Page 11 - John Hartley Design

Which Route Should

You Choose?

Learn about your 2014 Medical
Plan choices for Open Enrollment!

Which Route Should

You Choose?

The chart below is designed to provide you with a summary comparison of factors you
need to consider when making your enrollment decision. Use this chart, along with the
worksheet on the other side to help you determine which plan is best for you and your
family. Both resources are included in your 2014 Medical Plan Selection Guide, along
with additional information you should review.
2014 Plan Comparison Table

Comparison of Medical Plans
Standard Plan
Health Reimbursement Plan
Health Savings Plan
Carmeuse Contribution
$0
$500/$1,000
$1,000/$2,000
Your Deductible
$500/$1,000
$1,500/$3,000
$2,500/$5,000
Carmeuse Co-Insurance
80%
100%
100%
Your Out of Pocket Maximum
$2,000/$4,000
–
–
Preventative Coverage
100%
100%
100%
Ofice Visit
$25
$20
Deductible applies then plan
pays
100% after ER
$100
$100
deductible is met
Urgent Care Co-Pay
$40
$40
Teladoc
$15
$15
$40 (applies to deductible)

Comparison of Prescription Drug Coverage
Standard Plan
Health Reimbursement Plan
Health Savings Plan
Retail (30 day supply)
Generic
$5 Co-Pay
Deductible applies, then coverage is Preferred Brand (generic alternative not available)
25% co-insurance with $0 min and $150 max
Non-Preferred Brand (generic alternative available)
40% co-insurance with $50 min and $200 max
100% by plan after Mail Order (90 day supply)
deductible is met
Generic
$10 Co-Pay
Preferred Brand (generic alternative not available)
25% co-insurance with $0 min and $300 max
Non-Preferred Brand (generic alternative available)
40% co-insurance with $100 min and $400 max
Mail Order – required to use CVS Caremark
Specialty Pharmacy Service
35% with $0 min and $150 max
Monthly Employee Contribution Rates
Standard Plan
Health Reimbursement Health Savings Plan
Plan
Employee Only
$125
$80
$50
Two-Person
$215
$160
$100
Family
$250
$160
$100
See your local HR Representative
if you have any questions.

Refer to the Guide for additional important information.