A Side-By-Side Analysis
Major Medical Plan
Defined Contribution Plan
Meets MEC Requirements
Unlimited Benefits
High Deductible
Large Co-Pays
Savings go to Insurance Carrier
High Premiums
High Potential for Annual Premium Rate Increases
Defined Benefit Medical Plan
Specific Amount Paid for Specific Event
Does Not Meet MEC Requirements (No tax penalty)
Limited Benefits
Deductible on Hospital Admission Only
No Co-Pays
Savings go to Policyholder
Middle to Low Premiums
Low Potential for Annual Premium Rate Increases
Outpatient Surgery
Deductible Must Be Met
Outpatient Surgery
No Deductible
MRI, Labs, X-Rays
Deductible Must Be Met
MRI, Labs, X-Rays
Immediate Benefit - No Deductible
Doctor Visits
Co-Pays and/or Met Deductible
Doctor Visits
Immediate Benefit - No Co-Pays or Deductible
Prescription Drugs
Rx Co-Pay: $15 Generic / $35 - $75 Brand Name Rx
Rx Co-Pay does not count towards calendar year deductible
Prescription Drugs
Net Rx cost to patient equivalent or better than that of a Co-Pay
Net Rx cost to patient equivalent or better than that of a Co-Pay
Emergency Room
$100 - $1100 access fee plus full deductible must be met for additional benefit
Emergency Room
$400 - $800 benefit up front - $4000 additional if there for accident
PPO Network
Mandatory use by client
PPO Network
Choose Doctor or Hospital
Penalty
Doubles your deductible & Co-Insurance Penalty Applied
Penalty
No Out of Network Penalty
Telemedicine
Some charge fee per use
Telemedicine
Free and Unlimited
Additional Riders Offered
None
