HEALTH SAVINGS ACCOUNT (HSA)
WHICH PLAN IS RIGHT FOR YOU?
Below are cost illustrations of the POS Plans. Review these to decide what plan is best for you.
The HSA account is your own responsibility, and eligibility and compliance are between you and the IRS.
ANNUAL COST EXAMPLE OF EMPLOYEE ONLY COVERAGE FOR A HEALTHY INDIVIDUAL
HDHP
POS
Monthly Deductions, annualized
$2,191.80
$3,729.60
Preventive Care Visit
No Cost
No Cost
Sick Visits - 2
$100.00 x 2 = $200.00
$25.00 x 2 = $50.00
$40.00 x 12 = $480.00 (Tier 2 before deductible)
Monthly Prescription
$25.00 x 12 = $300.00
Total Expenses
$2,691.80
$4,259.60
Less Company HSA Contribution
($500.00)
-0-
Total Out of Pocket Expenses
$2,191.80
$4,259.60
ANNUAL COST EXAMPLE OF FAMILY COVERAGE FOR A HEALTHY FAMILY
HDHP
POS
Monthly Deductions, annualized
$6,702.00
$11,403.96
Preventive Care Visit
No Cost
No Cost
Sick Visits - 8
$100.00 x 8 = $800.00
$25.00 x 2 = $200.00
Monthly Prescription
$50.00 x 12 = $600.00
$40.00 x 12 = $480.00
Total Expenses
$8,102.00
$12,083.96
Less Company HSA Contribution
($1,000.00)
-0-
Total Out of Pocket Expenses
$7,102.00
$12,083.96
8 | Foley Products Company Benefit Guide
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