Decision Guidance Tool (DGT)
Answer 5 quick questions for general plan selection guidance.
- This guide does not use any personally identifying information.
- Your results are not saved.
- Please review the detailed medical plan Summary of Benefits and Coverage (SBC) to determine the best plan for your needs.
- You are responsible for the plan you select.
This decision guidance is educational and does not use personal medical history or claims data. The results are directional in nature and not to be used as specific, definitive recommendations.
Help Choosing a Medical Plan
All displayed values are estimates, please consult official benefit documentation for exact amounts.
Please Note: Decision guides can make mistakes. Please review the detailed medical plan information to determine the best plan for your needs. You are responsible for the plan you select.
Medical Plan Comparison
You have a choice of three medical plan options to help you and your family take charge of your health care and find the right fit. These plans have different copayments, coinsurance, deductibles, and out-of-pocket limits.
Each of the options includes prescription drug coverage.
Medical plans are administered by United Healthcare .
| Medical | HDHP 1 | HDHP 2 | Copay Plan | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network | |||||||
| Annual Deductible | ||||||||||||
| Individual | $3,400 | $4,000 | $5,000 | $6,000 | $1,500 | $3,000 | ||||||
| Family | $6,800 | $8,000 | $10,000 | $12,000 | $3,000 | $6,000 | ||||||
| Coinsurance | 20% | 40% | 20% | 40% | 20% | 40% | ||||||
| Annual Out-of-Pocket Maximum | ||||||||||||
| Individual | $4,100 | $4,700 | $6,000 | $7,000 | $3,000 | $6,000 | ||||||
| Family | $8,200 | $9,400 | $12,000 | $14,000 | $6,000 | $12,000 | ||||||
| Services What you pay after meeting the deductible | In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network | ||||||
| Preventive Care | Covered 100% | 40% | Covered 100% | 40% | Covered 100% | 40% | ||||||
| Telehealth via LiveHealthOnline Medical Therapy & Psychiatry | Covered 100% | 40% | Covered 100% | 40% | Covered 100% | 40% | ||||||
| Primary Care Office Visit | You pay 20% | You pay 40% | You pay 20% | You pay 40% | $30 | You pay 40% | ||||||
| Specialist Office Visit | You pay 20% | You pay 40% | You pay 20% | You pay 40% | $60 | You pay 40% | ||||||
| Urgent Care | You pay 20% | You pay 40% | You pay 20% | You pay 40% | $75 | You pay 40% | ||||||
| Emergency Room | You pay 20% | You pay 20% | $250 | |||||||||
| Hospitalization | You pay 20% | You pay 40% | You pay 20% | You pay 40% | You pay 20% | You pay 40% | ||||||
Note: Please consult plan documents for full benefits, exclusions, and limitations.
Cost of Coverage
| Employee Contributions per Payroll (Semi-Monthly = 24 pays per year) | ||||||
|---|---|---|---|---|---|---|
| Medical Plans | HDHP 1 | HDHP 2 | Copay Plan | |||
| Employee | $102.37 | $85.74 | $63.13 | |||
| Employee & Spouse | $251.21 | $185.71 | $168.10 | |||
| Employee & Child(ren) | $188.22 | $144.13 | $130.65 | |||
| Family | $251.21 | $185.71 | $168.10 | |||
HDHP1 - Summary of Benefits and Coverage
HDHP2 - Summary of Benefits and Coverage
Copay Plan - Summary of Benefits and Coverage
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