To select the right medical plan, you need to consider what’s most important for you and your family. Salesforce offers the following medical plans:
- PPO
- HDHP Premium
- HDHP Standard
- EPO
All plan options are available through both Aetna and UnitedHealthcare. Employees in California, Oregon, Washington and Georgia also have the option of the Kaiser Permanente HMO. For purposes of the scenarios below, we’ve compared the PPO, EPO, and HDHP Premium plans.
Use the scenarios below to determine which medical plan will best meet your needs. Remember: These examples are for illustrative purposes only. Be sure to review your plan options carefully, and consider all of the plans available to you before deciding which is the best fit for you.
- Andrea—moderate healthcare user, age 42, married, 2 children
- David—low healthcare user, age 28, single, no children
- Julia—high healthcare user, age 39, married, no children
- Karl—high healthcare user, age 50, single, 2 children
Meet Andrea: 42 years old, married, 2 children
Andrea has two children under the age of 12, so she makes a number of doctor visits every year—dealing with common colds and infections as well as the occasional soccer or roller-skating injury. She tries to follow all preventive care guidelines to keep her family healthy, but you can only do so much to avoid the doctor when you have two active kids.
Andrea is currently enrolled in the PPO plan, but she’s considering switching to the HDHP Premium plan. She’s looking for ways to save more money pretax and likes the added benefits of the health savings account—especially the ability to use it for medical expenses now or in the future.
Here’s how the plans compare for Andrea. In this scenario, she has the lowest annual out-of-pocket costs (premiums plus healthcare costs) with the HDHP Premium plan. However, she spends all of the money in her HSA.
|
PPO |
EPO |
HDHP Premium Plan |
|
|---|---|---|---|
|
Andrea's Annual Premiums |
|||
|
Employee + family coverage |
$6,096 |
$6,636 |
$3,348 |
|
Andrea's Health Savings Account Contribution |
|||
|
Andrea pays less in annual premiums with the HDHP Premium plan. She can save that money and put it into her HSA. |
N/A |
N/A |
|
|
Salesforce's HSA contribution |
N/A |
N/A |
$1,500 |
|
Andrea's Out-of-Pocket Costs |
|||
|
Annual Deductible Andrea can use the contribution from Salesforce to cover 50% of the HDHP Premium plan annual deductible. |
$1,500 |
$400 |
$3,000 |
|
Preventive Care Andrea pays nothing for her family’s preventive care. All plans cover preventive care at 100% in-network. |
$0 |
$0 |
$0 |
|
Doctor Visits Andrea visits her in-network PCP 4 times during the year. When her kids get sick, she takes them to their in-network PCP 6 times. Under the PPO and HMO, Andrea pays copays for doctor visits. Under the HDHP Premium plan, Andrea pays all costs until she meets the annual family deductible. |
$15 copay x 10 = $150 |
$15 copay x 10 = $150 |
$120 per visit x 10 = $1,200* *Paid from her HSA |
|
Prescriptions Andrea needs a 30-day supply of 3 non-preventive generic prescriptions for her family. Under the PPO and HMO, Andrea pays $25 copays for a 30-day supply. Under the HDHP Premium plan, Andrea pays 100% until she meets the annual family deductible. |
$25 copay x 3 = $75 |
$25 copay x 3 = $75 |
$43 per prescription x 3 = $129* *Paid from her HSA Non-preventive prescriptions are subject to the deductible and coinsurance. The amount shown is Andrea’s responsibility. |
|
ER Visits Andrea’s son kicks a soccer ball a little too hard; she takes him to the ER to treat a broken toe. |
$75 copay |
$75 copay |
$650 x 1 = $650* *$171 is paid from her HSA and $479 is paid by Andrea |
|
Andrea's Total Costs |
|||
|
Premiums + out-of-pocket costs |
$7,896 |
$7,336 |
$3,827 |
|
Amount left over in HSA |
N/A |
N/A |
$0 |
Meet David: 28 years old, single, no children
David loves all outdoor activities: running, biking, rafting, mountain climbing—you name it! Last year, he took a pretty nasty spill during a bike race, which left him with a broken arm for several months. He’s thankful for the physical therapy that got him back into his regular riding routine.
This year, David’s primary goal is to stay healthy (i.e., no broken bones). He wants a medical plan that covers him in case of a major illness or injury, but otherwise he doesn’t foresee having to use the plan all that much. His only consistent healthcare need is his seasonal allergy medication. He’d like to find a way to save more money pretax and to maximize his savings potential now, while he’s still single.
Here’s how the plans compare for David. Assuming he receives the healthcare services described below, he has the lowest annual costs (premiums plus healthcare costs) under the HDHP Premium plan. Plus, he has $587 in his HSA at the end of the year.
|
PPO |
EPO |
HDHP Premium Plan |
|
|---|---|---|---|
|
David's Annual Premiums |
|||
|
Employee-only coverage |
$1,152 |
$1,452 |
$636 |
|
David's Health Savings Account Contribution |
|||
|
David pays less in annual premiums with the HDHP Premium plan. He can save that money and put it into his HSA. |
N/A |
N/A |
|
|
Salesforce’s HSA contribution |
N/A |
N/A |
$750 |
|
David's Out-of-Pocket Costs |
|||
|
Annual Deductible David can use the contribution from Salesforce to cover 50% of the HDHP Premium plan annual deductible. |
$500 |
$200 |
$1,500 |
|
Preventive Care David pays nothing for his preventive care. All plans cover preventive care at 100% in-network. |
$0 |
$0 |
$0 |
|
Doctor Visits David visits his doctor once. Under the PPO and HMO, David pays copays for in-network doctor visits. Under the HDHP Premium plan, David pays all costs until he meets the annual deductible. |
$15 copay |
$15 copay |
$120 x 1 = $120* *Paid from his HSA |
|
Prescriptions David needs a 30-day supply of one non-preventive generic prescription. Under the PPO and HMO, David pays $10 copays for a 30-day supply. Under the HDHP Premium plan, David pays 100% until he meets the annual deductible. |
$10 copay |
$10 copay |
$43 x 1 = $43* *Paid from his HSA Non-preventive prescriptions are subject to the deductible and coinsurance. The amount shown is David’s responsibility. |
|
David's Total Costs |
|||
|
Premiums + out-of-pocket costs |
$1,177 |
$1,477 |
$636 |
|
Amount left over in HSA |
N/A |
N/A |
$587* *Amount rolls over to next year |
Meet Julia: 39 years old, married, no children
Julia does everything she can to stay healthy. She has annual preventive care exams, stays active, and maintains a well-balanced diet. But she still has high blood pressure. She has tried numerous medications and always follows her doctor’s advice. She knows that if she doesn’t manage her blood pressure now, she could be susceptible to serious health problems down the road.
Julia wants a medical plan that covers all of her and her spouse’s needs. She knows she’ll have to pay out-of-pocket for some costs.
Julia’s annual out-of-pocket costs are lowest if she selects the HDHP Premium plan. With the PPO, she pays a higher monthly contribution, but lower costs when she receives care. With the HDHP Premium plan, Julia’s monthly contributions are lower than they are with the PPO, and she generally pays more for services received. But Salesforce contributes $1,500 to her HSA, which helps to offset the additional costs.
|
PPO |
EPO |
HDHP Premium Plan |
|
|---|---|---|---|
|
Julia's Annual Premiums |
|||
|
Employee + Spouse coverage |
$3,684 |
$4,104 |
$1,920 |
|
Julia's Health Savings Account Contribution |
|||
|
Julia pays less in annual premiums with the HDHP Premium plan. She can save that money and put it into her HSA. |
N/A |
N/A |
|
|
Salesforce’s HSA contribution |
N/A |
N/A |
$1,500 |
|
Julia's Out-of-Pocket Costs |
|||
|
Annual Deductible Julia can use the contribution from Salesforce to cover 50% of the HDHP Premium plan annual deductible. |
$1,500 |
$400 |
$3,000 |
|
Preventive Care Julia pays nothing for her preventive care. All plans cover preventive care at 100% in-network. |
$0 |
$0 |
$0 |
|
Doctor Visits Julia visits her in-network PCP five times and an in-network specialist six times. Under the PPO and HMO, Julia pays copays for doctor visits. Under the HDHP Premium plan, Julia pays all costs until she meets the annual family deductible. |
$15 copay x 11 = $165 |
$15 copay x 11 = $165 |
5 x $120 PCP + 6 x $180 Specialist = $1,680* *$1,500 paid is from her HSA and $180 is paid by Julia. |
|
Prescriptions Julia needs to refill a 90-day supply of mail-order preventive drug prescription 4 times a year. Under the PPO and HMO, Julia pays $50 copays for a 90-day supply. Under the HDHP Premium plan, Julia pays 100% until she meets the annual family deductible. |
$50 copay x 4 = $200 |
$50 copay x 4 = $200 |
$50 copay x 4 = $200 If the required drug is not listed in the preventive drug list you pay 100% until the deductible is met. |
|
Julia's Total Costs |
|||
|
Premiums + out-of-pocket costs |
$4,049 |
$4,379 |
$2,300 |
|
Amount left over in HSA |
N/A |
N/A |
$0 |
Meet Karl: 50 years old, single, two children
Unfortunately, Karl and his two daughters were in a serious auto accident this year, resulting in long hospital stays for each of them. They’re recuperating well now and will make a full recovery, but they’ve incurred large healthcare bills.
Because of the high volume and cost of services they’ve received, the HMO would be the best option for Karl and his family. While the HMO has the highest premiums, it also has the lowest cost for services.
|
PPO |
EPO |
HDHP Premium Plan |
|
|---|---|---|---|
|
Karl's Annual Premiums |
|||
|
Employee + child(ren) coverage |
$3,168 |
$3,528 |
$1,620 |
|
Karl's Health Savings Account Contribution |
|||
|
Karl pays less in annual premiums with the HDHP Premium plan. He can save that money and put it into his HSA. |
N/A |
N/A |
|
|
Salesforce’s HSA contribution |
N/A |
N/A |
$1,500 |
|
Karl's Out-of-Pocket Costs |
|||
|
Annual Deductible Karl can use the contribution from Salesforce to cover 50% of the HDHP Premium plan annual deductible. |
$1,500 |
$400 |
$3,000 |
|
Preventive Care Karl pays nothing for his family’s preventive care. All plans cover preventive care at 100% in-network. |
$0 |
$0 |
$0 |
|
Doctor Visits Karl and his family visit their in-network PCPs 12 times. Under the PPO and HMO, he pays copays for doctor visits. Under the HDHP Premium plan, Karl pays all costs until he meets the annual family deductible. |
$15 copay x 12 = $180 |
$15 copay x 12 = $180 |
12 x $120 = $1,440* *$1,440 is paid from his HSA. |
|
Hospitalization Karl and his daughters were rushed to the hospital, where they were treated for five days. Under the HDHP Premium plan, they pay 100% until they meet the annual family deductible. |
$20,000 a day x 5 days x 3 people = $300,000 10% coinsurance after deductible = $30,000 Karl will pay $3,000 of this then reach the out-of-pocket maximum |
$0 |
$20,000 a day x 5 days x 3 people = $300,000 10% coinsurance after deductible cost = $30,000 Karl will pay $4,560 and then reach the out-of-pocket maximum |
|
Karl's Total Costs |
|||
|
Out-of-pocket maximum |
$4,500 |
$4,400 |
$6,000 |
|
Premiums + out-of-pocket costs |
$7,848 |
$3,708 |
$7,620 |
|
Amount left over in HSA |
N/A |
N/A |
$0 |