2015-2016 MODA PLANS If you buy: Medical plan shown & Dental plan 1 & Vision plan 4 MONTHLY COST
Med Plan A You pay
Med Plan B You pay
Med Plan C You pay
Med Plan D You pay
Med Plan E You pay
Med Plan F You pay
Med Plan G You pay
Med Plan H Single / Family deductibles
$1,139.13
$724.30
$447.66
$347.40
$264.10
$168.74
$63.48
$0 cost to buy insurance AND the district deposits $38.49 into your H.S.A.
$761.76
$0 cost to buy insurance AND the district deposits $461.88 annualy into your H.S.A.
→
Your monthly cost to buy insurance multiplied by 12 is your ANNUAL COST →
$13,669.56
$8,691.60
$5,371.92
$4,168.80
$3,169.20
$2,024.88
To help select your plan, compare annual cost to buy insurance to the annual deductible and maximum out of pocket you would pay for each plan. Deductible (Individual / Family) (applies toward out of pocket max.) Maximum Out-of-Pocket costs per year (per Individual / or max per Family) in Preferred Provider Network
$200 / $600
$350 / $1050
$500 / $1500
$750 / $2,250
$1,000 / $3,000
$1,250 / $3,750
$1,500 / $4,500
$1,500 / $3,000***
$2,400 / $7,200**
$2,950 / $8,850**
$3,300 / $9,900**
$3,800 / $11,400**
$4,250 / $12,700**
$5,500 / $12,700**
$6,350 / $12,700**
$5,000 / $10,000***
FOR THIS EXAMPLE, ADD TOGETHER THE ANNUAL COST BELOW: Learn what you would pay this year to buy insurance, and if one person on your plan maximized their insurance benefits due to a catestrophic event.
Med Plan A
Med Plan B
Med Plan C
Med Plan D
Med Plan E
Med Plan F
Med Plan G
Med Plan H Single / Family deductibles
$13,669.56
$8,691.60
$5,371.92
$4,168.80
$3,169.20
$2,024.88
$761.76
$0.00
$200.00
$350.00
$500.00
$750.00
$1,000.00
$1,250.00
$1,500.00
$1,500 / $3,000***
$2,200.00
$2,600.00
$2,800.00
$3,050.00
$3,250.00
$4,250.00
$4,850.00
$3,500 / $7,000
Health Savings Account contributions made by the district may be paid toward deductibles & other bills.
n/a
n/a
n/a
n/a
n/a
n/a
n/a
-$461.88
TOTAL ANNUAL COST: to buy and use insurance per year.
$16,069.56
$11,641.60
$8,671.92
$7,968.80
$7,419.20
$7,524.88
$7,111.76
$4,538.12 / $9,538.12
Add the annual cost to buy and use each plan! Annual payroll deduction to buy:
Annual deductible per person:
Annual out of pocket maximum: (Per person, not including deductible above)
Step 1: To make a fair comparison, assume the employee receives the full $1,150.00 district contribution monthly and selects the same dental and vision plans with each medical option. Compare the differences in out of pocket monthly cost that will be deducted from the employee's monthly paycheck depending on the Medical Plan selected.
Step 2: View the annual cost for the employee to purchase each medical plan option (with Dental plan 1 and Vision plan 4.)
Step 3. Assume the employee experiences a catestrophic medical event and accrues high medical bills. (For this example, other incidental costs are not included.) For comparison purposes, the employee will pay the individual deductible before the insurance company begins paying any medical bills.
Step 4. After the employee has paid an amount equal to the deductible to medical providers, Moda will begin paying 80% of the bills thereafter. The employee will pay 20% of the bills thereafter, until the employee has paid the Maximum out of Pocket in the plan year. The insurance company will treat all plans the same, so any incidental expenses such as additional cost tier charges, will apply to any of the plans (except plan H.) No other charges are considered in this example. After the employee pays the Maximum out of Pocket cost, Moda will* pay 100% of the remaining bills during the
Step 5: Add together the Annual payroll deduction, Annual deductible, and annual out of pocket maximum you would pay if you experienced a catestrophic medical event to learn the total annual cost to purchase your insurance and use your insurance.
Review the following page for Crook County School District - full time composite rate calculations
