Employer purchases the following plan from the carrier
Plan Type: PPO
Deductible:
Network: $1000 Single / $3000 Family
Non-Network - $1000 Single / $3000 Family
Co-insurance:
Network: 80/20
Non-Network: 60/40
Out of Pocket Maximum (including Deductible):
Network Services: $1500 Single / $3000 Family
Non-Network Services: $2000 Single / $4000 Family
Office visit Co-pay: $30
Prescription Co-pay: $10/$25/$50
Employer offers this plan to Employees
Deductible:
Network: $250 Single / $750 Family
Non-Network - $250 Single / $750 Family
Co-insurance:
Network: 80/20
Non-Network: 60/40
Out of Pocket Maximum (including Deductible):
Network Services: $750 Single / $1500 Family
Non-Network Services: $1250 Single / $2500 Family
Office visit Co-pay: $30
Prescription Co-pay: $10/$25/$50
Employer is assuming the risk for the following benefits
Deductible:
Network: $750 Single / $2250 Family
Non-Network - $750 Single / $2250 Family
Co-insurance:
Network: 80/20
Non-Network: 60/40
Out of Pocket Maximum (including Deductible):
Network Services: $750 Single / $1500 Family
Non-Network Services: $1250 Single / $2500 Family
How It Works
Annual Premium Based on Renewal from Current Carrier $139,200.00
Annual Premium for Proposed $1000 Ded. 80/60 Plan $99,468.00
Projected Annual HRA maximum liability based on
$250 Deductible, 80/60 Plan: $13,500.00
9 Single @ $20.84 per month or $1500 annually
9 Limited Family @ $62.50 per month or $6750 annually
6 Family @ $62.50 per month or $4500 annually
Plan Annual Administration cost @ $15/employee/month
$4,320.00
Set-up Fee (one time cost) $0.00
Total Estimated Annual Cost $117,288.00
Estimated Savings over current carrier $21,912.00
How a Network Claim is Paid
| Claim Amount | Employee Pays | Employer Pays | Insurance Pays |
|---|---|---|---|
| $0-$1,000 | $250 | $750 | $0 |
| $1,001-$3,500 | $500 | $0 | $2,000 |
| $3,001-$6,000 | $0 | $0 | To policy maximum |
| Over $6,000 | $0 | $0 | To policy maximum |
| Total | $750 | $750 | To policy maximum |
How a Non-Network Claim is Paid
| Claim Amount | Employee Pays | Employer Pays | Insurance Pays |
|---|---|---|---|
| $0-$1,000 | $250 | $750 | $0 |
| $1,001-$3,500 | $1,000 | $0 | $1,500 |
| $3,001-$6,000 | $0 | $0 | To policy maximum |
| Over $6,000 | $0 | $0 | To policy maximum |
| Total | $1,250 | $750 | To policy maximum |