Compare the plans
CDHP 1 and 2 vs. Traditional PPO
Compare the plans by viewing this document: Summary of Benefits for 2010.
Here are some sample cases to help you get started.
Case #1: The Smiths
- Married couple
- 2 school-age children
Factors:
- Abe Smith had back surgery in April.
- All family members had annual physicals in January.
- Abe had strep throat in September and needed an antibiotic.
- Maria Smith had a wart removed in December.
- Two additional prescriptions when Mr. Smith had surgery
Which is the best plan for the Smiths?
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|---|---|---|---|---|
| 4 annual physicals | $400 | $0 | $0 | $0 |
| Routine labs w/physicals | $250 | $0 | $0 | $0 |
| Vaccines w/physicals | $300 | $0 | $0 | $0 |
| Out-patient hospital $ surgery | $14,500 | $5,000 deductible | $3,000 deductible | $1,000 deductible |
| Co-Insurance | $1,900 co-insurance (20%-$9,500) |
$2,300 co-insurance (20% - $11,500) |
$2,700 (20% - $13,500) | |
| Dr. visit (Abe) | $80 | $16 | $16 | $16 |
| Antibiotic (generic) | $24 | $10 | $10 | $10 |
| Dr. visit (Maria) | $120 | $24 | $24 | $24 |
| Prescriptions (2 brand) | $150 | $30 | $30 | $30 |
| Employee premium | 0 | $1,291.68 | $5,750.16 | |
| Total cost | $6,980.00 | $6,671.68 | $9,530.16 | |
| State's contribution to HSA | - 2,750.28 | - 1,650.48 | - 0 | |
| Net cost to employee | $4,229.72 | $5,021.20 | $9,530.16 |
Case #2: The Jones
The Jones' are a young couple with family health care coverage. Mrs. Jones is pregnant, expecting in September. The baby has a normal delivery in September with follow-up well baby visits at 2 weeks, 1 month and 2 months, in the current year. Both Mr. and Mrs. Jones receive annual physicals. During their physicals both receive vaccinations and have routine lab work performed. Mrs. Jones decides to have her baby at Community Hospitals Indiana. In September, Mr. Jones has a strep throat, which requires a doctor's office visit and is treated with a generic antibiotic. The Jones use only in-network providers.
Factors:
- Annual Physicals $200.00 - January
- Routine Labs w/ Physicals $150.00 - January
- Vaccines w/ Physicals $200.00 - January
- OBGYN Costs $500.00 - Jan. - Sept
- Delivery $7,772.00 - September
- Well baby visits - $300.00 - Sept-Dec.
- Mr Jones strep throat $150.00 - September
- Generic Antibiotic $24.00 - September
Which is the best plan for the Jones family?
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|---|---|---|---|
| Annual Deductible | $5,000 | $3,000 | $1,000 |
| Annual Physicals | $0 | $0 | $0 |
| Routine labs w/physicals | $0 | $0 | $0 |
| Vaccines w/physicals | $0 | $0 | $0 |
| OBGYN Costs (applied to deductible) | $500 | $500 | $500 |
| Delivery | |||
| Applied to Deductible | $4,500 | $2,500 | $500 |
| Incurred at 20% Co-insurance | $654.40 | $1,054.40 | $1,454.40 |
| Jones Family Cost of Delivery | $5,154.40 | $3,554.40 | $1,954.40 |
| Well baby visits | $0 | $0 | $0 |
| Mr. Jones strep throat | $30 | $30 | $30 |
| Strep throat generic antibiotic | $10 | $10 | $10 |
| Total Point of Service Employee Costs | $5,694.40 | $4,094.40 | $2,494.40 |
| Employee Premium Contribution | $0 | $1,291.68 | $5,750.16 |
| State's contribution to HSA | $2,750.28 | $1,650.48 | - $0 |
| Net cost to employee | $2,944.12 | $3,735.60 | $8,244.56 |
Case #3: The Williams
The Williams' are a middle-aged couple with family health care coverage. Both Mr. and Mrs. Williams have annual physicals which include vaccines and routine lab work. Mrs. Williams also has a routine annual mammogram. Late in January Mrs. Williams visits the local ER believing she is having a heart attack. This is ultimately diagnosed, after multiple tests, as an anxiety attack and she is released from the ER and sent home. Between them, the Williams take three generic medicines for chronic conditions which are filled at a retail pharmacy. The Williams use only in-network providers for their health care needs.
Factors:
- Annual Physicals $200.00 - January
- Routine Labs w/ Physicals - $150.00 - January
- Vaccines w/ Physicals $200.00 - January
- Annual Mammogram $200.00 - January
- ER visit with Tests $3,000.00 - January
- Generic Chronic Condition RX $1,300.00 - Jan - Dec.
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|---|---|---|---|
| Annual Deductible | $5,000 | $3,000 | $1,000 |
| Annual Physicals | $0 | $0 | $0 |
| Routine labs w/physicals | $0 | $0 | $0 |
| Vaccines w/physicals | $0 | $0 | $0 |
| Annual Mammogram | $0 | $0 | $0 |
| ER Visit | |||
| Applied to Deductible | $3,000 | $3,000 | $1,000 |
| Incurred at 20% Co-insurance | $0 | $0 | $400 |
| Cost of ER Visit | $3,000 | $3,000 | $1,400 |
| Generic Chronic Condition Rx | |||
| Applied to Deductible | $1,300 | $0 | $0 |
| Incurred with Co-insurance | $0 | $360 | $360 |
| Cost of Chronic Condition Rx | $1,300 | $360 | $360 |
| Total Point of Service Employee Costs | $4,300 | $3,360 | $1,760 |
| Employee Premium Contribution | $0 | $1,291.68 | $5,750.16 |
| State's contribution to HSA | $2,750.28 | $1,650.48 | - $0 |
| Net cost to employee | $1,549.72 | $3,001.20 | $7,510.16 |
Case #4: Susan
Susan is single, a non-tobacco user and enrolled in the state's health care program. She has an annual physical exam in January which includes routine lab work and vaccinations. She also has an annual mammogram in connection with her physical. Susan suffers from an arthritic condition which is managed with the drug ENBREL (a specialty drug). She has chosen to self-administer her treatment. Susan uses only in-network providers for her health care needs.
Factors:
- Annual Physical $100.00 - January
- Routine Labs w/ Physical $75.00 - January
- Vaccines w/ Physical $100.00 - January
- Annual Mammogram $200.00 - January
- ENBREL treatments/month $1,250.00 - Monthly
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|---|---|---|---|
| Annual Deductible | $2,500 | $1,500 | $500 |
| Annual Physicals | $0 | $0 | $0 |
| Routine labs w/physicals | $0 | $0 | $0 |
| Vaccines w/physicals | $0 | $0 | $0 |
| Annual Mammogram | $0 | $0 | $0 |
| ER Visit | |||
| Applied to Deductible | $2,500 | $1,500 | $500 |
| Incurred with Coverage | $1,500 | $1,500 | $1,500 |
| Cost of ENBREL Treatments | $4,000 | $3,000 | $2,000 |
| Total Point of Service Employee Costs | $4,000 | $3,000 | $2,000 |
| Employee Premium Contribution | $0 | $546 | $1,990.56 |
| State's contribution to HSA | $1,375.92 | $826.80 | - $0 |
| Net cost to employee | $2,624.08 | $2,719.20 | $3,990.56 |
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