Laserfiche WebLink
Benchmarking Medical Plan Benefits <br />City of La Porte <br />Benchmark <br />Number of Enrolled Employees <br />408 <br />Plans Offered <br />3 <br />Current Carrier <br />Aetna <br />Plan Year <br />20222022 <br />Plan TypePPO PlanHDHP PPO PlanHF 1000HF1500 <br />Subscriber Enrollment 15495159 <br />% of Subscriber Enrollment 38%23%39% <br />PPO PlanHDHP PPO PlanHF 1000HF1500 <br />$1000 EE $500 EE $500 EE <br />n/an/a <br />$1,500 FAM$1,000 FAM$1,000 FAM <br />HSA or HRA Contribution <br />$500$1,000$1,500 <br />Individual Deductible$1,755$3,058 <br />$1,500$3,000$4,500 <br />Family Deductible$3,822$6,146 <br />$3,500$3,000$4,200 <br />Individual Out of Pocket$4,280$4,827 <br />$10,500$9,000$12,600 <br />Family Out of Pocket$9,031$9,776 <br />20%20%20% <br />Coinsurance 20%20% <br />$25 PCP Copay / $25 PCP Copay / <br />Ded./20%Ded./20%Ded./20% <br />$50 Specialist Copay$40 Specialist Copay <br />Office Visits/Specialist <br />$65 CopayDed./20%$40 CopayDed./20%Ded./20% <br />Urgent Care <br />$250 Copay + 20%Ded./20%$150 Copay$150 Copay$150 Copay <br />Emergency Room <br />Ded./20%Ded./20%Ded./20%Ded./20%Ded./20% <br />Inpatient Surgery <br />Tier 1 - $10Tier 1 - $10Tier 1 - $10Tier 1 - $10 <br />Pharmacy - Retail Only Tier 2 - $35Ded./20%Tier 2 - $30Tier 2 - $30Tier 2 - $30 <br />Tier 3 - $70Tier 3 - $60Tier 3 - $60Tier 3 - $60 <br />© 2022 HUB International Limited. <br />25 <br /> <br />