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.

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Medical Expense Example When Paying with Medical Only
Matt’s medical expenses.1 Cost of service
Ambulance (ground) $150
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.

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Base Plan Coverage Example Payment
Base Plan coverage.2
  Payment amount
Ambulance (ground) $300
Emergency room visit $150
Initial physician visit $60
Total payment to Matt:
Premium cost:3 $7/month
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Base Plus Enhanced Coverage Payment Example
Base + Enhanced Plan coverage.2
  Payment amount
Base plan coverage $510
Diagnostic X-ray exam $240
Wrist fracture treatment $720
Surgical ligament tear repair $600
Knee brace $140
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
Premium cost:4 $11/month

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).