Using the drop-down boxes, please select an option for each feature to build the plan your company would be most likely to purchase.

You’ll see a percentage next to each feature comparing its cost to that of your current plan – either higher or lower. The total percentage at the bottom of the screen will update as you make your selections. It will also take into account the 10% cost increase that we’ve asked you to imagine that you’ll already be receiving at renewal.

If you need a refresher on any of these items, just hover over the item to see the description again.
Please select one for each feature.
Features:Your Selections: 
Deductible
(Single member)
Deductible: The amount a member will pay out-of-pocket in a plan year before the benefits are covered.
%
Maximum Out-of-Pocket Costs
(Single member)
Maximum Out-of-Pocket (OOP) Costs: The most a member will pay for covered health care expenses in a plan year.
%
Coinsurance
Coinsurance: The percentage of the cost a member is responsible for after the deductible has been met but before the maximum out-of-pocket has been met.
%
Office Visit Copay:
PCP / Specialist
Office Visit Copay: The amount a member must pay for each visit to a primary care physician (PCP) or specialist.
%
Medical Network
Medical Network
The size of the network will determine the proportion of members would have to change their doctor.
Broad Network: includes all “contract-able” medical groups and individual providers - each at the same cost level.
Multi-Tiered Network: includes all “contract-able” medical groups and individual providers. This type of network could include up to 3 tiers of physicians and hospitals with different cost levels.
Narrow Network: Includes approximately 50% of medical provider groups and individual practitioners in the area, each at same cost level. This single network is comprised of only health care providers that meet both quality and cost-effective requirements. The member pays the full costs of health care providers used outside of this network. There is a moderate possibility that some employees will need to change providers to have services covered at the in-network level.
Micro-Network: Includes a few selected groups of hospitals and providers in the area, each at the same cost level. The member pays the full costs of providers used outside of this network. There is a high possibility that some employees will need to change providers to have services covered at the in-network level.
%
Emergency Room Benefits
Emergency Room Benefits
Copay Only: Member makes a $300 copay to cover the ER visit and all services performed during that visit.
Deductible, then Copay, then Coinsurance:
    •The cost of the ER visit would count towards the deductible
    •Then the member makes a $300 copay to cover the visit
    •Then the plan coinsurance applies for the remaining costs of the visit
%
Pharmacy/Prescription Drug
Prescription Drug Formulary
Broad Formulary: A list of medications that includes all drugs with minimal exclusions
Narrow Formulary: A list of medications that includes only the most cost effective drugs, and excludes all others

Pharmacy Network
Broad Rx Network: Includes all pharmacy chains and major retailers, plus independent pharmacies. Prescriptions are filled at the same cost to the member across all locations.
2-Tiered Rx Network: Pharmacies are categorized into 2 levels of cost differences. Level 1 is primarily major pharmacy chains, while Level 2 includes other pharmacies with somewhat higher prescription costs than Level 1.
Narrow Rx Network: Includes only the most used pharmacy chains. Members pay the full cost of prescriptions filled outside of the network. There is a moderate possibility that some employees will need to change pharmacies in order to have services covered at the in-network level.
%
Pharmacy Cost Shares:
Tier 2 Preferred = $50;
Tier 3 Non-Preferred = $90
Pharmacy Benefit Cost Shares
Prescription medications are categorized into non-preferred or preferred with preferred drugs costing less than non-preferred drugs.

You’ll be evaluating plans that include varying costs for medications depending on the tier or level. Tiers 2 and 3 (brand name medications) have the same cost shares for all options, but Tiers 1 and 4 can vary.
%
 % Price Difference vs. Your Current Plan %