Out of Pocket Calculator Help

Consumer Driven Plan

Consumer Driven Plan is one of the models to select from in the Select a Plan Model portion of the Plan Information section in the General Plan Information Sheet. Consumer Driven refers to the plan containing a High Deductible Health Plan, plus a Savings or Spending Account that can be used to pay funds from to meet the High Deductible requirement, such as a Health Savings Account (HSA) or Health Reimbursement Account (HRA). The High Deductible Health Plan typically has PPO benefits, but sometimes might involve HMO benefits. The Consumer Driven Plan model assumes the following default benefit features:

General Individual Deductible: $1,850
General Family Deductible: $3,700
Inpatient Deductible Per Admission- Participating Hospitals: $0
Inpatient Deductible Per Admission- Non-Participating Hospitals: $0
Coinsurance- Participating Hospitals: 20%
Coinsurance- Non-Participating Hospitals: 30%
Maximum Allowable Per Day- Non Participating Hospitals: $5,000
Maximum Individual Annual Out of Pocket – Participating Providers: $3,000
Maximum Individual Annual Out of Pocket – Non Participating: $4,000
Maximum Family Annual Out of Pocket – Participating Providers: $6,000
Maximum Family Annual Out of Pocket – Non Participating: $8,000
Funds available in Savings or Spending Account: $1,200