Health Plan Medical Scenarios

You told us you wanted to know the costs for common medical procedures and how they play out across the three health plan options, in order to help you better compare values.

We have heard you! This year, you can see six common medical scenarios that UVA employees experience, according to Aetna. Each situation provides estimates for what you would pay for each service (keep in mind that the real costs depend on the services you receive and how the doctor or health care facility bills Aetna). The scenarios use different tiers: employee only, employee + spouse, employee + child, and family.

Annual Premiums Included

To see the bigger picture, you'll also want to consider your annual premium. If each scenario was the ONLY medical event you had in a year, you can see what your total estimated out-of-pocket cost would be for the year. The premiums used in these scenarios apply to full-time faculty, classified staff, Medical Center team members, post-doctoral research associates, senior professional research staff, and University staff.

Create Your Own Scenarios

Of course, most people will touch the health care system more than once in a year. To find out what multiple medical events would cost you in a year for each of the three health plan options, the Aetna One Advocate team can provide you with specific cost estimates based on your own circumstances. See their contact information at the bottom of this page and also on the right sidebar.

Aetna Tools: Visit the Aetna website and click on “Log in/Register” to access these resources:

Aetna Navigator: Offers a Find Care & Pricing tool option. This compares costs to give you real-time, personalized estimates and provides average in-network and out-of-network costs
Custom Doctor Find: Confirms whether providers are in-network
Aetna Institute of Quality List: Lists IOQ facilities

How You Share Costs With the UVA Health Plan

The below illustration explains how your health care out-of-pocket costs change as you reach your deductible and your out-of-pocket limit:

Health plan cost share illustration

Common Medical Scenarios

Inpatient Hospital Services - Traditional Delivery of Baby

Emily is having a baby. The estimates below include an uncomplicated vaginal delivery without sterilization, and a hospital stay of three nights for Emily and her baby. Emily and her newborn are the only people covered by her health plan option.

These estimates include the deductible and coinsurance limits for Emily and baby. With the inclusion of the baby's estimated costs and associated deductible and coinsurance limits, the estimate you see here may appear higher than the deductible and coinsurance limits listed in the medical plan details. Check your plan benefits for specific details.

Here are Emily's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

Basic Health	Value Health	Choice Health
DEDUCTIBLE - Employee Only: $2,000	DEDUCTIBLE - Individual Only: $800	DEDUCTIBLE - Individual Only: $500
DEDUCTIBLE - Employee + Dependent: $4,000	DEDUCTIBLE - Family: $1,600	DEDUCTIBLE - Family: $1,000
COINSURANCE: 20%	COINSURANCE: 20%	COINSURANCE: 15%
MAXIMUM OUT-OF-POCKET - Individual Only: $5,500	MAXIMUM OUT-OF-POCKET - Individual Only: $5,500	MAXIMUM OUT-OF-POCKET - Individual Only: $5,500
MAXIMUM OUT-OF-POCKET - Family: $11,000	MAXIMUM OUT-OF-POCKET - Family: $11,000	MAXIMUM OUT-OF-POCKET - Family: $11,000
ANNUAL PREMIUM - Employee Only (before birth): $240 ANNUAL PREMIUM - Employee + Child (after birth): $303 HSA Offset - Employee Only: -$1,000	ANNUAL PREMIUM - Employee Only (before birth): $1,050 ANNUAL PREMIUM - Employee + Child (after birth): $1,683	ANNUAL PREMIUM - Employee Only (before birth): $2,196 ANNUAL PREMIUM - Employee + Child (after birth): $4,443

Here are cost estimates for Emily's delivery.

These estimates below presume no prior deductible was met
The estimates are for in-network providers only
The estimates are for inpatient hospital service
Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted.

Emily's Costs:

Cost Breakdown	Basic Health	Value Health	Choice Health
Cost of Service for Emily	$16,045.09	$16,045.09	$16,045.09
Aetna member rate	$10,527.11	$10,527.11	$10,527.11
Emily's deductible	$4,000.00	$800.00	$500.00
Emily's coinsurance	$1,305.42	$1,945.42	$1,504.07
Total cost for Emily	$5,305.42	$2,745.42	$2,004.07

Newborn's Costs:

Cost Breakdown	Basic Health	Value Health	Choice Health
Cost of Service for Newborn	$8,346.74	$8,346.74	$8,346.74
Aetna member rate	$7,690.00	$7,690.00	$7,690.00
Newborn's deductible	$0.00**	$800.00	$500.00
Newborn's coinsurance	$1,538.00	$1,378.00	$1,078.50
Total cost for Newborn	$1,538.00	$2,178.00	$1,578.50
Total Cost for Emily and Newborn	$6,843.42	$4,923.42	$3,582.57

** No deductible for newborn; Emily has already met the family deductible.

Total Costs and Annual Premiums: Factoring in annual premiums, Emily's projected costs for the year she delivers a new baby would be:

Total Projected Costs	Basic Health	Value Health	Choice Health
Total Cost for Emily + Newborn	$6,843.42	$4,923.42	$3,582.57
Annual Premium, Employee + Child	303.00	$1,683.00	$4,443.00
HSA (Basic Health only)***	($1,000.00)	$0.00	$0.00
Emily and Newborn's Total Cost + Premium***	$6,146.42	$6,606.42	$8,025.57

*** Emily was Employee Only prior to her baby being born; her HSA employer contribution would be for Employee Only as of the beginning of the year, and her premiums would change to Employee + Child level with her Qualifying Life Event.

These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:

Payment Estimator: Compares costs to give you real-time, personalized estimates
Cost of Care Estimator: Provides average in-network and out-of-network costs

Imaging Services - Foot X-ray

Bella lives by herself, and recently injured her foot and needs help figuring out what to do about it. The estimates below include a complete foot x-ray, with a minimum of three views. Some facilities may charge an additional fee for the radiologist to read the x-ray. Check your plan benefits for more details.

Here are Bella's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

Basic Health	Value Health	Choice Health
DEDUCTIBLE - Employee Only: $2,000	DEDUCTIBLE - Individual Only: $800	DEDUCTIBLE - Individual Only: $500
COINSURANCE: 20%	COINSURANCE: 20%	COINSURANCE: 15%
MAXIMUM OUT-OF-POCKET - Individual Only: $5,500	MAXIMUM OUT-OF-POCKET - Individual Only: $5,500	MAXIMUM OUT-OF-POCKET - Individual Only: $5,500
ANNUAL PREMIUM - Employee Only: $240 HSA Offset - Employee Only: -$1,000	ANNUAL PREMIUM - Employee Only: $1,050	ANNUAL PREMIUM - Employee Only: $2,196

Here are cost estimates for Bella's foot x-rays.

These estimates below presume no prior deductible was met
The estimates are for in-network providers only
The estimates are for non-preventive x-ray procedure
Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted.

Bella's Costs:

Cost Breakdown	Basic Health Employee Only	Value Health	Choice Health
Cost of Service for Bella	$725.00	$725.00	$725.00
Aetna member rate	$593.00	$593.00	$593.00
Bella's deductible	$593.00	$593.00	$500.00
Bella's coinsurance	$0.00	$0.00	$13.95
Total cost for Bella	$593.00	$593.00	$513.95

Total Costs and Annual Premiums: Factoring in annual premiums, Bella's projected costs for the year she injures her foot would be:

Total Projected Costs	Basic Health	Value Health	Choice Health
Total Cost for Bella	$593.00	$593.00	$513.95
Annual Premium, Employee Only	$240.00	$1,050.00	$2,196.00
HSA (Basic Health only)	($1,000.00)	$0.00	$0.00
Bella's Total Cost + Premium	$0.00	$1,643.00	$2,709.95

These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:

Payment Estimator: Compares costs to give you real-time, personalized estimates
Cost of Care Estimator:Provides average in-network and out-of-network costs

Type 1 Diabetes Continuous Glucose Monitor

Mark's family is very concerned for him, as he just found out he has Type 1 diabetes. His doctor has prescribed a continuous glucose monitor for him. The estimates below include a continuous glucose monitor, receive, transmitter, and sensor, purchased through an in-network Durable Medical Equipment supplier. Check your plan benefits for more details.

Here are Mark's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

Basic Health	Value Health	Choice Health
DEDUCTIBLE - Employee Only: $2,000	DEDUCTIBLE - Individual Only: $800	DEDUCTIBLE - Individual Only: $500
DEDUCTIBLE - Employee + Dependent: $4,000	DEDUCTIBLE - Family: $1,600	DEDUCTIBLE - Family: $1,000
COINSURANCE: 20%	COINSURANCE: 20%	COINSURANCE: 15%
MAXIMUM OUT-OF-POCKET - Individual Only: $5,500	MAXIMUM OUT-OF-POCKET - Individual Only: $5,500	MAXIMUM OUT-OF-POCKET - Individual Only: $5,500
MAXIMUM OUT-OF-POCKET - Family: $11,000	MAXIMUM OUT-OF-POCKET - Family: $11,000	MAXIMUM OUT-OF-POCKET - Family: $11,000
ANNUAL PREMIUM - Family: $756 HSA Offset - Family: -$1,500	ANNUAL PREMIUM - Family: $3,387	ANNUAL PREMIUM - Family: $8,472

Here are cost estimates for Mark's continuous glucose monitor, receive, transmitter, and sensor.

These estimates below presume no prior deductible was met
The estimates are for in-network providers only
The estimates are for Durable Medical Equipment service
Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted.

Mark's Costs:

Cost Breakdown	Basic Health Employee Only	Basic Health Employee + Dependent(s)	Value Health	Choice Health
Cost of Service for Mark	$3,522.61	$3,522.67	$3,522.67	$3,522.67
Aetna member rate	$1,700.00	$1,700.00	$1,700.00	$1,700.00
Mark's deductible	$1,700.00	$1,700.00	$800.00	$500.00
Mark's coinsurance	$0.00	$0.00	$180.00	$180.00
Total cost for Mark	$1,700.00	$1,700.00	$980.00	$680.00

Total Costs and Annual Premiums: Factoring in annual premiums, Mark's projected costs for the year he is diagnosed with Type 1 diabetes would be:

Total Projected Costs	Basic Health Employee only	Basic Health Family	Value Health	Choice Health
Total Cost for Mark	$1,700.00	$1,700.00	$980.00	$680.00
Annual Premium	$240.00	$756.00	$3,387.00	$8,472
HSA (Basic Health only)	($1,000.00)	($1,500.00)	$0.00	$0.00
Mark's Total Cost + Premium	$940.00	$956.00	$4,367.00	$9,152.00

These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:

Payment Estimator: Compares costs to give you real-time, personalized estimates
Cost of Care Estimator: Provides average in-network and out-of-network costs

Physical Therapy Services - Back Pain

Robert and his wife Claire are on the UVA Health Plan, and Claire encouraged Robert to seek medical advice for a nagging back pain he hasn't been able to heal. His primary care physician recommends that Robert start physical therapy on his back immediately.

The estimates below are for physical therapy, therapeutic procedure, one or more areas. Check your plan benefits for more details.

Here are Robert's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

Basic Health	Value Health	Choice Health
DEDUCTIBLE - Employee Only: $2,000	DEDUCTIBLE - Individual Only: $800	DEDUCTIBLE - Individual Only: $500
DEDUCTIBLE - Employee + Dependent: $4,000	DEDUCTIBLE - Family: $1,600	DEDUCTIBLE - Family: $1,000
COINSURANCE: 20%	COINSURANCE: 20%	COINSURANCE: 15%
MAXIMUM OUT-OF-POCKET - Individual Only: $5,500	MAXIMUM OUT-OF-POCKET - Individual Only: $5,500	MAXIMUM OUT-OF-POCKET - Individual Only: $5,500
MAXIMUM OUT-OF-POCKET - Family: $11,000	MAXIMUM OUT-OF-POCKET - Family: $11,000	MAXIMUM OUT-OF-POCKET - Family: $11,000
ANNUAL PREMIUM - Employee + Spouse: $399 HSA Offset - Employee + Spouse: -$1,500	ANNUAL PREMIUM - Employee + Spouse: $2,115	ANNUAL PREMIUM - Employee + Spouse: $5,724

Here are cost estimates for Robert's physical therapy on his back; this is a per visit estimate.

These estimates below presume no prior deductible was met
The estimates are for in-network providers only
The estimates are for physical therapy, therapeutic procedure, one or more areas
Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted.

Robert's Costs:

Cost Breakdown	Basic Health Employee + Dependent(s)	Value Health	Choice Health
Cost of Service for Robert	$281.48	$281.48	$281.48
Aetna member rate	$88.48	$88.48	$88.48
Robert's deductible	$88.48	$0.00	$88.48
Robert's coinsurance	$0.00	$0.00	$0.00
Robert's copayment	N/A	$40.00	N/A
Total cost for Robert	$88.48	$40.00	$88.48

Total Costs and Annual Premiums: Factoring in annual premiums, Robert's projected costs for the year he has back pain and seeks physical therapy would be:

Total Projected Costs	Basic Health	Value Health	Choice Health
Total Cost for Robert	$88.48	$40.00	$88.48
Annual Premium, Employee + Spouse	$399.00	$2,115.00	$5,724.00
HSA (Basic Health only)	($1,500.00)	$0.00	$0.00
Robert's Total Cost + Premium	$0.00	$2,155.00	$5,812.48

These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:

Payment Estimator: Compares costs to give you real-time, personalized estimates
Cost of Care Estimator: Provides average in-network and out-of-network costs

Professional Services In office -Medical Visit

Ken hasn't been feeling well lately, and decides to visit his primary care physician to discover what is troubling his body.

The estimates below are for a typical primary care established patient office visit. A typical office visit at your primary care physician's office would entail just the cost of the visit itself for low to moderate severity problems. Check your plan benefits for more details.

Here are Ken's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

*Mental Health outpatient treatment office visit offer the same member cost-share as Primary Care provider office visits.

Basic Health	Value Health	Choice Health
DEDUCTIBLE - Employee Only: $2,000	DEDUCTIBLE - Individual Only: $800	DEDUCTIBLE - Individual Only: $500
COINSURANCE: 20%	COINSURANCE: 20%	COINSURANCE: 15%
MAXIMUM OUT-OF-POCKET - Individual Only: $5,500	MAXIMUM OUT-OF-POCKET - Individual Only: $5,500	MAXIMUM OUT-OF-POCKET - Individual Only: $5,500
ANNUAL PREMIUM - Employee Only: $240 HSA Offset - Employee Only: -$1,000	ANNUAL PREMIUM - Employee Only: $1,050	ANNUAL PREMIUM - Employee Only: $2,196

Here are cost estimates for Ken's primary care physician office visit.

These estimates below presume no prior deductible was met
The estimates are for in-network providers only
The estimates are for a typical primary care established patient office visit
Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted.

Ken's Costs:

Cost Breakdown	Basic Health Employee Only	Value Health	Choice Health
Cost of Service for Robert	$195.00	$195.00	$195.00
Aetna member rate	$165.91	$165.91	$165.91
Ken's deductible	$165.91	$0.00	$165.91
Ken's coinsurance	$0.00	$0.00	$0.00
Ken's copayment	N/A	$40.00	N/A
Total cost for Ken	$165.91	$40.00	$165.91

Total Costs and Annual Premiums: Factoring in annual premiums, Ken's projected costs for the year he visits his primary care physician would be:

Total Projected Costs	Basic Health	Value Health	Choice Health
Total Cost for Ken	$165.91	$40.00	$165.91
Annual Premium, Employee Only	$240.00	$1,050.00	$2,196.00
HSA (Basic Health only)	($1,000.00)	$0.00	$0.00
Ken's Total Cost + Premium	$0.00	$1,090.00	$2,361.91

These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:

Payment Estimator: Compares costs to give you real-time, personalized estimates
Cost of Care Estimator: Provides average in-network and out-of-network costs

Total Knee Replacement

Tim's right knee had been bothering him for a long time, and he finally decided to have it replaced. His total knee replacement includes most typical services, from admission to discharge, but does not include physical therapy after his knee replacement. Charges may vary greatly depending on the type of implant Tim receives.

Here are Tim's possible deductible, coinsurance, maximum out-of-pocket cost, and annual premiums, depending on health plan option. Included also is the HSA employee contribution for Basic Health participants.

Basic Health	Value Health	Choice Health
DEDUCTIBLE - Employee Only: $2,000	DEDUCTIBLE - Individual Only: $800	DEDUCTIBLE - Individual Only: $500
COINSURANCE: 20%	COINSURANCE: 20%	COINSURANCE: 15%
MAXIMUM OUT-OF-POCKET - Individual Only: $5,500	MAXIMUM OUT-OF-POCKET - Individual Only: $5,500	MAXIMUM OUT-OF-POCKET - Individual Only: $5,500
ANNUAL PREMIUM - Employee Only: $240 HSA Offset - Employee Only: -$1,000	ANNUAL PREMIUM - Employee Only: $1,050	ANNUAL PREMIUM - Employee Only: $2,196

Here are cost estimates for Tim's total knee replacement.

These estimates below presume no prior deductible was met
The estimates are for in-network providers only
The estimates are for in-patient hospital services
The estimates are for a typical primary care established patient office visit
Your real costs will depend on the services you receive and how Aetna is billed by the doctor or health care facility
We cannot guarantee the accuracy of any cost or estimate, as they can change without notification
This information is solely for use in evaluating and estimating the out-of-pocket costs for services by a doctor or facility
Basic Health members are responsible for the balance of their deductible and out of pocket expenses if/when the HSA funds have exhausted.

Tim's Costs:

Cost Breakdown	Basic Health Employee Only	Value Health	Choice Health
Cost of Service for Tim	$77,011.11	$77,011.11	$77,011.11
Aetna member rate	$17,717.77	$17,717.77	$17,717.77
Tim's deductible	$2,000.00	$800.00	$500.00
Tim's coinsurance	$3,143.55	$3,383.55	$2,582.67
Tim's copayment	N/A	$40.00	N/A
Total cost for Tim	$5,143.55	$4,183.55	$3,082.67

Total Costs and Annual Premiums: Factoring in annual premiums, Tim's projected costs for the year he has a total knee replacement would be:

Total Projected Costs	Basic Health	Value Health	Choice Health
Total Cost for Tim	$5,143.55	$4,183.55	$3,082.67
Annual Premium, Employee Only	$240.00	$1,050.00	$2,196.00
HSA (Basic Health only)	($1,000.00)	$0.00	$0.00
Tim's Total Cost + Premium	$4,383.55	$5,233.55	$5,278.67

These scenarios are pulled from Aetna's database. If you would like to create your own scenarios, visit Aetna’s website and click on “Log in/Register” to access these resources:

Payment Estimator: Compares costs to give you real-time, personalized estimates
Cost of Care Estimator: Provides average in-network and out-of-network costs

Enjoy these NEW personal video stories about why each of the HR team members made the choices they did during Open Enrollment, whether they're considering which health plan option to use, wanting to know what options are available for mental health needs, thinking about taking advantage of the Dependent Daycare FSA, or wanting to explore adding additional life insurance coverage.