Choosing Coverage

Medical

During the year, Sam will visit his doctor for an annual physical and then again for a sore throat. The total cost for the services and medications he receives is $374:

• 1 preventive doctor’s office visit: $172 ($0 cost to Sam)
• 1 diagnostic doctor’s office visit: $127
• 1 Tier 2 antibiotic: $75. 

*The amount shown does not include premium amounts. Consider monthly premiums before making your coverage decision. To model your own health care costs with applicable premium amounts, download the Health Care Cost Modeling Tool.

With the Health Savings Plan, Sam will pay the lowest monthly premium available. If Sam is comfortable paying the Health Savings Plan’s annual deductible and managing his Health Savings Account, the Health Savings Plan may be his best choice.

Dental

Sam had braces growing up, but since then he hasn’t needed any dental work. However, he knows it’s smart to get yearly dental checkups, which are available at no cost if he elects dental coverage.

Vision

Sam switches between glasses and contacts, and he likes mixing it up every year with a new style of frames. The additional frame allowance and more frequent exam coverage makes the Enhanced Plan the better option for Sam.

Voluntary Benefits

Sam recently graduated college and wants to keep his expenses low. He decides to wait on enrolling in any of The University’s voluntary benefits until later.

Medical

Their daughter has tonsillitis. She has an outpatient tonsillectomy and is prescribed two Tier 2 antibiotics. One month later, she has a follow-up visit with her doctor. Her total cost before the plan pays benefits is $4,061:

• 1 outpatient surgery: $3,154
• 2 Tier 2 antibiotics: $780
• 1 doctor’s office visit: $127.

Their son has pink eye and goes to urgent care to get a prescription. His total cost before the plan pays benefits is $188:

• 1 urgent care visit: $155
• 1 Tier 1 antibiotic: $33.

Plus, the whole family gets annual physicals:

• 4 preventive doctor’s office visits: $688 ($0 cost to the family).

*The amount shown does not include premium amounts. Consider monthly premiums before making your coverage decision. To model your own health care costs with applicable premium amounts, download the Health Care Cost Modeling Tool.

Jen and Mike have a high costs at the beginning of the year with their daughter’s tonsillectomy and reach her deductible early on, under all three plans. However, under the Health Savings Plan they have not met the family deductible so their son’s urgent care visit and Tier 1 prescription will still apply to that. The Health Savings Plan will require Jen and Mike to pay all of the cost until their deductible is met, which may be a concern for them. They will have the lowest out-of-pocket expenses with the Classic and Premier Plans. It will be important for them to consider this as well as factor in their premium costs to decide between the plans, since the Premier Plan premium is the highest.

Dental

Both of Jen and Mike’s kids will need braces. They’re comforted by the fact that their dental insurance covers 50% of the cost without having to meet the annual deductible. Plus, Jen, Mike and their kids can all get no-cost annual preventive dental exams.

Vision

With one child who wears glasses, the added protection of no-cost lenses with scratch-resistant coating and ultraviolet protection makes the Enhanced Plan a clear winner for Jen and Mike. Plus, even though only one child wears glasses, Jen and Mike can get discounts of up to 30% on non-prescription sunglasses for the rest of the family.

Voluntary Benefits

With two kids, Mike and Jen want to ensure their children are financially protected if anything should ever happen to one of them. They enroll in Optional Long Term Disability Insurance, Optional Life Insurance and Optional Accidental Death and Dismemberment Insurance. The extra coverage gives them peace of mind in the event either is ever unable to provide for their family.

Last year, Jen and Mike’s son opened a malicious pop-up on their home computer, crashing the entire system. To be proactive about potential cyber risks, they enrolled in ID Watchdog, which monitors their personal data and notifies them of any threats. ID Watchdog also helped them set up new accounts and protections after last year’s attack and provided them with information to teach their son about internet safety.

Medical

• Wanda is 58 years old—she’s starting to feel the effects of arthritis
• Barry is 63 years old—he has a bad back and high blood pressure
• Their children are grown and living on their own

Barry suffers a stroke and Wanda calls an ambulance. After recovering, he starts regular check-up visits with his doctor. His total cost before the plan pays benefits is $19,856:

• 1 ambulance: $1,040
• 1 emergency room visit: $1,233
• 4 days in the hospital: $10,876
• 1 Tier 3 medication: $2,980
• 3 specialist diagnostic doctor’s office visits: $381
• 14 physical therapy visits: $3,346

*The amount shown does not include premium amounts. Consider monthly premiums before making your coverage decision. To model your own health care costs with applicable premium amounts, download the Health Care Cost Modeling Tool.

Since Barry and Wanda have high surgery and emergency room expenses, the Premier Plan may save them the most money. However, if they are comfortable paying more in out-of-pocket expenses with the Health Savings Plan, they should consider the monthly premiums in their overall evaluation.

Dental

Barry has always had good teeth and he attributes it to his annual preventive dental care exam, which is covered fully by his dental insurance. Wanda has dentures, which could cost her up to $3,000 without insurance. With dental coverage, she only pays 50% of the cost after she meets her $50 annual deductible.

Vision

Barry and Wanda both wear glasses. They haven’t changed their frames in many years but still get their prescriptions updated as needed. No-cost exams every two years and coverage for new lenses is all they need, so they choose the Basic Plan. 

Voluntary

Barry and Wanda are nearing retirement and want to make sure they have the coverage they need before taking that big step. They enroll in Legal Shield for help with their wills and to discuss what they need to consider before retirement with a lawyer at a discounted rate.

Choosing the best medical plan for your needs is a personal decision. Here are some things to consider as you make your choice.

Your Anticipated Medical Expenses

• What is your and your family’s general state of health?
• Do you and/or family members tend to see the doctor frequently and/or take prescription drugs?
• Do you and/or family members have a medical condition and/or anticipate any surgeries, new prescription drugs or other medical expenses?
• Are you and/or family members expecting a major life event, like getting married, divorced, legally separated or adding an eligible dependent? Be sure to consider medical expenses for any dependent that you may add.

How This Affects Your Medical Plan Choice

• If you expect high medical costs, you may want to consider the Classic or Premium Plan, since your out-of-pocket costs will be lower with these options.
• If you are healthy and rarely see the doctor—and expect this to continue—or if paying out-of-pocket expenses in full until you reach the deductible is not a concern, you may want to consider the Health Savings Plan, since your premiums will be lowest with this option. If you choose this plan, you’ll also benefit from The University’s contribution to your HSA. But, remember, until you meet your deductible, you will pay 100% of covered charges.

Health Savings Account vs. Healthcare Flexible Spending Account

Do you want to get the tax-savings of using a Health Savings Account (HSA) to help pay for medical expenses? As required by law, you can only have an HSA with the Health Savings Plan. With the Classic or Premier Plan, you have the option of a Healthcare Flexible Spending Account (FSA). Review a comparison of the HSA and FSA to help you make your decision.

What You Will Pay in Premiums

Do you prefer to pay less out of pocket as you have medical expenses or less in monthly premiums? If you prefer to pay less in monthly premiums, the Health Savings Plan may be the best choice.