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Medical Plan Annual Cost

2017 – 2018 Medical Annual Cost 

Monthly Single 

Monthly Dependent 

Monthly 
Family 

Medical Plan 2

  • $250/$500 deductible; 20% coinsurance
  • $750/$1,500 Out of Pocket Maximum (OPM)
  • $20 office copay in-network, $40 office copay out-of-network
  • 40% coinsurance for out-of-network
  • 30% cost-share (no deductible)
  • Prescription drug OPM 3,000/4,000

 

$674.59 

 

+ $722.89

 

= $1,397.48

Medical Plan 3

  • $500/$1,000 deductible; 20% coinsurance
  • $1,250/$2,500 Out of Pocket Maximum (OPM)
  • $20 office copay in-network, $40 office copay out-of-network
  • 40% coinsurance for out-of-network
  • 30% cost-share (no deductible)
  • Prescription drug OPM 3,000/4,000

 

$634.76

 

+ $679.36

 

= $1,314.12

Medical Plan 4

  • $1,000/$2,000 deductible; 20% coinsurance
  • $2,000/$4,000 Out of Pocket Maximum (OPM)
  • $20 office copay in-network, $40 office copay out-of-network
  • 40% coinsurance for out-of-network
  • 30% cost-share (no deductible)
  • Prescription drug OPM 3,000/4,000

 

$585.03 

 

+ $626.15

 

 = $1,211.18

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