Bill

Bill is single. He doesn't use nicotine products and gets his annual physical. He uses in-network doctors and Preferred Medical and Wellness Providers when possible, but he's had a tough year.

Let's take a look…

Provider Billed Cost
He gets his free annual physical.

$80
100% paid by the company!

He starts to feel bad and goes to his primary care doctor several times. His doctor gives him several generic 30-day medications that he fills at the pharmacy.

$100 visit x 6
$20 generic 30-day x 3

His problem gets worse, so he starts to see a specialist every week. During a few of his visits, he is sent to an outside facility for lab work.

$140 visit x 6
$100 labs x 3

Provider Billed Cost
His condition gets worse and he goes to the ER twice.

$2,000 visit x 2

Later he has surgery for his condition.

$25,000 surgery and hospital stay

He sees a physical therapist eight times to recover from his surgery and fills two new generic 90-day prescriptions through mail order.

$80  visit x 8
$85 generic 90-day x 2

Bill's total expenses:

Bill has incurred a total of $31,690 in expenses from providers and services. Now, let’s see which plan would have been better for Him!

$31,690
in total expenses.
back_hand
Wait! We also need to remember that Bill has been paying for medical coverage from His paycheck too. We'll add that in.

Remember, Bill incurred $31,690 in total expenses from providers and services.

Because the choice of funding account impacts the cost of care in the Whole Health plan, both the PWA and HSA options are shown here.

Surest Plan
National Select (PWA)
National Choice (PWA or HSA)
Whole Health Plan (HSA)
Whole Health Plan (PWA)
Costs paid by
 
Bill
$4,550
$3,325
$6,650
$3,325
$3,325
Paycheck
 
contributions
$1,170
$1,378
$650
$650
$650
WFM PWA/HSA contributions
N/A
($500)
($1,000)
($1,000)
($1,500)
($1,000)
($1,500)
($1,000)
($1,500)
And the winner is...

Depending on which plans Bill is eligible for, the National Select and Whole Health Plans are the winners!

Surest Plan
National Select (PWA)
National Choice (PWA or HSA)
Whole Health Plan (HSA)
Whole Health Plan (PWA)
Costs paid by
 
Bill
$4,550
$3,325
$6,650
$3,325
$3,325
Paycheck
 
contributions
$1,170
$1,378
$650
$650
$650
WFM PWA/HSA contributions
N/A
($500)
($1,000)
($1,000)
($1,500)
($1,000)
($1,500)
($1,000)
($1,500)
Total Costs
 
 
$5,720
$4,203
$6,300
$2,975
$2,975

Click here to view a detailed breakdown of the costs in each of the plans.

Bill

Bill es soltero. No consume productos con nicotina y se hace el chequeo médico anual. - Acude a médicos y proveedores médicos y de bienestar preferentes dentro de la red siempre que es posible, pero ha tenido un año difícil.

Echemos un vistazo…

Provider Billed Cost
Le hacen el chequeo médico anual gratuito.

$80 x 1 = $80
¡La empresa paga el 100 %!

Empieza a sentirse mal y acude varias veces a su médico de atención primaria. El médico le receta varios medicamentos genéricos para 30 días.

$100, consulta x 6
$20, genéricos para 20 días x 3

Su estado empeora, así que empieza a acudir a un especialista todas las semanas. Durante algunas de sus consultas lo envían a un centro externo para que le hagan análisis de laboratorio.

$140, consulta x 6
$100, análisis de laboratorio x 3

Provider Billed Cost
Su estado empeora y acude dos veces a la sala de emergencias.

$2.000, consulta x 2

Más tarde, acaba operándose debido a su problema de salud.

$25,000, cirugía y días de hospitalización

Acude ocho veces a un fisioterapeuta para recuperarse de la cirugía y surte por correo dos recetas nuevas de medicamentos genéricos para 90 días.

$80, consulta x 8
$85, genéricos para 90 días x 2

Gastos totales de Bill:

Bill ha incurrido en un total de $31,690 en gastos de proveedores y servicios. Veamos ahora qué plan hubiese sido mejor para Bill.

$31,690
en gastos totales
back_hand
¡Un momento! También debemos recordar que Bill ha estado pagando la cobertura médica con su salario. Agregaremos eso.

Recuerde que Bill ha incurrido en un total de $31,690 en gastos de proveedores y servicios.

Dado que la elección de la cuenta de financiamiento repercute en el costo de la atención en el Whole Health Plan, aquí se muestran tanto la opción de la PWA como la HSA.

Surest Plan
National Select (PWA)
National Choice (PWA or HSA)
Whole Health Plan (HSA: nivel preferente)
Whole Health Plan (PWA: nivel preferente)
Costos a cargo de
 
Bill
$4,550
$3,325
$6,650
$3,325
$3,325
Deducciones del cheque de paga
 
 
$1,170
$1,378
$650
$650
$650
Contribuciones de WFM a la PWA/HSA
N/A
($500)
($1,000)
($1,000)
($1,500)
($1,000)
($1,500)
($1,000)
($1,500)
Y el indicado es…

En función de los planes a los que puede acceder Bill, ¡el National Select Plan o el Whole Health Plan son los indicados!

Surest Plan
National Select (PWA)
National Choice (PWA or HSA)
Whole Health Plan (HSA: nivel preferente)
Whole Health Plan (PWA: nivel preferente)
Costos a cargo de
 
Bill
$4,550
$3,325
$6,650
$3,325
$3,325
Deducciones del cheque de paga
 
 
$1,170
$1,378
$650
$650
$650
Contribuciones de WFM a la PWA/HSA
N/A
($500)
($1,000)
($1,000)
($1,500)
($1,000)
($1,500)
($1,000)
($1,500)
Costo anual total
 
 
$5,720
$4,203
$6,300
$2,975
$2,975

Haga clic aquí para obtener un desglose detallado de los costos en cada uno de los planes.