Picking the right health care plan can be confusing…
….Let us help simplify the process
We Make it Easy
When it comes to choosing a medical provider or facility, it helps to see how your options work — and what it could cost you. That’s exactly what this page is designed to do. By following these steps, you can find the care that’s the best fit for your health needs and your wallet.
We offer two medical plan options to fit different needs and budgets. Each plan covers preventive care at 100% and includes valuable resources like Telehealth and mental health support. Watch our videos to learn more about the PPO, the HDHP, and how an HSA can help you save money now and in the future. Then review the summaries below to decide which plan is right for you.
Understand the Parts of Your Medical Plan
Annual Deductible
The amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
Copays
A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
Coinsurance
Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Out-of-Pocket Maximum
The most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
Compare Your Options
Understanding the basics of each plan is the first step in making the right choice. The chart below shows a side-by-side comparison of your medical plan options, highlighting key costs like deductibles, copays, and coinsurance. Use this chart to get a feel for how each plan handles different types of care — from routine visits to major health events. As you review, think about how you typically use healthcare and which plan might work best for your needs and budget.
| PPO PLAN | HDHP PLAN | |||
|---|---|---|---|---|
| Network | Out-of-Network | Network | Out-of-Network | |
| YOU PAY | ||||
| CALENDAR YEAR DEDUCTIBLE | ||||
| Per Individual | $1,000 | $2,000 | $1,700 | $3,400 |
| Per Family | $2,000 | $4,000 | $3,400 | $6,800 |
| CALENDAR YEAR OUT-OF-POCKET MAXIMUM (INCLUDES DEDUCTIBLE) | ||||
| Per Individual | $3,000 | $5,000 | $4,000 | $10,000 |
| Per Family | $6,000 | $10,000 | $8,000 | $20,000 |
| COINSURANCE / COPAYS | ||||
| Preventive Care | $0 copay | Not Covered | $0 copay | Not Covered |
| Primary Care Physician | $25 copay | 40%* | 20%* | 40%* |
| Specialist | $40 copay | 40%* | 20%* | 40%* |
| Virtual Visits | $20 copay | 40%* | 20%* | 40%* |
| Urgent Care | $50 copay | 40%* | 20%* | 40%* |
| Emergency Room: Facility | $200 copay | $200 copay | 20%* | 40%* |
| Emergency Room: Physician | 20%* | 20%* | 20%* | 20%* |
| RETAIL RX (UP TO 30-DAY SUPPLY) | ||||
| Generic | $5 copay | Not covered | 20%* | Not Covered |
| Brand | $35 copay | 20%* | ||
| Non-Formulary | $60 copay | 20%* | ||
| Specialty | $60 copay | N/A | ||
| MAIL ORDER RX (UP TO 90-DAY SUPPLY) | ||||
| Generic | $10 copay | Not covered | 20%* | Not covered |
| Brand | $70 copay | 20%* | ||
| Non-Formulary | $120 copay | 20%* | ||
| Specialty | $120 copay | N/a | ||
Learn More About Your Plan Options
Take a few minutes to learn about the PPO plan, the HDHP plan, and how an HSA can help you save — all in these short videos.
PPO PLAN
HDHP PLAN
HOW TO USE YOUR HSA
See How the Plans Work in Real Life
It can be hard to picture how a health plan actually works until you use it — so we’ve put together a few examples to show you. Each one highlights a different type of person with unique healthcare needs, from someone who barely visits the doctor to someone managing a chronic condition. For each example, you’ll see how much care they needed, what the plans covered, and what they paid out of pocket. Click below to meet these individuals and find the situation that looks most like yours — it’s a helpful way to see how your own costs could add up under each plan.
Meet Jake
Jake is a 28-year-old single who elects Individual coverage.
He is generally healthy and only needs annual preventive care and the occasional sick visit.
Estimated Care in 2026:
- 1 preventive check-up with a primary care provider
- 1 virtual visit for a sinus infection
- 1 generic prescription refill
| PPO PLAN | HDHP PLAN | |
|---|---|---|
| In-Network | In-Network | |
| PARTS OF YOUR MEDICAL PLAN | ||
| Deductible (Individual) | $1,000 | $1,700 |
| Out-of-Pocket Maximum (Individual) | $3,000 | $4,000 |
| HEALTH CARE SERVICES | ||
| Preventive Care | $0 | $0 |
| Virtual Visit (1) | $20 | $75 |
| Tier 1 Rx (30-Day) | $5 | $10 |
| TOTAL COST OF HEALTH CARE SERVICES | $25 | $85 |
| WHAT JAKE PAID OUT-OF-POCKET | ||
| Health Care Services (+) | $25 | $85 |
| Annual Premium (+) | $2,990 | $2,600 |
| Company HSA Contribution (-) | $0 | $500 |
| TOTAL JAKE PAID IN 2026 | $2,990 | $2,600 |
Meet the Martins
Claire and her husband, Ben, elect Family coverage for themselves and their two active kids. The children need regular pediatric care like well-child visits and vaccinations, and unexpected events happen too — like when their daughter broke her arm and needed an ER visit, imaging, and follow-up with an orthopedic specialist. Claire also makes her own well-being a priority by scheduling regular therapy sessions.
Estimated Care in 2026:
- 4 well-child visits and vaccinations
- 1 ER visit + imaging + follow-up with an orthopedic specialist
- 2 urgent care or sick visits for kids
- 6 therapy sessions for Claire
| PPO PLAN | HDHP PLAN | |
|---|---|---|
| In-Network | In-Network | |
| PARTS OF YOUR MEDICAL PLAN | ||
| Deductible (Family) | $2,000 | $3,400 |
| Out-of-Pocket Maximum (Family) | $6,000 | $8,000 |
| HEALTH CARE SERVICES | ||
| Preventive Care (4) | $0 | $0 |
| Emergency Room | $2,500 | $2,500 |
| Primary Care Visit (4) | $100 | $600 |
| Specialist Visit (1) | $40 | $250 |
| Therapy Sessions (24) | $960 | $3,000 |
| Tier 1 Rx (Generic) (3) | $15 | $15 |
| TOTAL COST OF HEALTH CARE SERVICES | $3,615 | $6,365 |
| WHAT THE MARTINS PAID OUT-OF-POCKET | ||
| Health Care Services (+) | $3,615 | $6,365 |
| Annual Premium (+) | $11,440 | $7,306 |
| Company HSA Contribution (-) | $0 | $1,000 |
| TOTAL THE MARTINS PAID IN 2026 | $15,055 | $12,671 |
Meet the Parkers
Susan and Dave are in their early 60s and elect Employee + Spouse coverage. They both manage chronic conditions, and Susan is preparing for knee surgery later this year. They need a plan with predictable out-of-pocket costs and access to trusted providers.
Estimated Care in 2026:
- 4 specialist visits for Dave’s diabetes care
- 12 months of insulin prescriptions
- 8 physical therapy sessions for Susan (pre-surgery)
- 1 knee surgery with hospital stay + outpatient rehab
- 6 mental health therapy sessions for Susan
| PPO PLAN | HDHP PLAN | |
|---|---|---|
| In-Network | In-Network | |
| PARTS OF YOUR MEDICAL PLAN | ||
| Deductible (Family) | $2,000 | $3,400 |
| Out-of-Pocket Maximum (Family) | $6,000 | $8,000 |
| HEALTH CARE SERVICES | ||
| Preventive Care (2) | $0 | $0 |
| Knee Surgery | $30,000 | $30,000 |
| Physical Therapy (20) | $2,000 | $2,000 |
| Tier 2 Rx (3) | $210 | $255 |
| TOTAL COST OF HEALTH CARE SERVICES | $32,210 | $32,255 |
| WHAT THE PARKERS PAID OUT-OF-POCKET | ||
| Health Care Services (+) | $6,000 | $8,000 |
| Annual Premium (+) | $8,398 | $5,694 |
| Company HSA Contribution (-) | $0 | $1,000 |
| TOTAL THE PARKERS PAID IN 2026 | $14,398 | $12,694 |
Which Plan is Right for Me? Compare Your Costs and Choose Your Plan
Choosing the right health plan can be tricky, but this interactive tool makes the process simple. To accurately estimate your health care costs and compare plans, you’ll need to enter a few details based on your expected health care use. This interactive calculator helps you estimate your potential healthcare spending under each medical plan. Just enter how many times you expect to use care, and see your out-of-pocket costs update instantly.
How to Use This Tool:
This tool helps you see exactly how different plan options stack up based on your family’s unique health care needs.
- Start by selecting your coverage level—this is who you’ll be covering under your plan (just yourself, you and your spouse, your kids, or your whole family).
- Estimate your yearly usage for each service listed. Think about how many times you might visit your primary care doctor, specialists, urgent care, or use prescription drugs. Remember: Preventive care typically costs $0, and virtual visits may also have no cost—consider this when estimating your usage.
- Enter the numbers in the “Usage” column. The calculator automatically updates costs based on your estimates, giving you a clearer comparison between plans.
How Costs Are Calculated
Your cost for health care services will never exceed your plan’s out-of-pocket maximum. Your total cost equals the cost of health care services plus your premiums, minus any employer contributions to your Health Savings Account (HSA). The figures shown are for illustration only—your actual costs may vary. All sample amounts are based on national averages to demonstrate how costs accumulate under different plan designs.
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| Usage | PPO Plan | HDHP Plan | |
|---|---|---|---|
| In-Network | In-Network | ||
| PARTS OF YOUR MEDICAL PLAN | |||
| Deductible | $0 | $0 | |
| Out-of-Pocket Maximum | $0 | $0 | |
| HEALTH CARE SERVICES | |||
| Preventive Care | $0 | $0 | |
| Primary Care Visit | $0 | $0 | |
| Specialist Visit | $0 | $0 | |
| Urgent Care | $0 | $0 | |
| Outpatient Medical Visit | $0 | $0 | |
| Diagnostic Labs | $0 | $0 | |
| Diagnostic Imaging (MRI, CT, etc.) | $0 | $0 | |
| Outpatient Surgery | $0 | $0 | |
| Hospitalization | $0 | $0 | |
| Tier 1 Rx (Generic) | $0 | $0 | |
| Tier 2 Rx (Preferred) | $0 | $0 | |
| Tier 3 Rx (Non-Preferred) | $0 | $0 | |
| TOTAL COST OF HEALTH CARE SERVICES | $0 | $0 | |
| WHAT YOU PAY OUT-OF-POCKET | |||
| Health Care Services (+) | $0 | $0 | |
| Annual Premium (+) | $0 | $0 | |
| Company HSA Contribution (–) | $0 | $0 | |
| TOTAL YOU PAY IN 2026 | $0 | $0 | |
Need Assistance?
Benefits Department
555-555-5555
hr@mybenefits.com