| Use this work sheet to compare the costs of health insurance plans. |
Plan A |
Plan B |
Plan C |
| 1. What is the annual deductible? |
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For an individual
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For a family
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| 2. What is the annual premium?
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For an individual
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For individual and spouse
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For individual and family
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For a family
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3. What is your co-payment each time you use a service?
(To estimate your annual cost, multiply the co-payment
by the number
of times you expect to use the service
during the plan year.)
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Physician visit co-payment
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Hospital visit co-payment
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Prescription co-payment
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Other services co-payment
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4. What is the maximum amount you may pay out-of-pocket
in each year or a lifetime?
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5. What percentage of the cost will you be responsible for after you reach
your deductible?
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6. What will you pay if you use providers outside the health plan’s
network?
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7. How much will services not covered by the plan cost you annually?
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8. Are there limits on days or services covered or the amount
the plan will
pay each year?
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9. What is the limit on what the plan will pay for a major illness?
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10. What is the limit on what the plan will pay over your lifetime?
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