Savings Account funds to pay out-of-pocket expenses

When they compare their plan options, Sofia and Ricardo realize the HSA Plan would offer the best value. Even though they pay a little more out-of-pocket (what they pay when they receive services), the amount Sofia pays in her premium (the amount taken out of her paycheck) more than offsets the higher out-of-pocket costs. And Sofia knows that she can contribute to her HSA so she can use those dollars to pay for eligible out-of-pocket costs.

Take a moment to use the Medical Plan Cost Estimator to see how the plans compare for you.