Medical Costs on Management Health Plan - Skip Brown

 

Examples under Option #1 of costs for a married employee, with children and

working spouse who turned down his/her company’s medical plan:

Medical Costs

Scenario #1

 

Employee pays

Plan pays

Doctor visit (sore throat) = $200

$200

Cholesterol drug (Brand name) =$400

$400

Broken leg = $5000

$2120

X-Ray = $175

$35

Child breaks arm = $3725

 

$745

New baby = $5000

$1000

Cholesterol drug (Brand name) x 3 = $1200

$240

New baby Doctor visits = $3800

$760

Total

$5,500

Doctor visit (sore throat) = $200

$0

Cholesterol drug (Brand name) =$400

$0

Broken leg = $5000

$2880

X-Ray = $175

$140

Child  breaks  arm = $3725

 

$2980

New baby = $5000

$4000

Cholesterol drug (Brand name) x 3 = $1200

$960

New baby Doctor visits = $3800

$3040

Total

$14,000

 

Employee pays

Plan collects

 

 

Payroll deduction

$2750

Working Spouse penalty

$1565

Health Reimbursement Account

(company pays)

-$1000

Total

$3315

Payroll deduction

$2750

Working Spouse penalty

$1565

Health Reimbursement Account

(company pays)

-$1000

Total

$3315

 

Employee pays = $8,815 (payroll deduction/deductable/co-pay/working spouse penalty)

 

Company pays = $10,685 (medical payments/HRA – employee deductions)

 

Employee pays 46%, Company pays 54%,

 

 

 

 

 

 

 

 

Scenario #2

 

Employee pays

Plan pays

Doctor visit (sore throat) = $200

$200

Cholesterol drug (Brand name) =$400

$400

Broken leg = $5000

$2120

X-Ray = $175

$35

Child breaks arm = $3725

$745

Cholesterol drug (Brand name) x 3 = $1200

$240

Total

$3740

Doctor visit (sore throat) = $200

$0

Cholesterol drug (Brand name) =$400

$0

Broken leg = $5000

$2880

X-Ray = $175

$140

Child breaks arm = $3725       

$2980

Cholesterol drug (Brand name) x 3 = $1200

$960

Total

$6960

 

Employee pays

Plan collects

Payroll deduction

$2750

Working Spouse penalty

$1565

Health Reimbursement Account

(company pays)

-$1000

Total

$3315

Payroll deduction

$2750

Working Spouse penalty

$1565

Health Reimbursement Account

(company pays)

-$1000

Total

$3315

 

No baby

 

 

Employee pays = $7,055 (payroll deduction/deductable/co-pay/working spouse penalty)

 

Company pays = $3,645 (medical payments/HRA – employee deductions)

 

Employee pays 65%, Company pays 35%,

 

 

 

 

 

 

 

 

 

 

 

Scenario #3

 

Employee pays

Plan pays

Doctor visit (sore throat) = $200

$200

Cholesterol drug (Brand name) =$400

$400

X-Ray = $175

$35

Child breaks arm = $3725

$1837

Cholesterol drug (Brand name) x 3 = $1200

$240

Total

$2712

Doctor visit (sore throat) = $200

$0

Cholesterol drug (Brand name) =$400

$0

X-Ray = $175

$140

Child  breaks  arm = $3725

$1888

Cholesterol drug (Brand name) x 3 = $1200

$960

Total

$2988

 

Employee pays

Plan collects

Payroll deduction

$2750

Working Spouse penalty

$1565

Health Reimbursement Account

(company pays)

-$1000

Total

$3315

Payroll deduction

$2750

Working Spouse penalty

$1565

Health Reimbursement Account

(company pays)

-$1000

Total

$3315

 

No baby, no broken leg

 

Employee pays = $6,027 (payroll deduction/deductable/co-pay/working spouse penalty)

 

Company makes profit = $327 (medical payments/HRA – employee deductions)

 

Company collects $327 profit

 

 

 

 

 

 

 

 

 

 

 

 

Scenario #4

 

Employee pays

Plan pays

Doctor visit (sore throat) = $200

$200

Cholesterol drug (Brand name) =$400

$400

Cholesterol drug (Brand name) x 3 = $1200

$240

Total

$840

Doctor visit (sore throat) = $200

$0

Cholesterol drug (Brand name) =$400

$0

Cholesterol drug (Brand name) x 3 = $1200

$0

Total

$0

 

Employee pays

Plan collects

Payroll deduction

$2750

Working Spouse penalty

$1565

Health Reimbursement Account

(company pays)

-$840

Total

$3475

Payroll deduction

$2750

Working Spouse penalty

$1565

Health Reimbursement Account

(company pays)

-$840

Total

$3475

 

No baby, no broken leg, no broken arm

 

Employee pays = $4,315 (payroll deduction/deductable/co-pay/working spouse penalty)

 

Company makes profit = $3475 (employee deductions - HRA)

 

Company collects $3475 profit

Employee pays $3475 just to get into the plan and then pays 100% of all medical expenses

 

 

 

 

 

 

 

 

 

 

 

 

 

Employee costs before company starts to make any co-pays

 

 

Option #1 - Employees must pay $5,315.00 + $1000.00 HRA before the company

starts to co-pay.

Option #2 - Employees must pay $5,440.00 + $1000.00 HRA before the company

starts to co-pay.

Option #3 - Employees must pay $4,690.00 + $1000.00 HRA before the company

starts to co-pay.

 

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Employee costs and total costs before company pays 100%

 

 

Option #1- Employee must pay $8,815.00 + $1000.00 HRA and medical bills must total

$19,500.00 before the company pays 100% coverage

Option #2 - Employee must pay $9940.00 + $1000.00 HRA and medical bills must total

$25,500.00 before the company pays 100% coverage

Option #2 - Employee must pay $10,119.00 +$1000.00 and medical bills must total

$31,500.00 before the company pays 100% coverage