During this assignment you will be comparing three different health insurance plans based on costs, access, and other factors. You must choose one PPO and one HMO as well as a third option. The choice of health insurance options is up to you but feel free to use the following documents or to choose your own plans.This assignment will be using an excel spreadsheet to compare costs. After finding the insurance plans, or using the ones provided, you will choose one of the following that most closely describes your situation and then calculate the yearly cost. Within these files you will notice two things. First, the three labels for insurance plans are for the above policy, if you have chosen different policies these labels may change. Second, the costs without insurance are estimates of what this would cost and would only be needed for the final part of the assignment. Finally, this file you will use each policy to determine each cost then add all costs to determine the total yearly cost. (Note that Employee Percentage, in dollars, would be used for the annual cost to you in the first line of the excel file and all other costs should be in dollars)Once you have completed the excel comparison upload the file here along with a minimum of one paragraph describing which plan would be the best option. Remember that cost is not the only thing that matters with health insurance and your decision should reference the advantages and disadvantages from the textbook.
Column1
HMO
Employee % of Annual Cost (Total Cost)
Sample Medical Costs Below
5 Primary Care Office Visits
1 Specialist Visit
5 prescriptions (Tier 1)
Emergency Room Visit ($500)
In Hospital Surgery ($14000)
Outpatient Surgery ($4000)
X-Rays ($500)
Lab Tests ($1000)
4 Chiropractic Visits
Child Immunization (1)
Total Annual Medical Costs
$
Triple Option
–
$
PPO Core
–
$
No Insurance
$
–
–
$
$
$
$
$
$
$
$
$
$
$
750.00
225.00
375.00
500.00
40,000.00
9,000.00
500.00
1,000.00
500.00
250.00
53,100.00
Medical Benefits Options
Effective for plan year July 1, 2021– June 30, 2022
BlueChoice HMO OpenAccess
BlueChoice Providers
The Benefits
Level 1
BlueChoice Providers
DEDUCTIBLE—CONTRACT
YEAR JULY 1–JUNE 30
$150 Individual / $300 Family aggregate
(Deductible applies to all services unless
otherwise noted; does not apply to Rx benefits)
$50 Individual / $100 Family aggregate
(Deductible applies to all services
unless otherwise noted; does not
apply to Rx benefits)
MEDICAL OUT-OF-POCKET
MAXIMUM
$6,600 Individual/$13,200 Family
(integrated with Rx out-of-pocket maximum)
$1,200 Individual /$2,400 Family
(combined in- and out-of-network)
LIFETIME MAXIMUM
Unlimited
Unlimited
Hospital Room/Semi-Private*
100% AB
100% AB
Skilled Nursing Facility*
100% AB (limited to 60 days/contract year)
100% AB
Inpatient Rehabilitation*
100% AB (limited to 90 days/contract year)
100% AB
Outpatient Surgery
100% AB
100% AB
Emergency Care**
Emergency Room—$75 copay (waived if
admitted);
Urgent Care Center—$35 copay
Emergency Room—$75 copay (waived
if admitted);
Urgent Care Center—$20 copay
Surgeon
100% AB
100% AB
Assistant Surgeon
100% AB
100% AB
Anesthesiologist
100% AB
100% AB
In-Hospital Medical
100% AB
100% AB
Office Visits
$15 PCP/$20 Specialist copay
$15 PCP/$20 Specialist copay
Outpatient Facility
100% AB
100% AB
Outpatient Physician
$15 PCP/$20 Specialist copay
$15 PCP/$20 Specialist copay
Diagnostic X-rays
100% AB
100% AB
Radiation Therapy
$20 Specialist copay
100% AB
Chemotherapy
$20 Specialist copay
100% AB
Laboratory Tests
100% AB (LabCorp only)
100% AB (LabCorp only)
Allergy Testing
$15 PCP/$20 Specialist copay
100% AB
Allergy Treatment/Injections
$15 PCP/$20 Specialist copay
100% AB
HOSPITAL
PHYSICIAN SERVICES
MEDICAL SERVICES
AB = Allowed Benefit
This chart contains highlights only and is subject to change. The specific terms of coverage, exclusions and limitations are contained in the
Summary Plan Description, the Group Benefit Guide or the Group Service Agreement. AB—Allowed Benefit. AWP—Average Wholesale Price.
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Harford County Public Schools—Benefits Enrollment & Reference Guide
Medical Benefits Options
CareFirst BlueCross BlueShield Preferred Provider
Organization CORE
Triple Option
Level 2
BlueCross BlueShield
PPO Providers
Level 3
Participating and
Non‑participating Providers
In-network
BlueCross BlueShield
PPO Providers
Out-of-network
Participating and
Non-participating Providers
$50 Individual / $100
Family aggregate
(Deductible applies to all
services unless otherwise
noted; does not apply to
Rx benefits)
$250 Individual / $500 Family
aggregate (Deductible applies
to all services unless otherwise
noted; does not apply to Rx
benefits)
$150 Individual / $300 Family
aggregate (Deductible applies
to all services unless otherwise
noted; does not apply to Rx
benefits)
$350 Individual / $700 Family
aggregate (Deductible applies
to all services unless otherwise
noted; does not apply to Rx
benefits)
$1,200 Individual /$2,400 Family
(combined in- and out-of-network)
$2,400 Individual / $4,800 Family
(combined in- and out-of-network)
Unlimited
100% AB
80% AB
90% AB
70% AB
100% AB
80% AB
90% AB
70% AB
100% AB
80% AB
90% AB
70% AB
100% AB
80% AB
90% AB
70% AB
Emergency Room—
$75 copay (waived if
admitted); Urgent Care
Center—$25 copay
Emergency Room—$75 copay
(waived if admitted); Urgent
Care Center—80% AB
Emergency Room—$100
copay (no deductible—
waived if admitted); Urgent
Care Center—$25 copay (no
deductible)
Emergency Room—$100
copay (no deductible—waived
if admitted); Urgent Care
Center—70% AB
100% AB
80% AB
90% AB
70% AB
100% AB
Paid as Level 2
90% AB
Paid as in-network
100% AB
Paid as Level 2
90% AB
Paid as in-network
100% AB
80% AB
90% AB
70% AB
$20 PCP/$25 Specialist
copay
80% AB
$20 PCP / $25 Specialist copay
(no deductible)
70% AB
100% AB
80% AB
100% AB
70% AB
$30 copay
80% AB
$30 copay
70% AB
100% AB
Inpatient—Paid as Level 2
Office & Outpatient—80% AB
90% AB
90% AB inpatient / 70% AB
office
100% AB
80% AB
90% AB
70% AB
100% AB
80% AB
90% AB
70% AB
100% AB
Inpatient—Paid as Level 2
Office & Outpatient—80% AB
90% AB
90% AB inpatient / 70% AB
office
100% AB
80% AB
90% AB
70% AB
100% AB
80% AB
90% AB
70% AB
* Precertification required or penalties may apply.
** Overnight stays for observation are not considered an inpatient admission.
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33
Medical Benefits Options
BlueChoice HMO OpenAccess
BlueChoice Providers
The Benefits
Level 1
BlueChoice Providers
MEDICAL SERVICES
(CONTINUED)
Physical, Speech and
Occupational Therapy
(combined visits)
$20 Specialist copay; 60 visit maximum per
condition per contract year combined with
speech and occupational therapy
$20 Specialist copay; 100 visit
maximum per contract year combined
with speech and occupational therapy
Chiropractic Care (Spinal
Manipulation)
$20 Specialist copay; 60 visit maximum per
condition per contract year
$20 Specialist copay
Acupuncture
Not covered
$20 Specialist copay
Well Child Care/Immunization
100% AB (no deductible)
100% AB (no deductible)
Routine Physical Exam
100% AB (no deductible)
100% AB (no deductible)
Breast Cancer Screening/
Routine Mammography
100% AB (no deductible)
100% AB (no deductible)
Prostate Cancer Screening
100% AB (no deductible)
100% AB (no deductible)
Routine Gynecological Exam
(one per contract year)
100% AB (no deductible)
100% AB (no deductible)
Eye Exams
$10 copay per annual visit no-referral
(Davis Vision provider) (no deductible)
$10 copay per annual visit no-referral
(Davis Vision provider) (no deductible)
Eye Glasses/Lenses/Contact
Lenses
Discounts available; See pages 29–31
Discounts available; See pages
29–31
Durable Medical Equipment
100% AB
100% AB
Home Health Care Visits*
100% AB
100% AB
Hospice*
100% AB
100% AB
Maternity Care (Pre/Post/
Delivery)
100% AB
100% AB
Nursery Care
(Must be enrolled within 30
days)
100% AB
100% AB
Infertility Services
Pre-approval required Artificial
Insemination—50% AB of charges (limited
to 6 attempts per live birth); In Vitro
Fertilization—50% AB of charges (limited to 3
attempts per live birth not to exceed a maximum
lifetime limit of $100,000)
Pre-approval required Artificial
Insemination—100% AB of charges
(limited to 6 attempts per live birth); In
Vitro Fertilization—100% AB of charges
(limited to 3 attempts per live birth not
to exceed a maximum lifetime limit of
$100,000)
Lapband Benefits
100% AB
100% AB
Surgical Treatment for Morbid
Obesity (Gastric Bypass
& Gastric Sleeve) (prior
authorization required)
100% AB at a BlueDistinction center
100% AB at a BlueDistinction center
PREVENTIVE CARE
SPECIAL SERVICES
AB = Allowed Benefit
This chart contains highlights only and is subject to change. The specific terms of coverage, exclusions and limitations are contained in the
Summary Plan Description, the Group Benefit Guide or the Group Service Agreement. AB—Allowed Benefit. AWP—Average Wholesale Price.
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Harford County Public Schools—Benefits Enrollment & Reference Guide
Medical Benefits Options
CareFirst BlueCross BlueShield Preferred Provider
Organization CORE
Triple Option
Level 2
BlueCross BlueShield
PPO Providers
Level 3
Participating and
Non‑participating Providers
In-network
BlueCross BlueShield
PPO Providers
Out-of-network
Participating and
Non-participating Providers
$25 Specialist office;
$30 OP Facility; $30 OP
Professional; 100 visit
maximum per contract
year (occupational/
speech combined in- and
out-of-network)
80% AB; 100 visit maximum per
contract year (occupational/
speech combined in- and outof-network)
$25 Specialist office copay; $30
OP Facility, $30 OP Professional
(no deductible); 100 visit
maximum per contract year
(occupational/speech combined
in- and out-of-network)
70% AB; 100 visit maximum per
contract year (occupational/
speech combined in- and outof-network)
$25 Specialist copay
80% AB
$25 Specialist copay
70% AB
$25 Specialist copay
80% AB
$25 Specialist copay
70% AB
100% AB (no deductible)
80% AB
100% AB (no deductible)
70% AB
100% AB (no deductible)
80% AB
100% AB (no deductible)
70% AB
100% AB (no deductible)
100% AB (no deductible)
100% AB (no deductible)
100% AB (no deductible)
100% AB (no deductible)
100% AB (no deductible)
100% AB (no deductible)
100% AB (no deductible)
100% AB (no deductible)
80% AB
100% AB (no deductible)
70% AB
No Benefit
No Benefit
Discounts available; See pages 29–31
No Benefit
No Benefit
100% AB
80% AB
90% AB
70% AB
100% AB
80% AB
90% AB
70% AB
100% AB
80% AB
90% AB
70% AB
100% AB
80% AB
100% AB
70% AB
100% AB
80% AB
90% AB
70% AB
Artificial
Insemination—100% AB,
pre-approval required
(limited to 6 attempts
per live birth); In Vitro
Fertilization—100% AB,
pre-approval required;
(limited to 3 attempts per
live birth not to exceed a
maximum lifetime limit of
$100,000)
Artificial Insemination—80% AB,
pre-approval required (limited
to 6 attempts per live birth);
In Vitro Fertilization—80% AB,
pre-approval required; (limited
to 3 attempts per live birth not
to exceed a maximum lifetime
limit of $100,000)
Artificial Insemination—90% AB,
pre-approval required (limited
to 6 attempts per live birth);
In Vitro Fertilization—90% AB,
pre-approval required; (limited
to 3 attempts per live birth not
to exceed a maximum lifetime
limit of $100,000)
Artificial Insemination—70% AB,
pre-approval required (limited
to 6 attempts per live birth);
In Vitro Fertilization—70% AB,
pre-approval required; (limited
to 3 attempts per live birth not
to exceed a maximum lifetime
limit of $100,000)
100% AB
80% AB
90% AB
70% AB
100% AB at a
BlueDistinction center
80% AB at a BlueDistinction
center
90% AB at a BlueDistinction
center
70% AB at a BlueDistinction
center
$10 copay per annual visit no-referral
(Davis Vision provider) (no deductible)
* Precertification required or penalties may apply.
** Mandatory generic substitution—see the CareFirst Drug Program section on page 20.
Harford County Public Schools—Benefits Enrollment & Reference Guide
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35
Medical Benefits Options
BlueChoice HMO OpenAccess
BlueChoice Providers
The Benefits
Level 1
BlueChoice Providers
SPECIAL SERVICES
(CONTINUED)
Ambulance When Medically
Necessary (surface, air,
private, and public)
100% AB
100% AB
Hearing Exam
$20 copay
$20 copay
Hearing Aids (one per hearing
impaired ear every 36 months)
100% AB
100% AB
Inpatient Care*
100% AB
100% AB
Outpatient Facility
100% AB
100% AB
Office Visits
$15 copay
$15 copay
Prescription Drug Out-ofPocket Max.
$6,600 Individual / $13,200 Family (integrated
with medical out-of-pocket maximum)
$5,400 Individual / $10,800 Family
Retail Prescription Drug**
$10 copay—Generic drug (Tier 1)
$20 copay—Preferred Brand (Tier 2)
$40 copay—Non-preferred Brand (Tier 3)
Maintenance drugs: 90 day supply, 2 times retail
copay at CVS only:
$20 copay—Generic drug (Tier 1)
$40 copay—Preferred Brand (Tier 2)
$80 copay—Non-preferred Brand (Tier 3)
$15 copay Generic drug (Tier 1)
$30 copay Preferred Brand (Tier 2)
$45 copay Non-preferred Brand (Tier 3)
Maintenance medication up to 90 day
supply 1 times retail at CVS only:
$15 copay—Generic drug (Tier 1)
$30 copay—Preferred Brand (Tier 2)
$45 copay—Non-preferred Brand (Tier 3)
Mail Order Drug**
CVS Caremark Mail Order—2 times retail copay—
up to 90 day supply
$20 copay—Generic drug (Tier 1)
$40 copay—Preferred Brand (Tier 2)
$80 copay—Non-preferred Brand (Tier 3)
CVS Caremark Mail Order Prescription
Program for maintenance medication 1
times copay—Up to 90 day supply
$15 copay—Generic drug (Tier 1)
$30 copay—Preferred Brand (Tier 2)
$45 copay—Non-preferred Brand (Tier 3)
Oral Contraceptives**
100% AB
100% AB
Diabetic Supplies
100% AB
100% AB
MENTAL HEALTH AND
SUBSTANCE ABUSE SERVICES
PRESCRIPTION DRUGS
USING FORMULARY 2
Remember: Maintenance medications after your second fill must be purchased at a CVS
pharmacy or through CVS Mail Service Pharmacy.
AB = Allowed Benefit
This chart contains highlights only and is subject to change. The specific terms of coverage, exclusions and limitations are contained in the
Summary Plan Description, the Group Benefit Guide or the Group Service Agreement. AB—Allowed Benefit. AWP—Average Wholesale Price.
36
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Harford County Public Schools—Benefits Enrollment & Reference Guide
Medical Benefits Options
CareFirst BlueCross BlueShield Preferred Provider
Organization CORE
Triple Option
Level 2
BlueCross BlueShield
PPO Providers
Level 3
Participating and
Non‑participating Providers
100% AB
Paid as Level 2
90% AB
Paid as in-network
$25 copay
80% AB
$25 copay
70% AB
100% AB
80% AB
90% AB (no deductible)
70% AB
100% AB
80% AB
90% AB
70% AB
100% AB
80% AB
90% AB
70% AB
$20 copay
80% AB
$20 copay (no deductible)
70% AB
$5,400 Individual / $10,800 Family
$15 copay Generic drug (Tier 1)
$30 copay Preferred Brand (Tier 2)
$45 copay Non-preferred Brand (Tier 3)
Maintenance medication up to 90 day supply 1 times
retail at CVS only:
$15 copay—Generic drug (Tier 1)
$30 copay—Preferred Brand (Tier 2)
$45 copay—Non-preferred Brand (Tier 3)
In-network
BlueCross BlueShield
PPO Providers
Out-of-network
Participating and
Non-participating Providers
$4,200 Individual / $8,400 Family
$15 copay Generic drug (Tier 1)
$30 copay Preferred Brand (Tier 2)
$45 copay Non-preferred Brand (Tier 3)
Maintenance medication up to 90 day supply 1 times retail at
CVS only:
$15 copay—Generic drug (Tier 1)
$30 copay—Preferred Brand (Tier 2)
$45 copay—Non-preferred Brand (Tier 3)
CVS Caremark Mail Order Prescription Program for
maintenance medication 1 times copay—Up to 90 day
supply
$15 copay—Generic drug (Tier 1)
$30 copay—Preferred Brand (Tier 2)
$45 copay—Non-preferred Brand (Tier 3)
CVS Caremark Mail Order Prescription Program for
maintenance medication 1 times copay—Up to 90 day supply
$15 copay—Generic drug (Tier 1)
$30 copay—Preferred Brand (Tier 2)
$45 copay—Non-preferred Brand (Tier 3)
100% AB
100% AB
100% AB
100% AB
* Precertification required or penalties may apply.
** Mandatory generic substitution—see the CareFirst Drug Program section on page 20.
Harford County Public Schools—Benefits Enrollment & Reference Guide
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37
Medical and Dental Deductions—
Active Employees
Plan
Total Annual
Premium
Employee
Monthly
Premium at
100%
Biweekly Payroll Deduction
BOE % of
Annual Cost
Employee
% of Annual
Cost
95%
5%
12 Month
Employees
(24 pays) Your
Bi-Weekly
Deduction
10 Month
Employees
(20 pays) Your
Bi-Weekly
Deduction
Medical Insurance Rates
HMO
Individual
$7,218.99
$601.58
$6,858.04
$360.95
$15.04
$18.05
Parent & Child
$14,257.76
$1,188.15
$13,544.87
$712.89
$29.70
$35.64
Employee &
Spouse
$17,045.24
$1,420.44
$16,192.97
$852.26
$35.51
$42.61
Family
$20,997.23
$1,749.77
$19,947.36
$1,049.86
$43.74
$52.49
90%
10%
Preferred Provider Core Plan
Individual
$8,095.95
$674.66
$7,286.36
$809.60
$33.73
$40.48
Parent & Child
$17,602.52
$1,466.88
$15,842.26
$1,760.25
$73.34
$88.01
Employee &
Spouse
$20,822.94
$1,735.25
$18,740.65
$2,082.29
$86.76
$104.11
Family
$22,581.99
$1,881.83
$20,323.79
$2,258.20
$94.09
$112.91
85%
15%
Triple Option
Individual
$8,505.14
$708.76
$7,229.36
$1,275.77
$53.16
$63.79
Parent & Child
$18,492.30
$1,541.03
$15,718.46
$2,773.85
$115.58
$138.69
Employee &
Spouse
$21,875.81
$1,822.98
$18,594.43
$3,281.37
$136.72
$164.07
Family
$23,721.80
$1,976.82
$20,163.53
$3,558.27
$148.26
$177.91
90%
10%
Dental Insurance Rates
Delta Premier
Individual
$259.92
$21.66
$233.93
$25.99
$1.08
$1.30
Parent & Child
$427.32
$35.61
$384.59
$42.73
$1.78
$2.14
Employee &
Spouse
$547.44
$45.62
$492.70
$54.74
$2.28
$2.74
Family
$798.36
$66.53
$718.52
$79.84
$3.33
$3.99
90%
10%
Delta PPO
Individual
$354.48
$29.54
$319.03
$35.45
$1.48
$1.77
Parent & Child
$581.88
$48.49
$523.69
$58.19
$2.42
$2.91
Employee &
Spouse
$746.16
$62.18
$671.54
$74.62
$3.11
$3.73
Family
$1,087.80
$90.65
$979.02
$108.78
$4.53
$5.44
Premium deductions will begin in July (September for ten-month employees) and coverage will be effective July 1, 2020. New hires coverage
will start on the first pay of the month following the date of hire and enrollment in the plan. Deductions will begin with the first pay of the
month following the date of hire and enrollment in the plan.
Harford County Public Schools—Benefits Enrollment & Reference Guide
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5
Column1
Employee % of Annual Cost (Total Cost)
Sample Medical Costs Below
2 Primary Care Office Visits
1 Specialist Visit
2 prescriptions (Tier 1)
Eye Exam ($250)
Glasses ($500)
Emergency Room Visit ($500)
Allergy Testing ($800)
Mammogram/Prostate Screening ($300)
Total Annual Medical Costs
HMO
$
Triple Option
–
$
–
PPO Core
$
No Insurance
$
–
–
$
$
$
$
$
$
$
$
$
250.00
150.00
150.00
250.00
500.00
500.00
800.00
300.00
2,900.00
Purchase answer to see full
attachment
