Details on potential changes to coverage

Learn about the potential changes


Changes to plan member cost sharing

We are considering changes to the way the extended health plan is structured, including changing the percentage of costs reimbursed after the deductible. Currently, the plan reimburses 70% of costs up to $1,000, then reimburses at 100%. The change being considered is to reimburse 75% up to $2,000, then reimburse at 100%.

In general, if your personal extended health costs are under $1,800 per year, the new option is better. If your personal costs are $1,800 and over, the current structure is better.  

This proposed structure would not change member premiums.

Current reimbursement formula Potential future formula
1. DEDUCTIBLE:
each person pays a $100 annual deductible, meaning that the first $0 -$100 in costs are not covered and the member is not reimbursed at all
1. DEDUCTIBLE:
Per person $100 annual deductible (NO CHANGE) 

2. 70% REIMBURSEMENT:
Of the next $1,428.57* spent, the member is reimbursed at 70%

*This equals $1,000 divided by 70%, meaning the member is reimbursed at 70% of their costs, until $1,000 in reimbursements are received.

2. 75% REIMBURSEMENT:
Of the next $2,666.67* spent, the member is reimbursed at 75%

*This equals $2,000 divided by 75%, meaning the member is reimbursed at 75% of their costs, until $2,000 in reimbursements are received.

3. 100% REIMBURSEMENT:
For everything spent over $1,528.59, the member is reimbursed the full amount (100%).
3. 100% REIMBURSEMENT:
For everything spent over $2,766.67, the member is reimbursed the full amount (100%).

 

Here are a few examples:

Person A spent $1,000.00 last year and claimed $900 in expenses after the deductible

Current formula Potential future formula
Plan pays Member pays Plan pays  Member pays
$0.00 (deductible) $100.00 $0 (deductible) $100.00
70% of $900.00 = $630.00 30% of $900.00 = $270.00 75% of $900.00 = $675.00 25% of $900.00 = $225.00
Total: $630.00 Total: $370.00 Total: $675.00 Total: $325.00

 

Person B spent $1,800.00 last year and claimed $1,700 in expenses after the deductible

Current formula Potential future formula
Plan pays Member pays Plan pays  Member pays
$0.00 (deductible) $100.00 $0.00 (deductible) $100.00
70% of $1,428.57 = $1,000.00 30% of $1,428.57 = $428.57 75% of $1,700.00 = $1,275.00 25% = $1,700.00 = $425.00
100% of $271.43 $0.00
Total : $1,271.43 Total: $528.57 Total: $1,275.00 Total: $525.00

 

Person C spent $3,000.00 last year and claimed $2,900 in expenses after the deductible

Current formula Potential future formula
Plan pays Member pays Plan pays  Member pays
$0.00 (deductible) $100.00 $0.00 (deductible) $100.00
70% of $1,428.57 = $1,000.00 30% of $1,428.57 = $428.57 75% = $2,666.67 = $2,000 25% of $2,666.67 = $666.67
100% of $1,471.43 $0.00 $233.33 $0.00
Total: $2,471.43 Total: $528.57 Total: $2,233.33 Total: $766.67