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Health Care

Medical (2009)

How a Sample Employee Uses the Medical Plan

Following is an example of how the Network Plan options work. You will need to determine which Medical Insurance Plan option is best for you and your family based on your situation.

EXAMPLE: Employee + Spouse + Children
Teresa enrolls her family for coverage. Their expenses total $2,060 for the year and are detailed below. For all services, Teresa's family uses in-network providers. The three sections below show how her expenses would be paid under each medical option.

Spouse's vision exam (preventive care): $50 } $1,200 preventive care expenses
Son's well-child care (preventive care): $400
Daughter's well-child care (preventive care): $350
Teresa's well-woman care (preventive care): $400
Teresa's office visit for infection: $150 } $860 illness/injury expenses
Daughter's office visit for pink eye: $130
Daughter's office visit and lab test for strep throat: $180
Spouse's office visit for knee pain: $150
Son's office visit for x-rays for broken finger: +  $250
Total $2,060  
$1,000 DEDUCTIBLE PLAN
 
KRAFT PAYS
TERESA PAYS
 
Preventive
80% Co-Insurance
Deductible1
20% Co-Insurance
Preventive care: $1,200
$1,200
-
-
-
Other treatment: $860
-
-
$860
-
Total
$1,200
-
$860
-
Based on her base salary of $39,000, Teresa's annual contributions total $564 ($47 a month).
$300 DEDUCTIBLE PLAN
 
KRAFT PAYS
TERESA PAYS
 
Preventive
80% Co-Insurance
Deductible1
20% Co-Insurance
Preventive care: $1,200
$1,200
-
-
-
Other treatment: $860
-
$208
$600
$52
Total
$1,200
$208
$600
$52
Based on her base salary of $39,000, Teresa's annual contributions total $1,620 ($135 a month).
ACCOUNT PLAN
Teresa has $1,640 left in her Health Reimbursement Account (HRA) at the end of 2008 to carry over into 2009. Therefore she begins the year with $2,840: the $1,2002 credited to her HRA for 2009 plus the $1,640 she carried over.
 
KRAFT PAYS
TERESA PAYS
 
Preventive
HRA
80% Co-Insurance
Deductible1
20% Co-Insurance
Preventive care: $1,200
$1,200
-
-
-
-
Other treatment: $860
-
$860
-
-
-
Total
$1,200
$8603
-
-
-

Based on her base salary of $39,000, Teresa's annual contributions total $2,460 ($205 a month).

  1. The family deductible is two times the individual deductible.
  2. Amount will be prorated for new hires hired after the first quarter.
  3. At the end of 2009 Teresa still has $1,980 remaining in her family’s HRA. This amount will be added to her HRA for 2010, if she re-elects the Account Plan.

Disclaimers