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Medical Claims Examples

These examples can help you find the right Bloomin’ Brands medical plan.

Choosing the right plan

The illustrative claim examples below can help you get a feel for the impact of paycheck contributions and your share of typical out-of-pocket expenses for the various plan options.

Choice HSAValue HSAChoice HRAValue HRA
Annual deductible$2,500$4,300$5,000$6,550
Annual paycheck contributions$1,616.42$1,346.80$1,136.46$1,121.38
1 preventive office visit$0$0$0$0
1 primary care doctor visit$208$208$208$208
1 teladoc visit$55$55$55$55
Subtotal$1,879.42$1,609.80$1,399.46$1,384.38
Tax-advantaged account money-$400-$400-$400-$400
Total expenses$1,479.42$1,209.80$999.46$984.38

Choice HSAValue HSAChoice HRAValue HRA
Annual deductible$2,500$4,300$5,000$6,550
Annual paycheck contributions$1,616.42$1,346.80$1,136.46$1,121.38
1 preventive office visit$0$0$0$0
2 primary care doctor visits$416$416$416$416
2 teladoc visits$110$110$110$110
1 outpatient surgery$560$560$560$560
Subtotal$2,702.42$2,432.80$2,222.46$2,207.38
Tax-advantaged account money-$400-$400-$400-$400
Total expenses$2,302.42$2,032.80$1,822.46$1,807.38

Choice HSAValue HSAChoice HRAValue HRA
Annual deductible$5,000$8,600$10,000$13,100
Annual paycheck contributions$5,415.80$4,822.74$4,359.94$4,326.92
2 preventive office visits$0$0$0$0
5 primary care doctor visits$1,040$1,040$1,040$1,040
2 teladoc visits$110$110$110$110
1 outpatient surgery$560$560$560$560
1 emergency room visit$3,076$3,102$3,102$3,102
Subtotal$10,201.80$9,634.74$9,171.94$9,138.92
Tax-advantaged account money-$550-$550-$550-$550
Total expenses$9,651.80$9,084.74$8,621.94$8,588.92

Choice HSAValue HSAChoice HRAValue HRA
Annual deductible$5,000$8,600$10,000$13,100
Annual paycheck contributions$7,432.88$6,624.28$5,993$5,947.76
4 preventive office visits$0$0$0$0
5 primary care doctor visits$1,040$1,040$1,040$1,040
5 teladoc visits$385 $385 $385 $385
Subtotal$8,857.88$8,049.28$7,418$7,372.76
Tax-advantaged account money-$950-$950-$950-$950
Total expenses$7,907.88$7,099.28$6,468$6,422.76

Team Member Benefits

Learn more about the benefits available to eligible Team Members. Select the benefits category that matches your position.
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