Total Monthly Savings
Total Annual Savings
1st Month PS Premium
Deductible: $500 Coinsurance: 80/20%, Out-of-Pocket: $2,000
| Medical Rates | # on Plan | Total Monthly Premium |
||
|---|---|---|---|---|
| Employee | $505.70 | 54 | $27,307.80 | |
| E + Spouse | $1,061.97 | 13 | $13,805.61 | |
| E + Child(ren) | $1,061.97 | 1 | $1,061.97 | |
| Family | $1,643.53 | 14 | $23,009.42 | |
| Total Current Monthly Premium | $65,184.80 | |||
Total Monthly Premium = Number on Plan * Medical Rates
Deductible: $500 Coinsurance: 80/20%, Out-of-Pocket: $2,000
| Medical Rates | # on Plan | Monthly Premium |
||
|---|---|---|---|---|
| Employee | $677.03 | 54 | $36,559.62 | |
| E + Spouse | $1,421.77 | 13 | $18,483.01 | |
| E + Child(ren) | $1,421.77 | 1 | $1,421.77 | |
| Family | $2,200.35 | 14 | $30,804.90 | |
| Total Renewal Monthly Premium | $87,269.30 | |||
Total Monthly Premium = # on Plan * Medical Rates
Deductible: $5,000 Coinsurance: 100/0%, Out-of-Pocket: $0
Deductible: $500 per person Coinsurance: 0%, Out-of-Pocket: $0 Benefit: $4,500
| Medical Rates | PS Rates | Combined Rates | # on Plan | Total Monthly Premium | |
|---|---|---|---|---|---|
| Employee | $533.43 | $95.83 | $629.26 | 54 | $33,980.04 |
| E + Spouse | $1,066.85 | $210.21 | $1,277.06 | 13 | $16,601.78 |
| E + Child(ren) | $1,013.51 | $185.22 | $1,198.73 | 1 | $1,198.73 |
| Family | $1,706.96 | $297.67 | $2,004.63 | 14 | $28,064.82 |
| Monthly Totals | $67,585.22 | $12,260.15 | 82 | $79,845.37 |
**Contact your Product Specialist if annual savings is less than $65,184.80.
Alternate major medical rates could be an estimate. Actual rates are based on the major medical carrier's actual quote.
Each insured person has a $500 annual deductible. After the deductible is met, the insured person pays 0% until they pay $0 coinsurance. This plan wraps around your high deductible health plan and pays the amount applied to your major medical plan's Deductible and Coinsurance until our payments reach the Maximum Benefit Amount.
This plan covers all eligible expenses covered by your major medical plan except the professional fee of a physician in a doctor's office or medical clinic and outpatient prescription drugs.
$4,500 is the maximum benefit amount payable for benefits described on this page during a benefit year for each Insured Person.
Monthly Rates* (12 Month Rate Guarantee)
Employee: $95.83
E + Spouse: $210.21
E + Child(ren): $185.22
Family: $297.67
*Monthly rates include a non-commissionable $3.00 administration fee for billing.
Participation requirements: All persons covered by the group major medical or comprehensive health plan must be covered by the Premium Saver Plan except when the HSA is funded.
This is a brief description of coverage, see policy for complete details.