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2013 Sample Employee Scenarios: Using Purdue's Various Medical Plan Options

Single Employee – Sandy

Meet Sandy. Sandy is single and lives with her dog, Fido. When she's not working, she enjoys working out, hiking, and spending time with her friends.

Sandy is considering enrolling in the Purdue Choice Fund instead of her current election. As she considers what to do, she assumes that she will contribute the annual premium difference between the Purdue Incentive and Purdue Choice Fund to her HSA. Because Sandy is a good health care consumer, she always uses in-network providers and takes advantage of her preventive care benefits.

“Not-So-Healthy” Sandy

Sandy isn't getting to the gym as much as she would like, her diet is tending toward fast food, and she's caught a few viruses during the year. As a result, she:

  • Has $700 in covered medical expenses (non-primary care) and
  • Needs three preferred brand prescription drugs at a retail cost of $100 each.

Here’s what Sandy’s total costs might look like under each plan.

  • If Sandy makes over $44,000 per year

  • If Sandy makes under $44,000 per year

Employee + Child(ren) – Brenda

Meet Brenda. Brenda is divorced and has two children: Peter, age 11, and Kate, age 9. Between work and her children's school and sports activities, it's difficult for Brenda to find much time for herself. But when she does, she likes to stay active by walking, playing tennis, and playing with her kids. She makes over $44,000 per year.

Brenda is considering enrolling in the Purdue Choice Fund instead of her current election. As she considers what to do, she assumes that she will contribute the annual premium difference between the Purdue Incentive and Purdue Choice Fund to her HSA. Because Brenda is a good health care consumer, she always uses in-network providers and takes advantage of her preventive care benefits.

“Too Busy” Brenda

The kid's activities keep Brenda on the go throughout the year, with little time for herself. She's not exercising as much as she would like and her – and the kids' – diet is limited to fast food. This results in:

  • $2,400 in covered medical expenses (non-primary) and
  • The need for six preferred brand prescription drugs at a retail cost of $100 each.

Here's what Brenda's total costs might look like under each plan.

  • If Brenda makes over $44,000 per year
  • If Brenda makes under $44,000 per year

Employee + Spouse – Dave

Meet Dave. Dave has been married for 15 years, but has no children. He loves to ski with his wife during the winter months and spend time on the lake near their home during the summer. Dave is committed to an active lifestyle, but as he gets older, he has experienced some health issues.

Dave is considering enrolling in the Purdue Choice Fund instead of his current election. As he considers what to do, he assumes that he will contribute the annual premium difference between the Purdue Incentive and Purdue Choice Fund to his HSA. Because Dave is a good health care consumer, he always uses in-network providers and takes advantage of his preventive care benefits.

“I'm Getting Older” Dave

Dave and his wife both got injured on the ski slopes, in addition to some other illnesses throughout the year. For the year, he:

  • Has $4,600 in covered medical expenses (non-primary care) and
  • Needs four preferred brand prescriptions at a retail cost of $100 each.

Here's what Dave's total costs might look like under each plan.

  • If Dave makes over $44,000 per year
  • If Dave makes under $44,000 per year

Family – Joe

Meet Joe. Joe is married with three young children, ages 6, 3, and 18 months. This is a really busy time in Joe's life. Between work and family, he doesn't have a lot of free time to devote to his health. But he does what he can and works hard to take advantage of his Healthy Purdue's resources.

Joe is considering enrolling in the Purdue Choice Fund instead of his current election. As he considers what to do, he assumes that he will contribute the annual premium difference between the Purdue Incentive and Purdue Choice Fund to his HSA. Because Joe is a good health care consumer, he always uses in-network providers and takes advantage of his preventive care benefits.

“That Hurts” Joe

Joe injures his back running around with the kids and needs several surgeries, his wife has some serious medical issues, and the kids need a couple of trips to the ER. For the year:

  • His total covered health care expenses reach $38,000.
  • His family needs 20 preferred brand prescription drugs at a retail cost of $100 each.

Here's what Joe's total costs might look like under each plan.

  • If Joe makes over $44,000 per year
  • If Joe makes under $44,000 per year

Family - Peggy

Peggy and her husband, Bill, are expecting their first child in January 2013. They are both relatively healthy and have no medical expenses besides their maternity expenses.

Peggy is considering enrolling in the Purdue Choice Fund instead of her current election. As she considers what to do, she assumes that she will contribute the annual premium difference between the Purdue Incentive and Purdue Choice Fund to her HSA.

"Pregnant" Peggy

Because Peggy is a good health care consumer, she always uses in-network providers and takes advantage of her preventive care benefits.
As a result of her pregnancy, Peggy incurs the following expenses (for an uncomplicated vaginal birth):

  • $8,500 in delivery and hospital charges. (This amount includes all prenatal Dr. visits)
  • $300 prenatal ultrasound (performed at an independent outpatient facility).
  • $55 prenatal lab work (performed at a Tier 1 Lab provider).
  • $2,389 baby hospital charges
  • If Peggy makes over $44,000 per year
  • If Peggy makes under $44,000 per year

Single Employee - Hal

Hal is a very healthy single male. In his spare time he likes to run with his dog “Jake” and hang out with his friends on the golf course.

Hal is considering enrolling in the Purdue Choice Fund instead of his current election. As he considers what to do, he assumes that he will contribute the annual premium difference between the Purdue Incentive and Purdue Choice Fund to his HSA.

"Healthy" Hal

Because Hal is a good health care consumer, he always uses in-network providers and takes advantage of his preventive care benefits.
Hal has the following medical expenses during the year:

  • $300 in two primary care visits due to his seasonal allergies and a bout of bronchitis
  • Hal needs one preferred brand prescription drug at retail cost of $50 Under the Incentive plan, coinsurance amount should be $40 ($20 times 2 primary care visits)
  • If Hal makes over $44,000 per year
  • If Hal makes under $44,000 per year