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Simone

Simone and her husband have three kids. Everyone in the family gets their annual physicals, and she and her husband don't smoke. They use in-network doctors and Preferred Medical and Wellness Providers when possible. But this is a tough year for the family due to serious health conditions and a car accident.

Let's take a look…

Provider Billed Cost

All of the family members get their physicals, and the kids get their immunizations.

$80 x 5 = $400
100% paid by the company!

‍

Everyone gets sick a few times. Each time they receive multiple generic 30-day prescriptions to help them get better.

$100 visit x 10
$20 generic 30-day x 15

‍

Simone's two sons see a specialist twice for ongoing conditions. The doctor gives both boys a preferred brand 90-day prescription to treat their conditions and Simone refills them one more time.

$140 visit x 4
$340 preferred brand 90-day x 4

Provider Billed Cost

Simone's infant daughter has a serious case of bronchitis and is taken to the ER. They keep her in the hospital for two days of observation.

$2,000 visit x 1
$6,000 hospital stay

‍

Simone's husband is in a car accident that sends him to the hospital and requires surgery. He spends one day in the ICU and three more days in the hospital before he is released.

$25,000 surgery
$12,000 ICU
$3,000 hospital stay x 3

After her husband is released, his doctor sends him to physical therapy for several months to help with his recovery.

$80 visits x 12

Simone's total expenses:

Simone has incurred a total of $52,580 in expenses from providers and services. Now, let’s see which plan would have been better for Her!

$52,580

in total expenses.

back_hand

Wait! We also need to remember that Simone has been paying for medical coverage from Her paycheck too. We'll add that in.

Remember, Simone incurred $52,580 in total expenses from providers and services.

Because the choice of funding account impacts the cost of care in the Whole Health plan, both the PWA and HSA options are shown here.

National Select (PWA)

National Choice (PWA or HSA)

Whole Health Plan (HSA)

Whole Health Plan (PWA)

$6,650

$12,945

$6,650

$6,110

$3,432

($500)

($1,000)

($1,500)

($1,000)

($1,500)

($1,000)

($1,500)

And the winner is...

Depending on which plans Simone is eligible for, the National Choice and the Whole Health Plan with the PWA are the winners!

National Select (PWA)

National Choice (PWA or HSA)

Whole Health Plan (HSA)

Whole Health Plan (PWA)

$6,650

$12,945

$6,650

$6,110

$3,432

($500)

($1,000)

($1,500)

($1,000)

($1,500)

($1,000)

($1,500)

$11,760

$14,877

$8,582

Click here to view a detailed breakdown of the costs in each of the plans.

Simone

Simone está casada y tiene tres hijos, y el plan médico cubre a la familia. Todos los miembros de la familia se hacen los chequeos médicos anuales, y ella y el esposo no fuman. Acuden a médicos, farmacias y proveedores médicos y de bienestar preferentes dentro de la red siempre que es posible.

Este es un año difícil para la familia debido a graves problemas de salud y a un accidente de coche. Echemos un vistazo…

Provider Billed Cost

Todos los miembros de la familia se hacen los chequeos médicos.

$80 x 5 = $400
¡La empresa paga el 100 %!

Todos se enferman varias veces. Cada vez reciben varias recetas de medicamentos genéricos para 30 días, para que se mejoren.

$100, consulta x 10
$20, genéricos para 30 días x 15

Los dos hijos de Simone acuden dos veces a un especialista por problemas de salud crónicos. El médico les da a ambos recetas de medicamentos de marca preferida para 90 días y Simone las resurte una vez más.

$140, consulta x 4
$340, medicamentos de marca preferida para 90 días x 4

Provider Billed Cost

La hija de Simone tiene una bronquitis grave y la llevan a la sala de emergencias. La mantienen dos días en observación en el hospital.

$2,000, consulta x 1
$3,000, días de hospitalización x 2

El esposo de Simone tiene un accidente de coche. Lo trasladan al hospital y lo operan. Pasa un día en la unidad de cuidados intensivos y tres días más en el hospital antes de que le den el alta.

$25,000, cirugía
$12,000, unidad de cuidados intensivos
$3,000, días de hospitalización x 3

Cuando el esposo recibe el alta, el médico le indica hacer fisioterapia durante varios meses para recuperarse.

$80, consulta x 12

Simone's total expenses:

Simone ha incurrido en un total de $52,580 en gastos de proveedores y servicios. Veamos ahora qué plan hubiese sido mejor para Simone.

$52,580

en gastos totales

back_hand

¡Un momento! También debemos recordar que Simone ha estado pagando la cobertura médica con su salario. Agregaremos eso.

Remember, Simone incurred $52,580 in total expenses from providers and services.

Dado que la elección de la cuenta de financiamiento repercute en el costo de la atención en el Whole Health Plan, aquí se muestran tanto la opción de la PWA como la HSA.

National Select (PWA)

National Choice (PWA o HSA)

Whole Health Plan (HSA)

Whole Health Plan (PWA)

$6,650

$12,945

$6,650

$6,110

$3,432

($500)

($1,000)

($1,500)

($1,000)

($1,500)

($1,000)

($1,500)

Y el indicado es…

En función de los planes a los que puede acceder Simone, ¡el National Select Plan o el Whole Health Plan son los indicados!

National Select (PWA)

National Choice (PWA o HSA)

Whole Health Plan (HSA)

Whole Health Plan (PWA)

$6,650

$12,945

$6,650

$6,110

$3,432

($500)

($1,000)

($1,500)

($1,000)

($1,500)

($1,000)

($1,500)

$11,760

$14,877

$8,582

Haga clic aquí para obtener un desglose detallado de los costos en cada uno de los planes.