Plan B Cost

Plan B

Enter the plan name, type of plan, plan costs, and coinsurance or copay amounts for the second plan that you want to compare.

Plan Name

Plan Type

Employer Annual HSA Contributions

Total HSA contributions exceed 2019 limit. Adjust to $X,XXX or less.

Individual Annual HSA Contributions

Monthly Health Plan Premium

Annual Deductible

Annual Out-of-Pocket Maximum

Office Visit Coverage
Counts towards deductible
Routine Preventative Care
Specialist Office Visit
Diagnostic Coverage
Diagnostic Costs
Lab & Radiology
Imaging tests
Hospital Coverage
Inpatient Visits
Outpatient Visits
Emergency Room Care
Prescription Drug Coverage
Other Costs