The Employment Commons: Which Health Plan Is Right For Me?

Shopping for health insurance can be hard, but at Opolis, we make it easy.

If you’re reading this, you’ve probably started doing research into your health insurance options for the upcoming year. You may have heard about Opolis’ Employment Commons through a freelancing friend and thought, “This seems interesting- I can finally get a plan that travels with me from job to job?” You’re in the right place!

Now comes the hardest part of the process — picking which plan is right for you. Opolis’ Employment Commons currently offers three different plan types with several tiers under each plan. Before you sign up on our website, explore your options. If you need help or want to talk to a member specialist, book a call at a time that best suits your schedule.

Opolis’ plans offer different levels of coverage, and one might better suit your needs depending on your circumstances. No matter which tier you choose, these plans all offer the same essential health benefits. The difference between them is how much you’ll pay for care versus how much your plan will cover.

Gold 500 FSA + Vision

• Best option for people who manage a chronic health condition, take brand-name drugs, or have an upcoming procedure.
• Highest premium, lowest deductible, moderate out-of-pocket limit.
• Low copays for basic doctor visits, labs, urgent care, telehealth visits, and generic/preferred-brand drugs.
• Flexible Spending Account (FSA) eligible.

Silver 4250 HSA + Vision

• Great option for generally healthy people who expect to get routine care throughout the year and have generic drug prescriptions.
• Moderate premium, moderate deductible, low out-of-pocket limit.
• Copays for basic doctor visits, labs, urgent care, and generic/preferred-brand drugs are covered completely after meeting your deductible.
• Health Savings Account (HSA) eligible.

Bronze 5000 HSA + Vision

• Great option for healthy people who don’t see the doctor often and only take generic prescriptions.
• Low premium, higher deductible, moderate out-of-pocket limit.
• Low urgent care and telehealth copays before you hit your deductible, then you pay full negotiated rates until you hit your deductible.
• Health Savings Account (HSA) eligible.

Here are some terms you should know when choosing a plan:

• Deductible: This is the amount you must pay each calendar year before the plan begins to pay for certain benefits.
• Co-payment/Copay: This is the fee you must pay under your plan each time you go to a doctor or hospital for certain
• services. A copay is also required for prescription drugs.
• Co-Insurance: This is the percentage of cost that you pay for covered services after you have met the deductible.
• Out-of-Pocket Max (Limit): The plan limits the amount of money you will have to pay each year for covered expenses. Once you reach this dollar limit, the plan generally pays 100% of eligible expenses for the rest of the calendar year.

You’ll also want to know the difference between a PPO plan and an HDHP plan:

• PPO Plans: A PPO plan provides both in and out of network coverage, however, you save the most money when you seek services from an in-network provider. A PPO plan covers preventive care at 100% resulting in no out-of pocket costs to you. The most commonly used services, such as office visits, urgent care, and prescription drugs are not subject to the deductible.
• HDHP Plans: A HDHP (High Deductible Health Plan) provides both in-and out-of-network benefits, similar to a PPO plan, however, you must meet your deductible before insurance will begin to pay for covered services, except for preventive care which is covered at 100%. The HDHP option is a qualified plan for a Health Savings Account (HSA).

And finally, understanding the difference between an HSA and an FSA might be helpful too:

• A Health Savings Account (HSA) is an individually-owned, tax-advantaged account that you can use to pay for current or future IRS qualified medical expenses. With an HSA, you’ll have the potential to build more savings for healthcare expenses or additional retirement savings through self-directed investment options.
• A Flexible Spending Accounts (FSAs) allows employees to use pretax dollars for healthcare and/or child and dependent care expenses not covered by insurance plans. Employees contribute a portion of each paycheck to an FSA and save on taxes. Money in an FSA can be used to pay for out-of pocket medical, dental and vision expenses or dependent care expenses. The FSA Plan Year is January 1st through December 31st. The funds are subject to the “use it or lose it” rule. The Employment Commons offers two Health Flexible Spending Accounts: Healthcare FSA and Limited Purpose FSA, and also a third type called Dependent Care FSA.

Ready to access the benefits you need? Get a quote and enroll on our website.