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. 

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An example of paying with medical only
Matt's Medical Expenses1 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: $5,750
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An example of paying with Base coverageWhat Matt gets paid if he has the Accident Protection Plan.
Initial care/hospital care2 Payment Amount
Ambulance (ground) $200
Emergency room visit $100
Initial physician visit $40
Subtotal $340
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An example of the cost of follow-up care and common injuries
Follow-up care/common injuries2 Payment Amount
Diagnostic X-ray exam $160
Wrist fracture treatment $480
Surgical ligament tear repair $400
Knee brace $140
Follow-up physician visit $40
Physical therapy sessions
($30 per day up to 6 days)
$180
Organized sports injury benefit3 $350
Subtotal $1750
Total payment to Matt: $2,090
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. Example is based on a mid-level standard 24-hour plan design.
  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 $350 ($1,400 X 25% = $350).
  4. Premium costs are based on a 500-employee company, with voluntary (100 percent employee-paid) funding and employee-only coverage.