Health policy
You will be examining the medical expenses for ''jill''; an Emory University employee. Using the 2014 Benefit Guide, you will calculating her out-of-pocket and other expenses as determined by different health plan scenarios.
Scenario
Jill works for Emory University. Her medical expenses for last year were as follows. Calculate her out-of-pocket expenses. Then answer the questions below.
• $75 office visit for a sore throat at her primary care physician (in network)
• $75 annual gynecological exam (in network)
• $4500 trip to the Emory Hospital ER for a kidney stone (EPN)
• $200 office visit for a nephrologist (in network)
• $200 diagnostic lab from her nephrologist visit (in network)
• $95 teeth cleaning (in network)
• $65 routine eye exam (in network)
• $250 new contact lenses
*Assume that the in-network providers listed above are NOT in the Emory Provider Network (EPN) unless otherwise stated.
Calculate the following
Suppose Jill selected the Emory HSA Plan (individual, no spouse or family members covered). She also opted into the additional vision plan and the Aetna traditional dental plan (PPO).
1. Calculate Jill's annual premium for medical coverage. Assume she works at least 30 hours per week.
2. Calculate Jill's annual premium for vision
3. Calculate Jill's annual premium for dental.
4. Calculate Jill's out of pocket costs for the year (use the back of this sheet to show your work)
5. Subtract Emory's contribution to her HSA.
6. Ignoring earned incentives and taxes, calculate how much Jill paid for medical expenses this year, including premiums and cost sharing.
Suppose Jill selected the Emory POS plan (Individual, no spouse or family members covered). She did not opt into the vision plan or the dental plan.
7. Calculate Jill's annual premium for medical coverage. Assume she works at least 30 hours per week
8. Calculate Jill's out of pocket costs for the year (use the back of this sheet to show your work). Note: Assume that a routine annual eye exam is covered under routine preventive medical care. Contacts and teeth cleaning are not, nor do they count toward her medical plan's deductible.
9. Ignoring earned incentives and taxes, calculate how much Jill paid for medical expenses this year, including premiums and cost sharing.
10. In this case, which plan had the lower annual out-of-pocket cost?