The Villanovas
Perferred Plan
Cindy is a single mom with an active son, Manny who plays sports. She’s seen it all. While she gets her annual physicals, which are covered in full, she knows that Manny has a tendency to get hurt playing soccer. Over the years, he’s had a sprained ankle, a broken finger, and minor bumps and bruises that required a doctor’s visit or two. Let’s take a look at how the plans compare for Cindy based on her usage:
| Service | UMR Average Approved Amount | Preferred Plan | POS | HSA* |
| Emergency Room (child) | $2,005.00 | $250.00 | $250.00 | $2,005 |
| ($2,005 of $2,700 deductible) | ||||
| Physical Therapy – 6 visits (child) | $1,710.00 | $0 | $420.00 | $796.50 |
| Annual Physical — 2 visits (employee and child) | $380.00 | $0 | $0 | $0 |
| Primary Care Office Visit – 1 visit (child) | $78.00 | $10.00 | $40.00 | $78.00 |
| Specialist Office Visit — 3 visits (child) | $291.00 | $60.00 | $210.00 | $291.00 |
| Tier 1 Prescription – 1 Preventive Prescription (employee) | $304.80 ($25.40 x 12)* | $0 | $0 | $0 |
| Tier 2 Prescription - 1 Non-Preventive Prescription (child) | $23.75 | $20.00 | $20.00 | $2.38 |
| Subtotal | $4,792.55 | |||
| Total Medical Expense Out of Pocket | $340.00 | $940.00 | $3,172.88 | |
| Employee Annual Premium | $2,990.00 | $4,940.00 | $1,778.92 | |
| TOTAL ANNUAL COST | $3,330.00 | $5,880.00 | $4,951.80 | |
* 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 she compares her plan options, Cindy realize the Preferred Plan would offer the best value. She’s concerned about having to pay out-of-pocket for services and likes the comfort of knowing that with the Preferred Plan, her out-of-pocket costs would be the lowest.
Take a moment to use the Medical Plan Cost Estimator to see how the plans compare for you.