Choosing the medical plan option that’s right for you is important. Consider these questions before making a decision:
- Do you want flexibility in the providers and facilities you can use? If so, consider the benefits covered if you go in or out of network.
- Are the providers and facilities you want to use easily accessible and close by? For example, consider distance to doctors and hospitals.
- Would you rather pay more in medical plan premiums from your paycheck (fixed cost) or in out-of-pocket costs based on service usage (variable cost)?
- Based on your situation for the year, how often do you expect to use health care services (low, medium or high usage)?
Follow the steps below to see estimated costs under each medical plan option based on scenarios that may be similar to your own anticipated situation.
Important note: Assumptions used to determine low, medium or high usage of health care services (listed in step 2) may vary greatly from your own actual usage level. Scenarios and estimated costs are intended for illustrative purposes only.
Assumptions — What they mean for you
Understand assumptions prior to reviewing the estimated total costs under each of the plan options.
Below are assumptions you may want to keep in mind as you review the estimated total costs under each of the health plan options.
- All claims are assumed to be incurred in-network.
- All prescription drug claims are assumed to be generic and use the UCM DCAM/Ingalls network.
- Contributions shown are based on full-time employees.
- Usage costs determined by Blue Cross Blue Shield.
- Usage costs assume individual or family coverage.
- For family coverage under Care Network HDHP, the entire family deductible must be met before the plan pays benefits.
- For family coverage under Care Network PPO, once any one family member meets his or her individual deductible, the plan pays benefits for that individual.
Step 1
Select your coverage tier.
Step 2
How often do you think you’ll use health care services in 2021/2022?
Health Care Usage Assumptions - Family Coverage
High Usage
- Employee - Preventive: 1 Adult Preventive Care Visit; 8 Generic (Preventive) Mail Prescriptions
- Spouse - Preventive: 1 Adult Preventive Care Visit; 8 Generic (Preventive) Mail Prescriptions
- Child 1 - Preventive: 2 Well Child Visits; 6 Generic (Preventive) Mail Prescriptions
- Child 2 - Preventive: 2 Well Child Visits; 6 Generic (Preventive) Mail Prescriptions
- Employee - Covered In-Network Items: 4 PCP Office Visits; 5 Specialist Office Visits; 1 Inpatient Hospital Stay; 2 Lab/X-rays
- Spouse - Covered In-Network Items: 4 PCP Office Visits; 5 Specialist Office Visits; 1 Pregnancy; 1 Outpatient Procedure; 2 Lab/X-rays
- Child 1 - Covered In-Network Items: 1 PCP Office Visit; 1 ER Visit; 1 Outpatient Procedure
- Child 2 - Covered In-Network Items: 1 PCP Office Visit; 1 ER Visit; 1 Outpatient Procedure
- Employee - Retail Prescriptions (Non-Preventive): 2 Preferred Brand Retail Prescriptions
- Spouse - Retail Prescriptions (Non-Preventive): 2 Preferred Brand Retail Prescriptions
- Child 1 - Retail Prescriptions (Non-Preventive): 2 Preferred Brand Retail Prescriptions
- Child 2 - Retail Prescriptions (Non-Preventive): 2 Preferred Brand Retail Prescriptions
Medium Usage
- Employee - Preventive: 1 Adult Preventive Care Visit; 8 Generic (Preventive) Mail Prescriptions
- Spouse - Preventive: 1 Adult Preventive Care Visit; 8 Generic (Preventive) Mail Prescriptions
- Child 1 - Preventive: 2 Well Child Visits; 8 Generic (Preventive) Mail Prescriptions
- Child 2 - Preventive: 2 Well Child Visits; 8 Generic (Preventive) Mail Prescriptions
- Employee - Covered In-Network Items: 4 PCP Office Visits; 2 Specialist Office Visits; 1 Outpatient Procedure; 1 Lab/X-ray
- Spouse - Covered In-Network Items: 4 PCP Office Visits; 2 Specialist Office Visits; 1 Lab/X-ray
- Child 1 - Covered In-Network Item: 1 ER Visit
- Employee - Retail Prescriptions (Non-Preventive): 2 Preferred Brand Retail Prescriptions
- Spouse - Retail Prescriptions (Non-Preventive): 2 Preferred Brand Retail Prescriptions
Low Usage
- Employee - Preventive: 1 Adult Preventive Care Visit; 5 Generic (Preventive) Mail Prescriptions
- Spouse - Preventive: 1 Adult Preventive Care Visit; 4 Generic (Preventive) Mail Prescriptions
- Child 1 - Preventive: 2 Well Child Visits
- Child 2 - Preventive: 2 Well Child Visits
- Employee - Covered In-Network Items: 2 PCP Office Visits; 1 Specialist Office Visit
- Spouse - Covered In-Network Items: 2 PCP Office Visits; 1 Specialist Office Visit
Health Care Usage Assumptions - Individual Coverage
High Usage
- Employee - Preventive: 1 Adult Preventive Care Visit; 8 Generic (Preventive) Mail Prescriptions
- Employee - Covered In-Network Items: 4 PCP Office Visits; 5 Specialist Office Visits; 1 Inpatient Hospital Stay; 1 ER Visit; 2 Lab/X-rays
- Employee - Retail Prescriptions (Non-Preventive): 2 Preferred Brand Retail Prescriptions
Medium Usage
- Employee - Preventive: 1 Adult Preventive Care Visit; 8 Generic (Preventive) Mail Prescriptions
- Employee - Covered In-Network Items: 4 PCP Office Visits; 2 Specialist Office Visits; 1 Outpatient Procedure; 1 Lab/X-ray
- Employee - Retail Prescriptions (Non-Preventive): 2 Preferred Brand Retail Prescriptions
Low Usage
- Employee - Preventive: 1 Adult Preventive Care Visit; 3 Generic (Preventive) Mail Prescriptions
- Employee - Covered In-Network Items: 2 PCP Office Visits; 1 Specialist Office Visit
Step 3
Review the estimated costs you can expect to pay under each plan.
I intend to cover .
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Care Network PPO |
Care Network HDHP |
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| Out-of-Pocket Costs | ||||
| Amount you pay toward the deductible: | - |
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| Amount you pay in coinsurance/co-pays: | - |
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Adjusted Annual Out-of-Pocket Cost
Not including medical plan premium |
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Less amount HSA can pay
Annual employer HSA contribution |
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Net Employee Cost
Not including medical plan premiums |
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| Medical Plan Premiums | ||||
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- Save up to $1,000 on your annual medical plan premium when you complete Well Rewards requirements. Learn more and get started at UCMCwellness.org.