Gold Plan Example
How it works: Matt’s example2
Matt was playing in his weekly softball league game and badly injured his knee and wrist. Even with his health plan, Matt had deductible expenses, copayments and had to miss some work, which affected his income.
What Matt pays with only medical.
|Matt’s medical expenses.1||Cost of service|
|Emergency room visit||$180|
|Treatment of wrist, including pharmacy cost for pain medications||$1,800|
|Arthroscopic knee surgery||$3,300|
|Eight physical therapy visits||$320|
|Total of actual expenses:||$5750|
What Matt gets paid if he has the Accident Protection Plan.
|Base Plan coverage.2|
|Emergency room visit||$150|
|Initial physician visit||$60|
|Total payment to Matt:
|Base + Enhanced Plan coverage.2|
|Base plan coverage||$510|
|Diagnostic X-ray exam||$240|
|Wrist fracture treatment||$720|
|Surgical ligament tear repair||$600|
|Follow-up physician visit||$60|
|Physical therapy sessions
($30 per day up to 6 days)
|Organized sports injury benefit3||$525|
|Total payment to Matt:||$3135|
1 Example reflects reimbursement rates for a high-deductible health plan based on UnitedHealthcare’s health care cost estimator. Matt reached his annual out-of-pocket maximum of $5,000 because of expenses with his accident.
2 Benefit amounts may vary by state.
3 Organized sports injury benefit provides an additional 25% coverage up to $10,000. In this example, the organized sports injury enhanced benefit provides an additional $525 ($2,100 X 25% = $525).
4 Example reflects premium rates for 500-employee company, 24-hour plan design, voluntary (100% employee-paid) funding option, employee-only coverage).