Scenarios comparing out-of-pocket expenses with Group Health and KingCare^SM (Aetna)

The following scenarios of medical care compare the estimated out-of-pocket expenses for a range of medical care use under the county's Group Health and KingCare^SM (Aetna) plans. To get the most of this comparison tool in helping you make your medical plan decision for 2010, look for the scenario or combination of scenarios that most reflect your use of medical care. For KingCare^SM (Aetna), estimated expenses assume that services have been provided by a network provider at a cost around the midpoint of possible charges—estimated expenses may vary depending on the provider and treatment. For Group Health, expenses assume that services have been provided by a Group Health provider.

Scenario 1—Coverage for employee only 

An employee has one physician office visit and one inpatient hospital stay in 2010. The employee fills one generic drug and one preferred brand drug monthly at a local pharmacy and fills another generic drug and another preferred brand drug every three months through mail-order.

Scenario 2—Coverage for employee only

An employee has one preventive care visit, six physician office visits and one emergency room visit in 2010. The employee fills one generic drug and two preferred brand drugs monthly at a local pharmacy and fills another generic drug and another two preferred brand drugs every three months through mail-order.

Scenario 3—Coverage for employee and spouse/domestic partner

An employee has one physician office visit and the covered spouse/domestic partner has two physician office visits in 2010. The spouse/domestic partner has an operation with a stay at a local hospital. The employee fills one generic drug monthly at a local pharmacy and fills another generic drug every three months through mail-order. The spouse/domestic partner fills one preferred brand drug monthly at a local pharmacy and fills another preferred brand drug every three months through mail-order.

Scenario 4—Coverage for employee, spouse/domestic partner and one child

An employee has one physician office visit, the covered spouse/domestic partner has two physician office visits and the covered child has three physician office visits in 2010. The child has an operation with a stay at a local hospital. The employee fills one generic drug monthly at a local pharmacy and fills another generic drug every three months through mail-order. The spouse/domestic partner fills one preferred brand drug monthly at a local pharmacy and fills another preferred brand drug every three months through mail-order.

Scenario 5—Coverage for employee, spouse/domestic partner and one child, plus one newborn

An employee has one physician office visit, the covered spouse/domestic partner has two physician office visits and the covered child has three physician office visits in 2010. The spouse/domestic partner gives birth at a local hospital. The employee fills one generic drug monthly at a local pharmacy and fills another generic drug every three months through mail-order. The spouse/domestic partner fills one preferred brand drug monthly at a local pharmacy and fills another preferred brand drug every three months through mail-order.