Once you are familiar with each plan’s out-of-pocket expenses, you can use the graphic below to track the path of cumulative (increasing) out-of-pocket expenses until they meet the total out-of-pocket maximum and are covered 100 percent by the University. The scenarios below the graphic explain how each expense is recorded for both individual and family plans, and applied to the total out-of-pocket maximum.
Scenario 1 (Based on a single individual in each plan. This is your first visit of the year.)
You are not feeling well and decide to see your Primary Care Physician. During your visit, the doctor writes you a prescription for an antibiotic and schedules blood work for a CBC (Complete Blood Count). No follow-up appointment needed.
Under the PPO Savings Plan:
- Your visit, blood work, and prescription costs are all applied to the deductible (green box).
Scenario 2 (Based on a single individual in each plan. This is a subsequent visit to the first scenario.)
You see a specialist for your arthritis. During the visit the doctor schedules blood work, an X-ray and prescribes an anti-inflammatory prescription drug for you to take.
Under the PPO Savings Plan:
- Your office visit, blood works, X-rays, and prescription costs are applied to the deductible (the green box).
Scenario 3 (Based on family coverage)
Your child was injured during soccer practice and must to be taken to the emergency room (ER) for an X-ray. The X-ray indicates a fracture of the tibia, and the leg has to be casted. He is sent home with pain relievers and crutches.
Under the PPO Savings Plan:
- You will be billed for the ER visit, the X-ray, the prescription drug, and the crutches. All will be applied toward your family deductible (green box).
Scenario 4 (based on family coverage)
That same year, you have to have your gallbladder removed. You stay overnight in the hospital for the surgery and when you leave, you are given prescription medication for pain.
Under the PPO Savings Plan:
- You will be billed for your hospital stay, your surgery, and the prescription. Your son’s previous ER visit, X-ray and prescription drug costs brought you close to meeting the family deductible. Your surgery has put you over the deductible (green box). So, you pay 10 percent coinsurance for any dollar amount over $3,200 (blue box). You are now responsible for just 10 percent of all remaining health care costs for all family members throughout the year until you reach your out-of-pocket maximum.