Medical

ABC Company offers you a choice of three medical plans to best fit your family’s needs.

Preferred Provider Organization (PPO) Plan

If you use providers in-network, you do not have to meet your annual deductible before the plan pays for portions of certain services such as office visits and prescriptions. You are responsible for a set copay for such services, and the plan pays the rest of the cost. For other services, you and the plan share costs (also known as coinsurance) after you meet your deductible.

PPO plan features:

  • Lower deductibles and more predictable costs when you need care
  • Separate prescription drug deductibles and copays
  • 100% covered in-network preventive care, with no copay or deductible

High-Deductible Health Plan (HDHP) Consumer Driven Health Plan (CDHP)

This plan lets you keep more of each paycheck because it has lower employee contributions than a PPO plan. An HDHP allows you to use a tax-advantaged Health Savings Account (HSA) to help pay for your medical costs (now and in the future).

HDHP features:

  • Lower employee contributions
  • A higher deductible to satisfy before it begins paying benefits
  • Before you have met your plan year deductible, the plan covers in-network preventive care at 100%

The chart below details the plan provisions, deductibles, copays, and coinsurance of each available plan:

Your Cost PPO PPO+ HDHP
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Annual deductible $3,000 individual/$6,000 family $9,000 individual/$18,000 family $1,000 individual/$2,000 family $3,000 individual/$6,000 family $1,500 individual/$3,000 family $4,500 individual/$9,000 family
Coinsurance You pay 20% after deductible You pay 50% after deductible You pay 20% after deductible You pay 40% after deductible You pay 20% after deductible You pay 50% after deductible
Out-of-pocket Maximum $6,500 individual/$13,000 family $19,500 individual/$39,000 family $4,000 individual/$8,000 family $12,000 individual/$24,000 family $5,000 individual/$10,000 family $15,000 individual/$30,000 family
Preventive care 100% covered 50% covered 100% covered 50% covered 100% covered 50% covered
Telehealth appointment $0 N/A $0 N/A You pay 20% after deductible You pay 50% after deductible
Office visit: Primary Care Physician (PCP) $40 copay You pay 50% after deductible $30 copay You pay 40% after deductible You pay 20% after deductible You pay 50% after deductible
Office visit: Specialist $60 copay You pay 50% after deductible $45 copay You pay 40% after deductible You pay 20% after deductible You pay 50% after deductible
Urgent care clinic $60 copay $45 copay You pay 20% after deductible You pay 50% after deductible
Emergency room $350 copay (waived if admitted) $250 copay (waived if admitted) You pay 20% after deductible You pay 20% after deductible
Employer HSA contribution N/A N/A $500 employee only
$1,000 employee + spouse
$1,000 employee + child(ren)
$1,000 employee + family

Prescription Drug Coverage

Prescription drug coverage is part of your medical plan. Your deductible, copays, and coinsurance depend on which plan you choose. See the table below for details:

PPO PPO+ HDHP
Retail $10 generic/$30 brand $10 generic/$30 brand $10 generic/$30 brand
Mail-Order $25 generic/$75 brand $25 generic/$75 brand $25 generic/$75 brand
Specialty Member pays 30%, up to $250 per prescription Member pays 30%, up to $250 per prescription Member pays 30%, up to $250 per prescription

Your Cost for Coverage

The below table displays the monthly cost for coverage for you and your family.

Medical Plan Employee Only Employee + Spouse Employee + Child(ren) Employee + Family
PPO $120 $250 $215 $350
PPO+ $150 $200 $225 $400
HDHP $120 $240 $200 $300