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2019 Benefits Guide

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Medical Matchup

Explore real-life examples of your different plan options.

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SurgeryPlus

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Medical Matchup

Matt

Meet Matt

Matt is single, in good health and doesn’t use tobacco. Matt has a pretty smooth year.

Let’s take a look...

He gets his free annual wellness exam.

$250

100% paid by ETP!

He goes to the doctor once for strep throat. The doctor prescribes Matt two generic medications.

$80 visit
$30 generic x 2

He goes to an urgent care clinic after a sports injury and gets an X-ray.

$250 visit
$500 X-ray

Matt sees a specialist twice during his recovery.

$110 visit x 2

Matt has incurred a total of $1,360 in medical expenses. Now, let’s see which medical plan would have been better for Matt!
$1,360
in total expenses
Wait!
We also need to remember that Matt has been paying for medical coverage from his paycheck. We'll add that in too!
Remember, Matt incurred $1,360 in total expenses

In the CDHP Matt pays all of the cost out-of-pocket. In the PPO, he pays some through copays.

CDHP PPO
Costs paid by Matt $1,110 $655
Matt's paycheck deductions $504 $1,449
Partnership-provided HSA contribution -$1,000 N/A
And the winner is...
The CDHP Plan is the winner for Matt!
CDHP PPO
Costs paid by Matt $1,110 $655
Matt's paycheck deductions $504 $1,449
Partnership-provided HSA contribution -$1,000 N/A
Matt's Total Cost $614 $2,104
To see a more detailed calculation of Matt's care click here.

Juanita

Meet Juanita

Juanita is married, but her husband has coverage with his employer. She doesn’t use tobacco. Juanita is typically in good health, but she’s had a bit of a bumpy year.

Let’s take a look...

She gets her free annual wellness exam.

$250

100% paid by ETP!

She starts having trouble with a condition that hasn’t bothered her in years. She goes to her primary care doctor four times. He prescribes her several generic medications that she fills at the pharmacy.

$80 visit x 4
$30 generic x 3

Her condition worsens and she goes to the ER.

$800 visit

After her ER visit she sees a specialist four times. He orders one round of tests and prescribes her a couple of generic medications she fill through mail order.

$110 visit x 4
$500 labs
$50 generic x 2

The specialist determines that Juanita needs to have surgery. She spends one night in the hospital.

$12,000 surgery + hospital stay

Juanita sees a physical therapist six times to recover from her surgery.

$90 visit x 6

Juanita has incurred a total of $15,040 in medical expenses. Now, let’s see which medical plan would have been better for Juanita!
$15,040
in total expenses
Wait!
We also need to remember that 
Juanita has been paying for 
medical coverage from her paycheck.We'll add that in too!
Remember Juanita incurred $15,040 in expenses.

In the CDHP, Juanita pays up to the out-of-pocket max. After that the Partnership pays 100%.

In the PPO, she pays some through copays and some through coinsurance until she meets her out-of-pocket max.

surgery_plus
Juanita could have saved several thousand dollars by using SurgeryPlus to schedule her surgery!
CDHP PPO
Costs paid by Juanita $3,750 $3,000
Juanita's paycheck deductions $504 $1,449
Partnership-provided HSA contribution -$1,000 N/A
And the winner is...
The CDHP Plan is the winner for Juanita!
CDHP PPO
Costs paid by Juanita $3,750 $3,000
Juanita's paycheck deductions $504 $1,449
Partnership-provided HSA contribution -$1,000 N/A
Juanita's Total Cost $3,254 $4,449
To see a more detailed calculation of Juanita's care click here.

Alex

Meet Alex

Alex is single, in good health and doesn’t use tobacco. Alex has really tough year. He has a minor sports injury early in the year then is in a major auto accident.

Let’s take a look..

He gets his free annual wellness exam.

$250

100% paid by ETP!

After his sports injury, Alex visits the ER and has an X-ray.

$800 visit
$500 X-ray

He has outpatient surgery as a result of his injury.

$6,000 procedure

As a result of the auto accident, Alex has surgery and spends several days in the hospital recovering.

$22,000 surgery & hospitalization

Alex has two MRIs, an X-ray and sees a physical therapist twelve times during recover from surgery.

$500 X-ray
$1,100 MRI x 2
$90 visit x 12

Throughout the year, Alex goes to the doctor six times and see a specialist ten times.

$80 visit x 6
$110 visit x 10

He also fills eight generic prescriptions at the pharmacy and one generic through mail order.

$30 generic X 8
$50 generic

Alex has incurred a total of $35,200 in medical expenses. Now, let's see which medical plan would have been better for Alex!
$35,200
in total expenses
Wait!
We also need to remember that Alex has been paying for medical coverage from her paycheck. We'll add that in too!
Remember Alex incurred $35,200 in expenses.

In the CDHP Alex pays up to the out-of-pocket max, then the Partnership pays 100%.

In the PPO, he pays some through copays and coinsurance up to the $3,750 maximum out-of-pocket.

CDHP PPO
Costs paid by Alex $3,750 $3,500
Alex's paycheck deductions $504 $1,449
Partnership-provided HSA contribution -$1,000 N/A
And the winner is...
The CDHP Plan is the best choice for Alex.
CDHP PPO
Costs paid by Alex $3,750 $3,500
Alex's paycheck deductions $504 $1,449
Partnership-provided HSA contribution -$1,000 N/A
Alex's Total Cost $3,254 $4,949
To see a more detailed calculation of Alex's care click here.

Carl

Meet Carl

Carl is married. He and his wife are in good health and don’t use tobacco. Carl has a pretty smooth year.

Let’s take a look...

They get their free annual wellness exams.

$500

100% paid by ETP!

Carl goes to the doctor once for the flu.

$80 visit

The doctor prescribes Carl two generic medications that he fills at the pharmacy.

$30 generic x 2

He goes to an urgent care clinic after a sports injury and gets an X-ray.

$250 visit
$500 X-ray

Carl sees a specialist during his recovery.

$110 visit

Carl's wife has allergies and goes to a specialist.

$110 visit

The doctor prescribes his wife two generic medications that she fills though mail order.

$50 generic x 2

Carl has incurred a total of $1,710 in medical expenses. Now, let’s see which medical plan would have been better for Carl!
$1,710
in total expenses
Wait!
We also need to remember that Carl has been paying for medical coverage from his paycheck. We'll add that in too!
Remember Carl incurred $1,710 in expenses.

In the CDHP Carl pays out-of-pocket for everything but the cost of the free physicals. In the PPO, he pays some through copays.

Carl will have $790 remaining in his HSA to carry over to the following year!
CDHP PPO
Costs paid by Carl $1,210 $675
Carl's paycheck deductions $929 $2,898
Partnership-provided HSA contribution -$2,000 N/A
And the winner is...
The CDHP Plan is the winner for Carl.
CDHP PPO
Costs paid by Carl $1,210 $675
Carl's paycheck deductions $929 $2,898
Partnership-provided HSA contribution -$2,000 N/A
Carl's Total Cost $929 $3,573
To see a more detailed calculation of Carl's care click here.

Doug

Meet Doug

Doug is married. He and his wife don’t use tobacco. Doug’s wife has Type 1 diabetes. She controls it with insulin but has some complications this year.

Let’s take a look...

They get their free annual wellness exams.

$500

100% paid by ETP!

Doug becomes ill a couple times in the year and the doctor sends out for lab work.

$80 visit x 2
$500 labs

He also has two prescriptions that he fills at the pharmacy.

$30 generic x 2

Doug’s wife has trouble with her diabetes and goes to her primary care doctor few times.

$80 visit x 4

Her doctor refers her to a specialist for additional treatment and he orders a round of lab work.

$110 visit x 10
$500 lab

Her condition worsens and she is hospitalized for six days.

$12,600 hospital stay

Doug’s wife takes a generic form of insulin that she fills through mail order.

$50 generic x 4

Doug has incurred a total of $15,940 in medical expenses. Now, let’s see which medical plan would have been better for Doug!
$15,940
in total expenses
Wait!
We also need to remember that Doug has been paying for medical coverage from his paycheck. We'll add that in too!
Remember Doug incurred $15,940 in expenses.

In the CDHP, Doug pays up to the out-of-pocket max. After that the Company pays 100%.

In the PPO, he doesn’t reach the out-of-pocket max. He pays some copays, his deductible and still continues to pay coinsurance

Because Doug's wife has a large claim, the individual deductible and max out-of-pocket applies to her care.
CDHP PPO
Costs paid by Doug $4,410 $4,090
Doug's paycheck deductions $929 $2,898
Partnership-provided HSA contribution -$2,000 N/A
And the winner is...
The CDHP Plan is the winner for Doug.
CDHP PPO
Costs paid by Doug $4,410 $4,090
Doug's paycheck deductions $929 $2,898
Partnership-provided HSA contribution -$2,000 N/A
Doug's Total Cost $3,339 $6,988
To see a more detailed calculation of Doug's care click here.

Lisa

Meet Lisa

Lisa is married. She and her husband don’t use tobacco. Lisa’s hip has been bothering her for years. Her pain becomes unbearable and she has her hip replaced.

Let’s take a look...

They get their free annual wellness exams.

$500

100% paid by ETP!

Lisa’s husband visits his doctor to renew his generic allergy prescription for the year. He uses the mail order service to fill it.

$80 visit
$50 generic x 4

Lisa visits her doctor three times for her hip pain. Her doctor prescribes a generic pain medication that she fills at the pharmacy and sends her to a specialist.

$80 visit x 3
$30 generic

Lisa sees the specialist four times. He prescribes her a different generic medication that she fills at the pharmacy. He also sends her to three physical therapy sessions.

$110 visit x 4
$30 generic
$90 visit x 3

The physical therapy does not help Lisa’s hip. She has surgery to replace her hip.

$30,000 surgery & hospital stay

During her recovery she sees the specialist four more times and the physical therapist seven more times.

$110 visit X 6
$90 visit x 7

She also has four additional prescriptions that she fills at the pharmacy.

$30 generic x 4

Lisa has incurred a total of $33,200 in medical expenses. Now, let’s see which medical plan would have been better for Lisa!
$33,200
in total expenses
Wait!
We also need to remember that Lisa has been paying for medical coverage from her paycheck. We'll add that in too!
Remember Lisa incurred $33,200 in expenses.

Because Lisa has a large claim, the individual deductible and max out-of-pocket will apply to her care.

surgery_plus
Lisa could have saved several thousand dollars by using SurgeryPlus to schedule her surgery!
CDHP PPO
Costs paid by Lisa $3,975 $3,565
Lisa's paycheck deductions $929 $2,898
Partnership-provided HSA contribution -$2,000 N/A
And the winner is...
The CDHP Plan is the winner for Lisa!
CDHP PPO
Costs paid by Lisa $3,975 $3,565
Lisa's paycheck deductions $929 $2,898
Partnership-provided HSA contribution -$2,000 N/A
Lisa's Total Cost $2,904 $6,463
To see a more detailed calculation of Lisa's care click here.

Robert

Meet Robert

Robert is married with one kid and his wife has medical coverage with her employer. He and his son are in fairly good health and he doesn’t use tobacco. Robert has a pretty smooth year.

Let’s take a look...

Robert gets his free wellness exam and takes his son in for his wellness visit and immunizations.

$500

100% paid by ETP!

Robert goes to the doctor once for a sinus infection and his doctor gives him a generic prescription that he fills at the pharmacy.

$80 visit
$30 generic

Robert takes his son to the urgent care clinic after an injury on the playground.

$250 visit

He takes his son to the doctor several times for a reoccurring illness. The doctor runs two rounds of lab work.

$80 visit x 3
$500 labs x 2

The doctor prescribes Robert’s son four generic medications. Robert fills three at the pharmacy and one through mail order.

$30 generic x 3
$50 generic

Robert has incurred a total of $2,240 in medical expenses. Now, let’s see which medical plan would have been better for Robert!
$2,240
in total expenses
Wait!
We also need to remember that Robert has been paying for medical coverage from his paycheck. We'll add that in too!
Remember Robert incurred $2,240 in expenses.

In the CDHP Robert pays out-of-pocket for everything but the cost of the free wellness exam. 

In the PPO, he pays some through copays.

Robert will have $260 remaining in his HSA to carry over to the following year!
CDHP PPO
Costs paid by Robert $1,740 $1,180
Robert's paycheck deductions $840 $2,608
Partnership-provided HSA contribution -$2,000 N/A
And the winner is...
The CDHP Plan is the winner for Robert!
CDHP PPO
Costs paid by Robert $1,740 $1,180
Robert's paycheck deductions $840 $2,608
Partnership-provided HSA contribution -$2,000 N/A
Robert's Total Cost $840 $3,788
To see a more detailed calculation of Robert's care click here.

Rebecca

Meet Rebecca

Rebecca is married and has two kids. Her husband has medical coverage through his employer. Rebecca doesn’t use tobacco. Rebecca and her kids are in good health but they have a rocky year.

Let’s take a look...

Rebecca gets her annual wellness exam and takes her kids in for their wellness visits and immunizations.

$750

100% paid by ETP!

She takes the kids to the doctor a few times for illnesses and they are given generic prescriptions that she fills at the pharmacy.

$80 visit x 6
$30 generic x 6

Rebecca goes to the doctor a couple times for allergies and she fills a prescription through mail order.

$80 visit x 2
$50 generic

Her son breaks his arm on the playground and she takes him to the ER. The X-ray shows he will need to have surgery that can be done outpatient.

$800 ER visit
$500 X-ray
$6,000 surgery

Rebecca goes to the ER after an auto accident. They do an MRI and CT scan.

$800 ER visit
$1,100 tests x 2

Rebecca fills several prescriptions at the pharmacy during her recovery.

$30 generic x 4

Rebecca has incurred a total of $12,040 in medical expenses. Now, let’s see which medical plan would have been better for Rebecca!
$12,040
in total expenses
Wait!
We also need to remember that Rebecca has been paying for medical coverage from her paycheck. We'll add that in too!
Remember Rebecca incurred $12,040 in expenses.

In the CDHP, Rebecca pays up to the out-of-pocket max. After that the Company pays 100%.

In the PPO, she doesn’t reach the out-of-pocket max. She pays some copays, her deductible and still continues to pay coinsurance.

CDHP PPO
Costs paid by Rebecca $7,500 $3,920
Rebecca's paycheck deductions $840 $2,608
Partnership-provided HSA contribution -$2,000 N/A
And the winner is...
The CDHP Plan is the winner for Rebecca!
CDHP PPO
Costs paid by Rebecca $7,500 $3,920
Rebecca's paycheck deductions $840 $2,608
Partnership-provided HSA contribution -$2,000 N/A
Rebecca's Total Cost $6,340 $6,528
To see a more detailed calculation of Rebecca's care click here.

Melissa

Meet Melissa

She is divorced and has a daughter. She doesn’t use tobacco. Melissa’s daughter is in good health but she has serious complications with an ongoing health condition.

Let’s take a look...

Melissa gets her annual wellness exam and takes her daughter in for her wellness visits and immunizations.

$500

100% paid by ETP!

Melissa takes her daughter to the doctor a few times for ear infections and fills a few generic prescriptions at the pharmacy.

$80 visit x 3
$30 generic x 3

Melissa goes to the doctor a couple times for allergies and she fills a prescription through mail order.

$80 visit x 2
$50 generic

Melissa has a condition that requires monthly visits to the specialist.

$110 visit x 12

She also takes several preferred brand prescriptions that she fills through mail order. She has monthly lab work to regulate her medication.

$100 brand x 8
$500 labs x 12

Melissa has two surgeries to help her condition. She stays in the ICU for one day and two additional days in the hospital each time.

$17,000 surgery
& hospital stay x 2

Melissa has incurred a total of $42,950 in medical expenses. Now, let’s see which medical plan would have been better for Melissa!
$42,950
in total expenses
Wait!
We also need to remember that Melissa has been paying for medical coverage from her paycheck. We'll add that in too!
Remember Melissa incurred $42,950 in expenses.

In the CDHP Melissa pays up to the out-of-pocket max. Then the Company pays 100%.

In the PPO, she pays some through copays and coinsurance up to the $6,000 maximum out-of-pocket.

CDHP PPO
Costs paid by Melissa $7,500 $7,000
Melissa's paycheck deductions $840 $2,608
Partnership-provided HSA contribution -$2,000 N/A
And the winner is...
The CDHP Plan is the winner for Melissa!
CDHP PPO
Costs paid by Melissa $7,500 $7,000
Melissa's paycheck deductions $840 $2,608
Partnership-provided HSA contribution -$2,000 N/A
Melissa's Total Cost $6,340 $9,608
To see a more detailed calculation of Melissa's care click here.

Chris

Meet Chris

Chris is married with with three kids. His family is in good health and he and his wife don’t use tobacco. Chris and his family have a pretty smooth year.

Let’s take a look...

The family all get their wellness exams and the kids get their immunizations.

$1,250

100% paid by ETP!

Chris and his wife go to the doctor when they get the flu. They take the kids to the doctor a few times during the year for ear and sinus infections.

$80 visit x 8

They also take several medications that they fill at the pharmacy and two more that they fill through mail order.

$30 visit x 6
$50 generic x 2

Chris goes to the doctor and has an MRI after he re-injures his knee playing with the kids.

$80 visit
$1,110 MRI

His son is diagnosed with allergies and goes to the specialist several times.

$110 visit x 5

He also goes through one round of allergy testing and has regular allergy shots.

$525 testing
$35 shots x 9

Chris has incurred a total of $4,750 in medical expenses. Now, let’s see which medical plan would have been better for Chris!
$4,750
in total expenses
Wait!
We also need to remember that Chris has been paying for medical coverage from his paycheck. We'll add that in too!
Remember Chris incurred $4,750 in expenses.

In the CDHP Chris pays out-of-pocket for everything but the cost of the free physical.

In the PPO, he pays some through copays.

CDHP PPO
Costs paid by Chris $3,500 $2,400
Chris's paycheck deductions $1,502 $4,095
Partnership-provided HSA contribution -$2,000 N/A
And the winner is...
The CDHP Plan is the winner for Chris!
CDHP PPO
Costs paid by Chris $3,500 $2,400
Chris's paycheck deductions $1,502 $4,095
Partnership-provided HSA contribution -$2,000 N/A
Chris's Total Cost $3,002 $6,495
To see a more detailed calculation of Chris's care click here.

Linda

Meet Linda

Linda is married and has three active kids. The family is healthy and Linda and her husband don’t use tobacco. This is a bumpy year for the family. All three of the kids have serious sports injuries.

Let’s take a look...

The family all get their wellness exams and the kids get their immunizations.

$1,250

100% paid by ETP!

Linda’s husband sees a specialist for his allergies. After a round of allergy testing he is given regular shots and starts taking a generic medication that he fills through mail order.

$110 visit x 2
$525 testing
$35 shots x 9
$50 generic x 4

The kids all get sick and go to the doctor a few times. They each take a few generic prescription that Linda fills at the pharmacy and a few that she fills through mail order.

$80 visit x 8
$30 generic x 6
$50 generic x 4

This is the year of the sports injury in Linda’s home. They start the year off with all of the kids taking trips to the urgent care clinic and follow-up visits to the doctor.

$180 urgent care x 3
$80 doctor visit x 4
$30 generic x 4

Later in the year, two of the kids have more serious injuries and are taken to the ER where they run several tests. Both of the kids have surgery and require multiple trips to specialists and physical therapy.

$800 ER visit x 2
$500 X-ray x 2
$1,100 tests x 2
$110 specialist x 13
$6,000 surgery x 2
$90 therapy visit x 6

Linda has incurred a total of $23,280 in medical expenses. Now, let’s see which medical plan would have been better for Linda!
$23,280
in total expenses
Wait!
We also need to remember that Linda has been paying for medical coverage from her paycheck. We'll add that in too!
Remember Linda incurred $23,280 in expenses.

In the CDHP, Linda pays up to the out-of-pocket max. After that the Company pays 100%.

In the PPO, she doesn’t reach the out-of-pocket max. She pays some copays, her deductible and still continues to pay coinsurance.

CDHP PPO
Costs paid by Linda $7,500 $6,301
Linda's paycheck deductions $1,502 $4,095
Partnership-provided HSA contribution -$2,000 N/A
And the winner is...
The CDHP Plan is the best choice for Linda!
CDHP PPO
Costs paid by Linda $7,500 $6,301
Linda's paycheck deductions $1,502 $4,095
Partnership-provided HSA contribution -$2,000 N/A
Linda's Total Cost $7,002 $10,396
To see a more detailed calculation of Linda's care click here.

Ellen

Meet Ellen

She is married with two young kids and one on the way. The family is generally in good health and she and her husband don’t use tobacco. Ellen has serious complications at the end of her pregnancy and the baby has surgery before being released.

Let’s take a look...

The family all get their wellness exams and the kids get their immunizations.

$1,000

100% paid by ETP!

The kids occasionally go to the doctor for ear and sinus infections. Her husband goes to the doctor when he gets the flu.

$80 visit x 10

They also fill eight generic prescriptions at the pharmacy and four generic through mail order.

$30 generic x 8
$50 generic x 4

Ellen has serious complications in the third trimester of her pregnancy and is put on in-hospital bed rest. She gives birth by C-section two weeks later.

$31,000 C-section & hospital stay

The baby has some complications and has surgery. He recovers in the NICU.

$17,000 neonatal surgery
$32,000 NICU stay

The baby has several specialist visits after being released from the hospital.

$110 visit x 8

Ellen has incurred a total of $83,120 in medical expenses. Now, let’s see which medical plan would have been better for Ellen!
$83,120
in total expenses
Wait!
We also need to remember that Ellen has been paying for medical coverage from her paycheck. We'll add that in too!
Remember Ellen incurred $83,120 in expenses.

In the CDHP Ellen pays up to the out-of-pocket max. Then The Company pays 100%.

In the PPO, she pays some through copays and coinsurance up to the $6,000 maximum out-of-pocket.

CDHP PPO
Costs paid by Ellen $7,500 $7,000
Ellen's paycheck deductions $1,502 $4,095
Partnership-provided HSA contribution -$2,000 N/A
And the winner is...
The CDHP Plan is the winner for Ellen!
CDHP PPO
Costs paid by Ellen $7,500 $7,000
Ellen's paycheck deductions $1,502 $4,095
Partnership-provided HSA contribution -$2,000 N/A
Ellen's Total Cost $7,002 $11,095
To see a more detailed calculation of Ellen's care click here.

Medical Plan Decision Worksheet

You have seen the samples, now download the Medical Plan Decision Worksheet and enter your own numbers to see which plans could be right for you.

Find a Doctor

Already have a great doctor or need a new one?

No matter which medical plan you choose, you can control your healthcare costs by using in-network providers. With AmeriBen, locating a Blue Cross Blue Shield (BCBS) in-network doctor is easier than ever before. Simply login to your MyAmeriBen account and use the Find a Doctor feature. If your doctor is not in the BCBS network, ask him or her about joining.

You can click here to find a BCBS doctor or call 1-866-215-0976.

Need to find a dentist?

Look for him or her in the Delta Dental network. If your dentist is not in the network, ask him or her about joining. Find a Delta Dental Dentist.

What about an eye doctor?

Look for him or her in the Vision Service Plan (VSP) network. If your eye doctor is not in the network, ask him or her about joining. Find a VSP Doctor.

2019 Benefits Open Enrollment is Closed.

Click here if you are a new hire or newly eligible for benefits and you are ready to enroll.

If you have questions about your benefit elections, please contact the Benefit Advocate Center at
1-855-562-5847, or email ETPbenefits@ajg.com.