2012 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 would contribute the difference between the annual premium contributions in the Purdue Choice Fund and the Purdue Incentive 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 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
| Feature | Purdue Choice Fund | Purdue Incentive | Purdue Copay |
| Sandy's annual premium cost: |
$567 |
$853 |
$1,270 |
| Her annual contribution to the HSA (difference in annual premium contributions): |
$286 |
Health Savings Account not available in Purdue Incentive plan |
Health Savings Account not available in Purdue Copay plan |
| Purdue contributes to her HSA: |
$650 |
| Total HSA dollars available for Sandy to use to pay for eligible health care expenses: |
= $936 |
| Total eligible health care expenses: |
$1,000
(medical & Rx) |
$700
(medical only) |
$700
(medical only) |
| HSA dollars Sandy uses to pay for eligible health care expenses: |
$936 |
NA |
NA |
| Remaining expenses: |
$64 |
$700 |
$700 |
| Sandy pays up to annual deductible: |
$64 |
$500 |
$0 |
| Sandy pays coinsurance on remaining charges up to out-of-pocket maximum: |
NA |
$40
(20% of remaining $200 in charges) |
$70* |
| Sandy's cost for prescription drugs: |
Included in health care expenses |
$90
(30% of $300) |
$90
(30% of $300) |
| Sandy 's total premium and benefit costs for the year: |
$917 |
$1,483 |
$1,430 |
| HSA dollars that roll over to next year: |
$0 |
NA |
NA |
*Although there is no coinsurance, this example assumes Sandy incurs $70 in copays over the course of the year.
- If Sandy makes under $44,000 per year
| Feature | Purdue Choice Fund | Purdue Incentive | Purdue Copay |
| Sandy's annual premium cost: |
$171 |
$329 |
$690 |
| Her annual contribution to the HSA (difference in annual premium contributions): |
$158 |
Health Savings Account not available in Purdue Incentive plan |
Health Savings Account not available in Purdue Copay plan |
| Purdue contributes to her HSA: |
$650 |
| Total HSA dollars available for Sandy to use to pay for eligible health care expenses: |
= $808 |
| Total eligible health care expenses: |
$1,000
(medical & Rx) |
$700
(medical only) |
$700
(medical only) |
| HSA dollars Sandy uses to pay for eligible health care expenses: |
$808 |
NA |
NA |
| Remaining expenses: |
$192 |
$700 |
$700 |
| Sandy pays up to annual deductible: |
$192 |
$500 |
$0 |
| Sandy pays coinsurance on remaining charges up to out-of-pocket maximum: |
NA |
$40
(20% of remaining $200 in charges) |
$70* |
| Sandy's cost for prescription drugs: |
Included in health care expenses |
$90
(30% of $300) |
$90
(30% of $300) |
| Sandy 's total premium and benefit costs for the year: |
$521 |
$959 |
$850 |
| HSA dollars that roll over to next year: |
$0 |
NA |
NA |
*Although there is no coinsurance, this example assumes Sandy incurs $70 in copays over the course of the 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 would contribute the difference between the annual premium contributions between the Purdue Choice Fund and the Purdue Incentive 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 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
| Feature | Purdue Choice Fund | Purdue Incentive | Purdue Copay |
| Brenda's annual premium cost: |
$908 |
$1,411 |
$2,097 |
| Her annual contribution to the HSA (difference in annual premium contributions): |
$503 |
Health Savings Account not available in Purdue Incentive plan |
Health Savings Account not available in Purdue Copay plan |
| Purdue contributes to her HSA: |
$1,300 |
| Total HSA dollars available for Brenda to use to pay for eligible health care expenses: |
= $1,803 |
| Total eligible health care expenses: |
$3,000
(medical & Rx) |
$2,400
(medical only) |
$2,400
(medical only) |
| HSA dollars Brenda uses to pay for eligible health care expenses: |
$1,803 |
NA |
NA |
| Remaining expenses: |
$1,197 |
$2,400 |
$2,400 |
| Brenda pays up to annual deductible: |
$797
($2,600 deductible - $1,803 in HSA dollars = $797) |
$1,000 |
$0 |
| Brenda pays coinsurance on remaining charges up to out-of-pocket maximum: |
$80
(20% of remaining $400 in charges) |
$280
(20% of remaining $1,400 in charges) |
$300* |
| Brenda's cost for prescription drugs: |
Included in health care expenses |
$180
(30% of $600) |
$180
(30% of $600) |
| Brenda's premium and benefit costs for the year: |
$2,288 |
$2,871 |
$2,577 |
| HSA dollars that roll over to next year: |
$0 |
NA |
NA |
*Although there is no coinsurance, this example assumes Brenda incurs $300 in copays over the course of the year.
- If Brenda makes under $44,000 per year
| Feature | Purdue Choice Fund | Purdue Incentive | Purdue Copay |
| Brenda's annual premium cost: |
$308 |
$598 |
$1,201 |
| Her annual contribution to the HSA (difference in annual premium contributions): |
$290 |
Health Savings Account not available in Purdue Incentive plan |
Health Savings Account not available in Purdue Copay plan |
| Purdue contributes to her HSA: |
$1,300 |
| Total HSA dollars available for Brenda to use to pay for eligible health care expenses: |
= $1,590 |
| Total eligible health care expenses: |
$3,000
(medical & Rx) |
$2,400
(medical only) |
$2,400
(medical only) |
| HSA dollars Brenda uses to pay for eligible health care expenses: |
$1,590 |
NA |
NA |
| Remaining expenses: |
$1,410 |
$2,400 |
$2,400 |
| Brenda pays up to annual deductible: |
$1010
($2,600 deductible - $1,590 in HSA dollars = $1,010) |
$1,000 |
$0 |
| Brenda pays coinsurance on remaining charges up to out-of-pocket maximum: |
$80
(20% of remaining $400 in charges) |
$280
(20% of remaining $1,400 in charges) |
$300* |
| Brenda's cost for prescription drugs: |
Included in health care expenses |
$180
(30% of $600) |
$180
(30% of $600) |
| Brenda's premium and benefit costs for the year: |
$1,688 |
$2,058 |
$1,681 |
| HSA dollars that roll over to next year: |
$0 |
NA |
NA |
*Although there is no coinsurance, this example assumes Brenda incurs $300 in copays over the course of the 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 would contribute the difference between the annual premium contributions between the Purdue Choice Fund and the Purdue Incentive 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 and
- Needs four preferred brand prescriptions at a 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
| Feature | Purdue Choice Fund | Purdue Incentive | Purdue Copay |
| Dave's annual premium cost: |
$1,419 |
$2,055 |
$3,051 |
| His annual contribution to the HSA (difference in annual premium contributions): |
$636 |
Health Savings Account not available in Purdue Incentive plan |
Health Savings Account not available in Purdue Copay plan |
| Purdue contributes to his HSA: |
$1,300 |
| Total HSA dollars available for Dave to use to pay for eligible health care expenses: |
= $1,936 |
| Total eligible health care expenses: |
$5,000
(medical & Rx) |
$4,600
(medical only) |
$4,600
(medical only) |
| HSA dollars Dave uses to pay for eligible health care expenses: |
$1,936 |
NA |
NA |
| Remaining expenses: |
$3,064 |
$4,600 |
$4,600 |
| Dave pays up to annual deductible: |
$664
($2,600 deductible - $1,936 in HSA dollars = $664) |
$1,000 |
$250 |
| Dave pays coinsurance on remaining charges up to out-of-pocket maximum: |
$480
(20% of remaining $2,400 in charges up to $6,600 out-of-pocket maximum) |
$720 (20% of remaining $3,600 in charges up to $3,600 out-of-pocket maximum) |
$650*
($300 copays + 20% of remaining $1,750 in charges for the outpatient procedure) |
| Dave's cost for prescription drugs: |
Included in health care expenses |
$120
(30% of $400) |
$120
(30% of $400) |
| Dave's total premium and benefit costs for the year: |
$3,199 |
$3,895 |
$3,821 |
| HSA dollars that roll over to next year: |
$0 |
NA |
NA |
*This example assumes Dave incurs $300 in copays over the course of the year and has one outpatient procedure done for $2,000.
- If Dave makes under $44,000 per year
| Feature | Purdue Choice Fund | Purdue Incentive | Purdue Copay |
| Dave's annual premium cost: |
$407 |
$869 |
$1,745 |
| His annual contribution to the HSA (difference in annual premium contributions): |
$462 |
Health Savings Account not available in Purdue Incentive plan |
Health Savings Account not available in Purdue Copay plan |
| Purdue contributes to his HSA: |
$1,300 |
| Total HSA dollars available for Dave to use to pay for eligible health care expenses: |
= $1,762 |
| Total eligible health care expenses: |
$5,000
(medical & Rx) |
$4,600
(medical only) |
$4,600
(medical only) |
| HSA dollars Dave uses to pay for eligible health care expenses: |
$1,762 |
NA |
NA |
| Remaining expenses: |
$3,238 |
$4,600 |
$4,600 |
| Dave pays up to annual deductible: |
$838
($2,600 deductible - $1,762 in HSA dollars = $838) |
$1,000 |
$250 |
| Dave pays coinsurance on remaining charges up to out-of-pocket maximum: |
$480
(20% of remaining $2,400 in charges up to $6,600 out-of-pocket maximum) |
$720 (20% of remaining $3,600 in charges up to $3,600 out-of-pocket maximum) |
$650*
($300 copays + 20% of remaining $1,750 in charges for the outpatient procedure) |
| Dave's cost for prescription drugs: |
Included in health care expenses |
$120
(30% of $400) |
$120
(30% of $400) |
| Dave's total premium and benefit costs for the year: |
$2,187 |
$2,709 |
$2,765 |
| HSA dollars that roll over to next year: |
$0 |
NA |
NA |
*This example assumes Dave incurs $300 in copays over the course of the year and has one outpatient procedure done for $2,000.
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 would contribute the difference between the annual premium contributions between the Purdue Choice Fund and the Purdue Incentive 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 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
| Feature | Choice Fund | Purdue Incentive | Purdue Copay |
| Joe's annual premium cost: |
$1,700 |
$2,483 |
$3,687 |
| His annual contribution to the HSA (difference in annual premium contributions): |
$783 |
Health Savings Account not available in Purdue Incentive plan |
Health Savings Account not available in Purdue Copay plan |
| Purdue contributes to his HSA: |
$1,300 |
| Total HSA dollars available for Joe to use to pay for eligible health care expenses: |
= $2,083 |
| Total eligible health care expenses: |
$40,000
(medical & Rx) |
$38,000
(medical only) |
$38,000
(medical only) |
| HSA dollars Joe uses to pay for eligible health care expenses: |
$2,083 |
NA |
NA |
| Remaining expenses: |
$37,917 |
$38,000 |
$38,000 |
| Joe pays up to annual deductible: |
$517
($2,600 deductible - $2,083 in HSA dollars = $517) |
$1,000 |
$500 |
| Joe pays coinsurance on remaining charges up to out-of-pocket maximum: |
$4,000
(20% of remaining $37,400 in charges up to $6,600 out-of-pocket maximum) |
$2,600 (20% of remaining $37,000 in charges up to $3,600 out-of-pocket maximum) |
$2,600*
($700 copays + 20% of remaining $24,500 in charges for inpatient and outpatient services, up to $2,400 out-of-pocket maximum) |
| Joe's cost for prescription drugs: |
Included in health care expenses |
$600
(30% of $2,000) |
$600
(30% of $2,000) |
| Joe's total premium and benefit for the year: |
$7,000 |
$6,683 |
$7,387 |
| HSA dollars that roll over to next year: |
$0 |
NA |
NA |
*This example assumes Joe incurs $700 in copays over the course of the year and he and his wife have $25,000 worth of inpatient and outpatient services.
- If Joe makes under $44,000 per year
| Feature | Choice Fund | Purdue Incentive | Purdue Copay |
| Joe's annual premium cost: |
$512 |
$1,049 |
$2,113 |
| His annual contribution to the HSA (difference in annual premium contributions): |
$537 |
Health Savings Account not available in Purdue Incentive plan |
Health Savings Account not available in Purdue Copay plan |
| Purdue contributes to his HSA: |
$1,300 |
| Total HSA dollars available for Joe to use to pay for eligible health care expenses: |
= $1,837 |
| Total eligible health care expenses: |
$40,000
(medical & Rx) |
$38,000
(medical only) |
$38,000
(medical only) |
| HSA dollars Joe uses to pay for eligible health care expenses: |
$1,837 |
NA |
NA |
| Remaining expenses: |
$38,163 |
$38,000 |
$38,000 |
| Joe pays up to annual deductible: |
$763
($2,600 deductible - $1,837 in HSA dollars = $763) |
$1,000 |
$500 |
| Joe pays coinsurance on remaining charges up to out-of-pocket maximum: |
$4,000
(20% of remaining $37,400 in charges up to $6,600 out-of-pocket maximum) |
$2,600 (20% of remaining $37,000 in charges up to $3,600 out-of-pocket maximum) |
$2,600*
($700 copays + 20% of remaining $24,500 in charges for inpatient and outpatient services, up to $2,400 out-of-pocket maximum) |
| Joe's cost for prescription drugs: |
Included in health care expenses |
$600
(30% of $2,000) |
$600
(30% of $2,000) |
| Joe's total premium and benefit for the year: |
$5,812 |
$5,249 |
$5,813 |
| HSA dollars that roll over to next year: |
$0 |
NA |
NA |
*This example assumes Joe incurs $700 in copays over the course of the year and he and his wife have $25,000 worth of inpatient and outpatient services.
Family - Peggy
Peggy and her husband, Bill, are expecting their first child in January 2012. 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 would contribute the difference between the annual premium contributions in the Purdue Choice Fund and the Purdue Incentive 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
| Feature | Purdue Choice Fund | Purdue Incentive | Purdue Copay |
| Peggy's annual premium cost: |
$1,700 |
$2,483 |
$3,687 |
| Her annual contribution to the HSA (difference in annual premium contributions): |
$783 |
Health Savings Account not available in Purdue Incentive plan |
Health Savings Account not available in Purdue Copay plan |
| Purdue contributes to her HSA: |
$1,300 |
| Total HSA dollars available for Peggy to use to pay for eligible health care expenses: |
= $2,083 |
| Total eligible health care expenses: |
$11,244
(medical & Rx) |
$11,189
(medical only, lab paid at 100%) |
$11,189
(medical only, lab paid at 100%) |
| HSA dollars Peggy uses to pay for eligible health care expenses: |
$2,083 |
NA |
NA |
| Remaining expenses: |
$8,644 |
$11,189 |
$11,189 |
| Peggy pays up to annual deductible: |
$517 |
$1,000 |
$500 |
| Peggy pays coinsurance on remaining charges up to out-of-pocket maximum: |
$1,625 |
$2,038
(20% of remaining $10,189 in charges) |
$1,378
($950 remainder Peggy's OOP, 20% of remaining $2,139 of baby's charges) |
| Peggy's cost for prescription drugs: |
$0 |
$0 |
$0 |
| Peggy 's total premium and benefit costs for the year: |
$4,625 |
$5,521 |
$5,565 |
| HSA dollars that roll over to next year: |
$0 |
NA |
NA |
- If Peggy makes under $44,000 per year
| Feature | Purdue Choice Fund | Purdue Incentive | Purdue Copay |
| Peggy's annual premium cost: |
$512 |
$1,049 |
$2,113 |
| Her annual contribution to the HSA (difference in annual premium contributions): |
$537 |
Health Savings Account not available in Purdue Incentive plan |
Health Savings Account not available in Purdue Copay plan |
| Purdue contributes to her HSA: |
$1,300 |
| Total HSA dollars available for Peggy to use to pay for eligible health care expenses: |
= $1,839 |
| Total eligible health care expenses: |
$11,244
(medical & Rx) |
$11,189
(medical only, lab paid at 100%) |
$11,189
(medical only, lab paid at 100%) |
| HSA dollars Peggy uses to pay for eligible health care expenses: |
$1,839 |
NA |
NA |
| Remaining expenses: |
$9,405 |
$11,189 |
$11,189 |
| Peggy pays up to annual deductible: |
$761 |
$1,000 |
$500 |
| Peggy pays coinsurance on remaining charges up to out-of-pocket maximum: |
$1,729 |
$2,038
(20% of remaining $10,189 in charges) |
$1,378
($950 remainder Peggy's OOP, 20% of remaining $2,139 of baby's charges) |
| Peggy's cost for prescription drugs: |
$0 |
$0 |
$0 |
| Peggy 's total premium and benefit costs for the year: |
$3,539 |
$4,087 |
$3,991 |
| HSA dollars that roll over to next year: |
$0 |
NA |
NA |
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 would contribute the difference between the annual premium contributions in the Purdue Choice Fund and the Purdue Incentive 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 primary care visits due to his seasonal allergies and a bout of bronchitis
- $50 in prescriptions
- If Hal makes over $44,000 per year
| Feature | Purdue Choice Fund | Purdue Incentive | Purdue Copay |
| Hal's annual premium cost: |
$567 |
$853 |
$1,270 |
| His annual contribution to the HSA (difference in annual premium contributions): |
$286 |
Health Savings Account not available in Purdue Incentive plan |
Health Savings Account not available in Purdue Copay plan |
| Purdue contributes to his HSA: |
$650 |
| Total HSA dollars available for Hal to use to pay for eligible health care expenses: |
= $936 |
| Total eligible health care expenses: |
$350
(medical & Rx) |
$300
(medical only, lab paid at 100%) |
$300
(medical only, lab paid at 100%) |
| HSA dollars Hal uses to pay for eligible health care expenses: |
$350 |
NA |
NA |
| Remaining expenses: |
$0 |
$300 |
$300 |
| Hal pays up to annual deductible: |
$0 |
$300 |
$0 |
| Hal pays coinsurance on remaining charges up to out-of-pocket maximum: |
$0 |
$0
(20% of remaining $0 in charges) |
$30* |
| Hal's cost for prescription drugs: |
Included in health care expenses |
$15
(30% of $50) |
$15
(30% of $50) |
| Hal 's total premium and benefit costs for the year: |
$853 |
$868 |
$1,315 |
| HSA dollars that roll over to next year: |
$586 |
NA |
NA |
- If Hal makes under $44,000 per year
| Feature | Purdue Choice Fund | Purdue Incentive | Purdue Copay |
| Hal's annual premium cost: |
$171 |
$329 |
$690 |
| His annual contribution to the HSA (difference in annual premium contributions): |
$158 |
Health Savings Account not available in Purdue Incentive plan |
Health Savings Account not available in Purdue Copay plan |
| Purdue contributes to his HSA: |
$650 |
| Total HSA dollars available for Hal to use to pay for eligible health care expenses: |
= $808 |
| Total eligible health care expenses: |
$350
(medical & Rx) |
$300
(medical only, lab paid at 100%) |
$300
(medical only, lab paid at 100%) |
| HSA dollars Hal uses to pay for eligible health care expenses: |
$350 |
NA |
NA |
| Remaining expenses: |
$0 |
$300 |
$300 |
| Hal pays up to annual deductible: |
$0 |
$300 |
$0 |
| Hal pays coinsurance on remaining charges up to out-of-pocket maximum: |
$0 |
$0
(20% of remaining $0 in charges) |
$30* |
| Hal's cost for prescription drugs: |
Included in health care expenses |
$15
(30% of $50) |
$15
(30% of $50) |
| Hal 's total premium and benefit costs for the year: |
$329 |
$644 |
$735 |
| HSA dollars that roll over to next year: |
$458 |
NA |
NA |
