Open Enrollment Meetings
Informational Meetings for STAFF
Tuesday, October 25, 10:00am in 17th Floor Conference Center
Friday, October 28, 11:00am
Meeting ID: 977 8368 0862
Informational Meeting for PARTNERS
Friday, October 28, 10:00am
Meeting ID: 969 7259 2771
Choose the best plan for you
Choosing a medical plan is a personal decision, and there is not always a “right” choice. The right medical plan for one person or family may be totally different for another. The following scenarios have been created to help you think about selecting the right plan for you. Please contact Alison Spring if you would like help determining which plan is right for you.
Barbara and her husband have 2 young children. They have a lot of outside expenses and don't like to make large expenditures.
In addition to preventative visits, this year, both kids will see a few specialists to monitor health conditions.
Barbara has been seeing a therapist weekly and is considering sending one kid to a therapist as well.
The whole family takes several monthly prescriptions.
Barbara's family sees doctors and therapists regularly. They like being able to pay a co-pay at the visit with no big bills. Their monthly prescriptions can be expensive, but they like the lower cost of the co-pays.
They are lucky and have found several providers in the BlueChoice network (with lower co-pays).
While the premium is slightly higher than other plans, they select the PPO plan.
Roberta, a partner at the Firm, has a spouse and 3 children. As a partner, Roberta pays the full medical premium for any plan selected.
Roberta has a child with a medical condition that requires several prescriptions, doctor visits and lab work.
Her husband is probably going to have knee replacement surgery this year.
It is likely that Roberta will meet the out-of-pocket maximum for any health plan this year.
Reviewing the premiums plus the maximum out-of-pocket expense, the HD 1500 plan is the best choice this year.
Dave is single and fairly healthy. He's comfortable saving money for future medical expenses.
Dave knows he will see his doctor for his annual physical and blood work.
He often gets a sinus infection each year requiring a doctor visit and prescription.
Other than that he's been pretty healthy.
Dave chose the HD 3000 plan.
He has plenty of savings in his HSA which would cover his costs if he should have a significant injury that causes him to meet his deductible and out-of-pocket maximum.
He likes saving money on premiums by choosing the lowest-cost plan.
Sam, a single employee, is fairly healthy and doesn’t currently have a primary doctor. His budget is tight and he hopes to keep costs low this year.
Sam is fairly healthy but is due for an annual physical. Sometimes he ends up in urgent care after playing sports with friends.
Sam selected the HMO Blue Advantage plan. He found a primary care doctor in the network. He likes the lower premium and lower copays compared to the other plans and doesn’t mind the trade-off that he can only see providers in the Blue Advantage Network.
Joe, married with 3 children. His wife has a medical condition they need to get diagnosed and probably treatment for this year. Thinking about sending 3 children to college soon, saving money is important.
Joe and the kids are fairly healthy with occasional doctor visits and one or two urgent care visits during the year for injuries or illnesses. His wife needs to get treatment for a medical condition and they don’t know how many tests will be required.
Joe selected the HMO Blue Advantage plan. He found primary care doctors for the family that were in the network. He likes the much lower deductible and the fact that most tests will not have a cost to the family. He knows the providers are good quality and will care for his family, while saving money with managed care.
Susan and her spouse have moderate medical needs. They prefer to see doctors they select, most of which are in-network.
Susan and her spouse take a few prescriptions monthly. Susan and her spouse have both been seeing a therapist weekly and her spouse goes to several specialist doctors each year to follow up on health conditions. This year they expect to have an MRI and lab tests related to her spouse’s conditions.
Susan selected the HD 1500 plan. Since many of the most expensive claims will require meeting a deductible in most plans, she selected the plan that will save them the most money this year based on her spending and medical plan premiums.
Susan might have also considered the PPO, while it has slightly higher premiums, the lower co-pays for medicine and therapy visits made up for meeting the deductible when they realized many of their providers were in the lower-cost BlueChoice network.
Choose the best plan for you
The following scenarios have been created to help you think about selecting the right plan for you. Please contact Alison Spring if you would like help determining which plan is right for you.
Susan has seen her current dentist for many years. She really likes the office and doesn't want to change providers.
She usually only needs preventative cleanings. She's had a few fillings over the years.
Susan doesn't want to change providers, and her current provider does not participate in the DHMO plan.
The PPO is the best choice for Susan.
Stuart recently moved into the city and doesn't have a dentist. He likes saving money when possible.
His teeth are quite healthy. He only has two fillings.
Stuart doesn't have a current dentist and is happy to select from the DHMO providers available. The premiums are significantly less than the PPO which makes him happy.
The DHMO is a good choice for Stuart.
Brady, his spouse and 2 children need dental insurance.
Brady's children both need braces in the next few years. Brady has been told he needs 3 crowns and has gum disease to manage in the upcoming year. He's not sure how he can afford all of this.
Brady may want to consider the DHMO plan.
Orthodontia has a clear cost (and no maximum benefit like the PPO). The DHMO plan has co-payments with no limit on the amount one person or family can spend.
Since Brady has high expected costs, the DHMO may be the most cost-effective way to cover his family.
Roberta's child is ready for braces. They plan to go to the orthodontist recommended by their family dentist.
In addition to braces, Roberta's younger child found out that he needs a few fillings and her husband just cracked a tooth and needs a crown.
While the expenses for the family are adding up quickly, each person's total cost will still likely be less than the $2,000 per person annual benefit maximum.
Roberta already has an orthodontist in mind, so the PPO may be the best choice.