| A | B | C | D | E | F | G | H | I | J | K | L | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Direct employment | Employer of Record (EOR) | Professional Employer Organization (PEO) | ||||||||||
2 | Plan A | Plan B | Plan C | Plan D | Plan E | Plan F | Plan G | Plan H | Plan Y | ||||
3 | Overview | Employment type | Direct | Direct | Direct | Prof. employer org | Prof. employer org | Prof. employer org | Prof. employer org | Prof. employer org | Prof. employer org | ||
4 | Provider | Blue Shield | UnitedHealthcare | Health Net | UnitedHealthcare | UnitedHealthcare | UnitedHealthcare | Aetna | Aetna | Aetna | |||
5 | Plan type | PPO | PPO | PPO | PPO | PPO | PPO | POS | POS | EPO | |||
6 | Total monthly premium | $3,294 | $2,945 | $2,869 | $1,975 | $1,927 | $1,855 | $3,060 | $3,022 | $2,202 | |||
7 | Premium + platform/maintenance | $3,414 | $3,065 | $2,989 | $1,975 | $1,927 | $1,855 | $3,178 | $3,140 | $2,320 | |||
8 | In-network coverage | Deductible | Amount staff pays before provider begins paying | $250 | $250 | $250 | $1,000 | $1,500 | $1,000 | $750 | $500 | $1,000 | |
9 | Family Deductible | Amount all dependents pay before provider begins paying | $500 | $500 | $500 | $2,000 | $3,000 | $2,000 | $1,500 | $1,000 | $2,000 | ||
10 | Out-Of-Pocket | Maximum amount staff could pay per year before provider begins covering 100% of costs | $3,500 | $3,800 | $3,800 | $9,150 | $9,450 | $9,150 | $3,000 | $3,500 | $5,500 | ||
11 | Family Out-Of-Pocket | Maximum amount dependent could pay per year before provider begins covering 100% of costs | $7,000 | $7,600 | $7,600 | $18,300 | $18,900 | $18,300 | $6,000 | $7,000 | $11,000 | ||
12 | Coinsurance | % of amount paid out-of-pocket before provider begins paying | 10% | 10% | 10% | 20% | 30% | 20% | 10% | 20% | 20% | ||
13 | Office Visit / PCP | Copayment amount for Primary Care Physician (PCP) | $10 | $15 | $15 | $30 | $10 | $30 | $25 | $25 | $20 | ||
14 | Specialty Doctor Office Visit | Copayment amount for visiting a specialist (e.g. dermatologist, orthopedic surgeon) | $10 | $30 | $30 | $60 | $70 | $60 | $50 | $50 | $65 | ||
15 | Urgent Care | Amount paid when staff is admitted to urgent care centre for conditions needing prompt attention but which aren't life-threatening (e.g. minor injury or infection) | $10 | $50 | $15 | $50 | $50 | $50 | $85 | $85 | $75 | ||
16 | Emergency Room | Amount paid when staff is admitted to ER for serious and/or life-threatening emergencies | $150 + 10% | $150 + 10% | 10% | $250 + 20% | $250 + 30% | $250 + 20% | $350 | $350 | $400 | ||
17 | Inpatient Hospital Services | Amount paid when staff is admitted to hospital and required to stay overnight | 10% | 10% | 10% | $250 + 20% | $250 + 30% | $250 + 20% | 10% | 20% | 20% | ||
18 | Lab | Amount paid when staff use laboratory services (e.g. blood, urine, genetic tests) | $100 + 10% | 10% | $30 | 40% | 50% | 40% | 10% | 20% | 20% | ||
19 | X-Ray | Amount paid for an X-ray | $30 | 10% | $30 | 40% | 50% | 40% | 10% | 20% | 20% | ||
20 | Outpatient Hospital | Amount paid when staff is admitted to hospital but not required to stay overnight | $100 + 10% | 10% | 10% | 40% | 50% | 40% | 10% | 20% | 20% | ||
21 | Rx deductible | Cost for prescription medication | $0 | $0 | $0 | $300 ($800) | $300 ($600) | $300 ($600) | Not covered | Not covered | $100 | ||
22 | Out-of-network coverage | Deductible | Amount staff pays before provider begins paying | $250 | $1,000 | $1,000 | $2,000 | $3,000 | $2,000 | $2,250 | $1,500 | Not covered | |
23 | Family Deductible | Amount all dependents pay before provider begins paying | $500 | $2,000 | $2,000 | $4,000 | $6,000 | $4,000 | $4,500 | $3,000 | Not covered | ||
24 | Out-Of-Pocket | Maximum amount staff could pay per year before provider begins covering 100% of costs | $7,000 | $7,600 | $9,000 | $18,300 | $18,900 | $18,300 | $8,000 | $7,000 | Not covered | ||
25 | Family Out-Of-Pocket | Maximum amount dependent could pay per year before provider begins covering 100% of costs | $14,000 | $15,200 | $18,000 | $36,600 | $37,800 | $36,600 | $16,000 | $14,000 | Not covered | ||
26 | Coinsurance | % of amount paid out-of-pocket before provider begins paying | 40% | 50% | 50% | 50% | 50% | 50% | 40% | 50% | Not covered | ||
27 | Office Visit / PCP | Copayment amount for Primary Care Physician (PCP) | 40% | 50% | 50% | 50% | 50% | 50% | 30% | 30% | Not covered | ||
28 | Specialty Doctor Office Visit | Copayment amount for visiting a specialist (e.g. dermatologist, orthopedic surgeon) | 40% | 50% | 50% | 50% | 50% | 50% | 140% Medicare | 140% Medicare | Not covered | ||
29 | Urgent Care | Amount paid when staff is admitted to urgent care centre for conditions needing prompt attention but which aren't life-threatening (e.g. minor injury or infection) | 40% | 50% | 50% | 50% | 50% | 50% | 140% Medicare | 140% Medicare | Not covered | ||
30 | Emergency Room | Amount paid when staff is admitted to ER for serious and/or life-threatening emergencies | $150 + 10% | $150 + 10% | 10% | $250 + 20% | $250 + 30% | $250 + 20% | 140% Medicare | 140% Medicare | Not covered | ||
31 | Inpatient Hospital Services | Amount paid when staff is admitted to hospital and required to stay overnight | 40% (up to $2,000 per day) | 50% | 50% | $250 + 50% | $250 + 50% | $250 + 50% | 40% | 50% | Not covered | ||
32 | Lab | Amount paid when staff use laboratory services (e.g. blood, urine, genetic tests) | 40% | Not covered | 50% | Not covered | Not covered | Not covered | 40% | 50% | Not covered | ||
33 | X-Ray | Amount paid for an X-ray | 40% | 50% | 50% | 50% | 50% | 50% | 40% | 50% | Not covered | ||
34 | Outpatient Hospital | Amount paid when staff is admitted to hospital but not required to stay overnight | 40% (up to $350 per day) | 50% | 50% | 50% | 50% | 50% | 40% | 50% | Not covered | ||
35 | Rx deductible | Cost for prescription medication | $0 | $0 | $0 | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | ||