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:

ServiceUMR Average Approved AmountPreferred PlanPOSHSA*
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
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)*
Tier 2 Prescription - 1 Non-Preventive Prescription (child)$23.75 $20.00$20.00$2.38
Total Medical Expense Out of Pocket$340.00
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.