Silver Plan Example
How it works: Matt’s example
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, coinsurance and had to miss some work, which affected his income.
|Matt's Medical Expenses1||Cost of Service|
|Emergency room visit||$180|
|Treatment of wrist, including pharmacy cost for pain medications||$1,800|
Arthroscopic knee surgery
|Eight physical therapy visits||$320|
|Total of actual expenses:||$5,750|
|Initial care/hospital care2||Payment Amount|
|Emergency room visit||$100|
|Initial physician visit||$40|
|Follow-up care/common injuries2||Payment Amount|
|Diagnostic X-ray exam||$160|
|Wrist fracture treatment||$480|
|Surgical ligament tear repair||$400|
|Follow-up physician visit||$40|
|Physical therapy sessions
($30 per day up to 6 days)
|Organized sports injury benefit3||$350|
|Total payment to Matt:||$2,090|
- 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.
- Benefit amounts may vary by state. Example is based on a mid-level standard 24-hour plan design.
- 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 $350 ($1,400 X 25% = $350).
- Premium costs are based on a 500-employee company, with voluntary (100 percent employee-paid) funding and employee-only coverage.