Medical

Asurion provides a range of medical coverage options so you can choose the one that best meets the needs of your health and wallet. When you elect Asurion medical coverage, prescription coverage is included.

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Medical options

Bronze Plus Option

The Bronze Plus option may be the right choice for you if:

You want low per-paycheck contributions, i.e., premiums.

And

You like predictability—to know exactly what you’ll pay when you see a provider or fill a prescription, i.e., copayments (copays).

Your Cost

How much you’ll pay for a medical option is a three-component equation:

1 What you pay to have coverage	2 What you pay when you need care	3 What you save for future healthcare needs
Paycheck premiums	Copayments (Copays)	Deductible	Healthcare savings
Varies depending on ZIP code and coverage level	Primary: $30 Specialist: $50	Employee only: $2,300 Family: $4,600	Flexible Spending Account annual limit Employee only: $3,200
Your per-paycheck cost	How much you pay when you see a provider Copays do not count toward your deductible	Deductible: The amount you have to reach before the option shares the cost of your care Coinsurance: 30% Your percentage of the cost of care that is shared with the option after you meet the deductible	Pretax payroll contributions How you can cover your out-of-pocket costs, including medical and prescription copays; your deductible and coinsurance; and other planned and unplanned out-of-pocket healthcare needs

What you pay to have coverage

What you pay when you need care

What you save for future healthcare needs

Paycheck premiums

Copayments (Copays)

Deductible

Healthcare savings

Varies depending on ZIP code and coverage level

Primary: $30
Specialist: $50

Employee only: $2,300
Family: $4,600

Flexible Spending Account
annual limit
Employee only: $3,200

Your per-paycheck cost

How much you pay when you see a provider
Copays do not count toward your deductible

Deductible: The amount you have to reach before the option shares the cost of your care
Coinsurance: 30%
Your percentage of the cost of care that is shared with the option after you meet the deductible

Pretax payroll contributions
How you can cover your out-of-pocket costs, including medical and prescription copays; your deductible and coinsurance; and other planned and unplanned out-of-pocket healthcare needs

How does the Bronze Plus option work for Caroline¹?

January

Health event: Preventive exam (i.e., annual physical)

	Deductible Expense	Non-deductible Expense
Preventive visit	$ 0	$ 0
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 20
Year-to-date total Caroline spent	$20

March

Health event: Sinus infection diagnosis

	Deductible Expense	Non-deductible Expense
Provider visit		$ 30
Rx: Tier 1 antibiotic		$ 12
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 62
Year-to-date total Caroline spent	$82

May

Health Event: Abnormal test follow up for diagnostic exam

	Deductible Expense	Non-deductible Expense
Specialist visit		$ 50
Lab test	$ 150
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 220
Year-to-date total Caroline spent	$302

July

Health Event: Cyst diagnosis and outpatient surgery

	Deductible Expense	Non-deductible Expense
Provider outpatient hospital facility visits	$ 1,250
Rx: Tier 2 post-surgical narcotic		$ 60
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 1,320
Year-to-date total Caroline spent	$1,632

September

Health Event: Bicycle accident

	Deductible Expense	Non-deductible Expense
Provider and urgent care center visits	$ 875
Rx: Tier 2 antibiotics		$ 60
Physical therapy		$ 800
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 1,755
Year-to-date total Caroline spent	$3,387

November

Health Event: Strep throat

	Deductible Expense	Non-deductible Expense
Telemedicine consultation		$ 30
Rx: Tier 1 antibiotics		$ 12
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 62
Year-to-date total Caroline spent	$3,449

January 1

$0December 31

$0$2,300

Deductible: You Pay 100%

$6,700

Coinsurance: You Pay 30%, Plan Pays 70%

Plan Pays: 100%

Out-of-pocket Maximum $6,700

^I Fictional example. Any similarity to a real individual is unintended. Assumes Employee only coverage; in-network care only.

Smart considerations

A flexible spending account may be a smart way to manage your out-of-pocket healthcare expenses for the year. Just remember that you have to use the balance in your FSA annually or you forfeit the remainder. The Bronze Plus option offers you the same doctors as the Gold option, but with lower premiums and a higher deductible.

Silver Option

The Silver option may be the right choice for you if:

You want low per-paycheck contributions, i.e., premiums.

And

You don’t expect to use a lot of medical services, or you can easily afford an expense like an unexpected doctor’s visit or prescription.

And

You want to save money for healthcare expenses—including your deductible and coinsurance, as well as future needs—in a pretax Health Savings Account.

Your Cost

How much you’ll pay for a medical option is a three-component equation:

1 What you pay to have coverage	2 What you pay when you need care	3 What you save for future healthcare needs
Paycheck premiums	Copayments (Copays)	Deductible	Healthcare savings
Varies depending on ZIP code and coverage level	You must pay the total cost of your service until you reach the deductible	Employee only: $1,700 Family: $3,400	Health Savings Account annual limit¹ Employee only: $4,250 Family: $8,500
Your per-paycheck cost		Deductible: The amount you have to reach before the option shares the cost of your care Coinsurance: 25% Your percentage of the cost of care that is shared with the option after you meet the deductible	Pretax payroll contributions How you can cover your out-of-pocket costs, including your deductible and coinsurance, and unplanned healthcare needs Use it now, save for later, reinvest a portion or roll over the balance until retirement

What you pay to have coverage

What you pay when you need care

What you save for future healthcare needs

Paycheck premiums

Copayments (Copays)

Deductible

Healthcare savings

Varies depending on ZIP code and coverage level

You must pay the total cost of your service until you reach the deductible

Employee only: $1,700
Family: $3,400

Health Savings Account
annual limit¹
Employee only: $4,250
Family: $8,500

Your per-paycheck cost

Deductible: The amount you have to reach before the option shares the cost of your care
Coinsurance: 25%
Your percentage of the cost of care that is shared with the option after you meet the deductible

Pretax payroll contributions
How you can cover your out-of-pocket costs, including your deductible and coinsurance, and unplanned healthcare needs
Use it now, save for later, reinvest a portion or roll over the balance until retirement

¹A Dental and Vision FSA is also available

You might be wondering if the Silver option will serve your needs well if you have a lot of medical and prescription expenses. It will—when you maximize your HSA savings. Consider the example below, showing someone with $5,000 of medical expenses in a year under the Gold and Silver options.

Comparison of $5,000 Annual Expenses

Employee Only Coverage	Gold Option (PPO)	Silver Option (HDHP)
12 months of premiums	$2,470	$614
Annual deductible	$800	$1,700
Coinsurance	($5,000 – $800) * .20= $840	($5,000 – $1,700) * .25 = $825
Total spent Jan.-Dec.	$4,110	$3,139

In this example, if you’re enrolled in the Silver option, you could pay your annual deductible plus coinsurance using pretax contributions you’ve saved in your HSA throughout the year.

How does the Silver option work for Caroline¹?

January

Health event: Preventive exam (i.e., annual physical)

	Deductible Expense	Non-deductible Expense
Preventive visit	$ 0	$ 0
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 20
Year-to-date total Caroline spent	$20

March

Health event: Sinus infection diagnosis

	Deductible Expense	Non-deductible Expense
Preventive visit	$ 150
Rx: Tier 1 antibiotic	$ 45
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 215
Year-to-date total Caroline spent	$235

May

Health Event: Abnormal test follow up for diagnostic exam

	Deductible Expense	Non-deductible Expense
Specialist visit	$ 250
Lab test	$ 150
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 420
Year-to-date total Caroline spent	$655

July

Health Event: Cyst diagnosis and outpatient surgery

	Deductible Expense	Non-deductible Expense
Provider outpatient hospital facility visits	$ 905
25% coinsurance on remaining $345	$ 86.25
Rx: Tier 2 post-surgical narcotic	$ 18.75
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 1,030
Year-to-date total Caroline spent	$1,685

September

Health Event: Bicycle accident

	Deductible Expense	Non-deductible Expense
Provider and urgent care center visits	$ 218.75
Rx: Tier 2 antibiotics	$ 18.75
Physical therapy	$ 250
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 508
Year-to-date total Caroline spent	$2,193

November

Health Event: Strep throat

	Deductible Expense	Non-deductible Expense
Telemedicine consultation		$ 30
Rx: Tier 1 antibiotics	$ 6.25
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 56.25
Year-to-date total Caroline spent	$2,248.75

January 1

$0December 31

$0$1,700

Deductible: You Pay 100%

$4,250

Coinsurance: You Pay 25%, Plan Pays 75%

Plan Pays: 100%

Out-of-pocket Maximum $4,250

^I Fictional example. Any similarity to a real individual is unintended. Assumes employee only coverage; in-network care only.

Silver option features a “True Family” deductible. If you enroll in any coverage other than Employee only, the “Family” deductible must be met before cost-sharing begins for any covered individual.

Smart considerations

A Health Savings Account is available only with the Silver option because it is a high-deductible health plan (HDHP).

CONTRIBUTIONS

are pretax (so your gross pay is lower for tax purposes, too)

INTEREST

accrues untaxed

EXPENDITURES

for qualified expenses are tax-free

Bottom line: If you need predictability in cost or don’t want to save money in an HSA, the Silver option probably will not be a good fit.

Gold Option

The Gold option may be the right choice for you if:

You want a low annual deductible in exchange for higher premiums.

And

You like predictability—to know exactly what you’ll pay when you see a provider or fill a prescription, i.e., copayments (copays).

Your Cost

How much you’ll pay for a medical option is a three-component equation:

1 What you pay to have coverage	2 What you pay when you need care	3 What you save for future healthcare needs
Paycheck premiums	Copayments (Copays)	Deductible	Healthcare savings
Varies depending on ZIP code and coverage level	Primary: $25 Specialist: $40	Employee only: $800 Family: $1,600	Flexible Spending Account annual limit Employee only: $3,200
Your per-paycheck cost	How much you pay when you see a provider Copays do not count toward your deductible	Deductible: The amount you have to reach before the option shares the cost of your care Coinsurance: 20% Your percentage of the cost of care that is shared with the option after you meet the deductible	Pretax payroll contributions How you can cover your out-of-pocket costs, including medical and prescription copays; your deductible and coinsurance; and other planned and unplanned out-of-pocket healthcare needs

What you pay to have coverage

What you pay when you need care

What you save for future healthcare needs

Paycheck premiums

Copayments (Copays)

Deductible

Healthcare savings

Varies depending on ZIP code and coverage level

Primary: $25
Specialist: $40

Employee only: $800
Family: $1,600

Flexible Spending Account
annual limit
Employee only: $3,200

Your per-paycheck cost

How much you pay when you see a provider
Copays do not count toward your deductible

Deductible: The amount you have to reach before the option shares the cost of your care
Coinsurance: 20%
Your percentage of the cost of care that is shared with the option after you meet the deductible

Pretax payroll contributions
How you can cover your out-of-pocket costs, including medical and prescription copays; your deductible and coinsurance; and other planned and unplanned out-of-pocket healthcare needs

How does the Gold option work for Caroline¹?

January

Health event: Preventive exam (i.e., annual physical)

	Deductible Expense	Non-deductible Expense
Preventive visit	$ 0	$ 0
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 20
Year-to-date total Caroline spent	$20

March

Health event: Sinus infection diagnosis

	Deductible Expense	Non-deductible Expense
Preventive visit		$ 25
Rx: Tier 1 antibiotic		$ 10
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 55
Year-to-date total Caroline spent	$75

May

Health Event: Abnormal test follow up for diagnostic exam

	Deductible Expense	Non-deductible Expense
Specialist visit		$ 40
Lab test	$ 150
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 210
Year-to-date total Caroline spent	$285

July

Health Event: Cyst diagnosis and outpatient surgery

	Deductible Expense	Non-deductible Expense
Provider outpatient hospital facility visits	$ 1,250
Rx: Tier 2 post-surgical narcotic		$ 40
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 1,310
Year-to-date total Caroline spent	$1,595

September

Health Event: Bicycle accident

	Deductible Expense	Non-deductible Expense
Provider and urgent care center visits	$ 875
Rx: Tier 2 antibiotics		$ 40
Physical therapy		$ 640
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 1,575
Year-to-date total Caroline spent	$3,170

November

Health Event: Strep throat

	Deductible Expense	Non-deductible Expense
Telemedicine consultation		$ 30
Rx: Tier 1 antibiotics		$ 10
Over-the-counter (OTC) allergy meds		$ 20
Total Caroline spent this month		$ 60
Year-to-date total Caroline spent	$3,230

January 1

$0December 31

$0$800

Deductible: You Pay 100%

$3,600

Coinsurance: You Pay 20%, Plan Pays 80%

Plan Pays: 100%

Out-of-pocket Maximum $3,600

^I Fictional example. Any similarity to a real individual is unintended. Assumes employee only coverage; in-network care only.

Smart considerations

Gold vs. Gold II—California

California has two Gold options. The Gold II option is an HMO with only in-network benefits.

	Gold	Gold II
PREVENTIVE CARE	100% covered	100% covered
COPAYMENT (COPAY) Primary physician / Specialist	$25 / $40	$25 / $40
DEDUCTIBLE Employee only / Family	$800 / $1,600	None
COINSURANCE	20%	30%
out-of-pocket maximum	$3,600 / $7,200	$5,400 / $10,800
HEALTHCARE ACCOUNT	Flexible Spending Account optional Health Savings Account not available	Flexible Spending Account optional Health Savings Account not available
PRESCRIPTION
Tier 1 Tier 2 Tier 3	$10 $40 $60	$10 $40 $60
MEDICAL OPTION	Preferred Provider Organization (PPO)	Health Maintenance Organization (HMO) Only in-network benefits

Notes: In-network rates shown only. PCP is your primary care physician. Deductible and out-of-pocket maximum listed as Employee only / Family.

Platinum Option

The Platinum option may be the right choice for you if:

You don’t mind paying the highest premiums.

And

You like the predictability of copayments when you see a provider or fill a prescription.

Your Cost

How much you’ll pay for a medical option is a three-component equation:

1 What you pay to have coverage	2 What you pay when you need care	3 What you save for future healthcare needs
Paycheck premiums	Copayments (Copays)	Deductible	Healthcare savings
Varies depending on ZIP code and coverage level	Primary: $25 Specialist: $40	Employee only: $250 Family: $500	Flexible Spending Account annual limit Employee only: $3,200
Your per-paycheck cost	How much you pay when you see a provider Copays do not count toward your deductible	Deductible: The amount you have to reach before the option shares the cost of your care Coinsurance: 15% Your percentage of the cost of care that is shared with the option after you meet the deductible	Pretax payroll contributions How you can cover your out-of-pocket costs, including medical and prescription copays; your deductible and coinsurance; and other planned and unplanned out-of-pocket healthcare needs

What you pay to have coverage

What you pay when you need care

What you save for future healthcare needs

Paycheck premiums

Copayments (Copays)

Deductible

Healthcare savings

Varies depending on ZIP code and coverage level

Primary: $25
Specialist: $40

Employee only: $250
Family: $500

Flexible Spending Account
annual limit
Employee only: $3,200

Your per-paycheck cost

How much you pay when you see a provider
Copays do not count toward your deductible

Deductible: The amount you have to reach before the option shares the cost of your care
Coinsurance: 15%
Your percentage of the cost of care that is shared with the option after you meet the deductible

Pretax payroll contributions
How you can cover your out-of-pocket costs, including medical and prescription copays; your deductible and coinsurance; and other planned and unplanned out-of-pocket healthcare needs

Smart considerations

Comparing plans

	Bronze Plus	Gold	Platinum	Silver
PREVENTIVE CARE	100% covered	100% covered	100% covered	100% covered
PREMIUMS Rates depend on ZIP code and coverage level	$	$$	$$$	$
COPAYMENT PCP / Specialist	$30 / $50	$25 / $40	$25 / $40	You pay the cost of visit until deductible is met
URGENT CARE	$50	$40	$25	None
DEDUCTIBLE Employee only / Family	$2,300 / $4,600	$800 / $1,600	$250 / $500	$1,700 / $3,400
COINSURANCE	30%	20%	15%	25%
Out-of-pocket maximum	$6,700 / $13,400	$3,600 / $7,200	$2,300 / $4,600	$4,250 / $8,500
HEALTHCARE ACCOUNTS Flexible Spending Account Health Savings Account	FSA optional HSA not available	FSA optional HSA not available	FSA optional HSA not available	Dental and vision FSA optional HSA available
PRESCRIPTION Copayment
Tier 1 Tier 2 Tier 3	$12 $60 $80	$10 $40 $60	$8 $30 $50	No copayments 25% after deductible

In-network rates shown only.
Deductible and out-of-pocket maximum listed as Employee only / Family.
Silver option features a “True Family” deductible, which means that under Family coverage you must meet the full deductible before the option begins sharing cost for any covered person.
Notes for CA employees: Certain carriers in California may be an exception, depending on ZIP code. California has an additional Gold option. See comparison of Gold and Gold II.

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Medical

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May

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September

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January

March

May

July

September

November

Smart considerations

CONTRIBUTIONS

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EXPENDITURES

January

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July

September

November

Smart considerations

Gold vs. Gold II—California

Smart considerations

Comparing plans

I’m not feeling well, where should I go?

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Smart considerations

January

March

May

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September

November

Smart considerations

CONTRIBUTIONS

INTEREST

EXPENDITURES

January

March

May

July

September

November

Smart considerations

Gold vs. Gold II—California

Smart considerations

Comparing plans

I’m not feeling well, where should I go?

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