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plan design for self-insured options

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1 Plan Design for Self-Insured Options Gold Plan Silver Plan Bronze Plan Network Provider Out-of-Network Network Provider Out-of-Network Network Provider Out-of-Network Medical Benefits Deductible* You $1,500 $3,000 $2,000 $4,000 $2,500 $5,000 You + Child(ren) or Spouse $2,250 $4,500 $3,000 $6,000 $3,750 $7,500 You + Family $3,000 $6,000 $4,000 $8,000 $5,000 $10,000 Plan Pays 85% 60%* 80% 60%* 75% 60%* ACA Preventive Care 100% Not covered 100% Not covered 100% Not covered Out-of-Pocket Limit* You $4,000 $8,000 $5,000 $10,000 $6,000 $12,000 You + Child(ren) or Spouse $6,000 $12,000 $7,500 $15,000 $9,000 $18,000 You + Family $8,000 $16,000 $10,000 $20,000 $12,000 $24,000 Base HRA Contribution You $400 $200 $100 You + Child(ren) or Spouse $600 $300 $150 You + Family $800 $400 $200 Pharmacy Benefits Tier 1 15%, Min $20, Max $50 15%, Min $20, Max $50 15%, Min $20, Max $50 Tier 2 25%, Min $50, Max $80 25%, Min $50, Max $80 25%, Min $50, Max $80 Tier 3 25%, Min $80, Max $125 25%, Min $80, Max $125 25%, Min $80, Max $125 * See ACA Glossary of Health Coverage and Medical Terms for definition; ** of Allowed Amount, See ACA Glossary for definition This is a high level plan design summary.

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Plan Design for Self-Insured Options. 1. - PowerPoint PPT Presentation

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Page 1: Plan Design for Self-Insured Options

1

Plan Design for Self-Insured Options

  Gold Plan Silver Plan Bronze PlanNetwork Provider Out-of-Network Network Provider Out-of-Network Network Provider Out-of-Network

Medical Benefits

Deductible*            

You $1,500  $3,000  $2,000  $4,000  $2,500  $5,000 

You + Child(ren) or Spouse $2,250  $4,500  $3,000  $6,000  $3,750  $7,500 

You + Family $3,000  $6,000  $4,000  $8,000  $5,000  $10,000 

Plan Pays 85% 60%* 80% 60%* 75% 60%*

ACA Preventive Care 100% Not covered 100% Not covered 100% Not  covered

Out-of-Pocket Limit*            

You $4,000  $8,000  $5,000  $10,000  $6,000  $12,000 

You + Child(ren) or Spouse $6,000  $12,000  $7,500  $15,000  $9,000  $18,000 

You + Family $8,000  $16,000  $10,000  $20,000  $12,000  $24,000 

Base HRA Contribution            

You $400  $200  $100 

You + Child(ren) or Spouse $600  $300  $150 

You + Family $800  $400  $200 

Pharmacy Benefits            

Tier 1 15%, Min $20, Max $50  15%, Min $20, Max $50 15%, Min $20, Max $50

Tier 2 25%, Min $50, Max $80 25%, Min $50, Max $80 25%, Min $50, Max $80

Tier 3 25%, Min $80, Max $125 25%, Min $80, Max $125 25%, Min $80, Max $125

* See ACA Glossary of Health Coverage and Medical Terms for definition; ** of Allowed Amount, See ACA Glossary for definition

This is a high level  plan design summary.  

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