How Aqua Might Work for You.
Aqua Family Policy.
Harry and Maria are both employed but this is the first time that they were able to buy health insurance through Maria’s employer, a small business. They and their two sons enroll in the Aqua family plan and Maria’s share of her monthly premium is automatically deducted from her paycheck.
They began the year with a $500 Aqua Health and Wellness Card and a $1,000 Aqua Allowance.
Health Expenses – Year One
Maria controls her diabetes by regular visits to her physician and medication:
- Office visits every other month – $60 a visit ($360 total).
- Lab work – $100
- Generic medication – $30, 4 times a year ($120 total).
Maria & Harry’s sons get each get their well child check-ups and one had an ear infection requiring an antibiotic:
- Office visit for ear infection – $60 a visit ($60 total).
- Well Child Visits – $80 each ($160 total).
- Generic antibiotics – $20.
Harry prides himself on being in great shape. This year he had an emergency appendectomy, which sent him to the hospital:
- Gym Membership – $500.
- Emergency appendectomy in-network hospitalization – $8,000.
- Office visits and lab work – $600.
- Generic medications – $20 each ($40 total).
Harry and Maria’s medical expenses were $1600 for the entire year – $1,000 was covered by the Aqua Allowance and they paid $600 out of their own pocket. They have to meet a $1,000 deductible for medical expenses under their plan after their Aqua Allowance is used up – $600 goes toward the $1,000 deductible.
Benefits Utilized |
Purpose |
Cost |
Covered By |
Coverage |
Subscriber Pays |
Balance Remaining (Aqua Health and Wellness Card) |
Balance Remaining (Aqua Allowance |
Start of Year |
N/A |
N/A |
N/A |
N/A |
$0 |
$500 |
$1,000 |
Gym Membership |
Wellness |
$500 |
Aqua Wellness Card |
100% ($500) |
$0 |
$0 |
$1,000 |
Office Visits |
Maria's Checkups (6) |
$360 |
Aqua Allowance |
100% ($360) |
$0 |
$0 |
$640 |
Diabetes Lab Work |
Maria's Lab Work |
$100 |
Aqua Allowance |
100% ($100) |
$0 |
$0 |
$540 |
Pharmacy Expenses |
Maria's Generic Medication (Mail Order, x4) |
$120 |
Aqua Pharmacy Benefit |
Mail Order Generic Prescription = $17.50 for 90 days |
$70 |
$0 |
$540 |
Office Visit |
Boy's Ear Infection |
$60 |
Aqua Allowance |
100% ($60) |
$0 |
$0 |
$480 |
Pharmacy Expenses |
Boy's Generic Medication |
$20 |
Aqua Pharmacy Benefit |
Generic Prescription = $7 each |
$7 |
$0 |
$480 |
Hospitalization |
Harry's Appendectomy |
$8,000 |
Aqua Hospital Benefit |
100% ($8,000) |
$0 |
$0 |
$0 |
Office Visits and Lab Work |
Harry's Treatment |
$600 |
Aqua Deductible |
$0 |
$600 |
$0 |
$0 |
Well Child Visits |
Visits for Boys |
$160 |
Aqua Well Child Benefit |
100% ($160) |
$0 |
$0 |
$0 |
Pharmacy Expenses |
Harry's Generic Medication |
$40 |
Aqua Pharmacy Benefit |
Generic Prescription = $7 each |
$14 |
$0 |
$0 |
Start of Year Two |
N/A |
N/A |
N/A |
N/A |
$0 |
$500 |
$1,000 |
Covered by Aqua Health and Wellness Card |
|
Covered by Aqua Allowance |
|
Covered by Aqua Pharmacy Benefit |
|
| Covered by Aqua Hospital Benefit | |
| Aqua Dedcuctibles paid by Policyholder |
*Note – the dollar amounts used are for illustration purposes only. They do not reflect the discounted rates for in-network services.
