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Health Plan Comparison Worksheet

Compare total yearly cost — not premium alone.

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Plan comparison
Plan APlan BPlan C
Plan name
Annual premium ($)
Deductible — individual ($)
Deductible — family ($)
Out-of-pocket max ($)
Primary care copay
Specialist copay
Rx tier 1 / 2 / 3
HSA employer contribution ($)
Doctors in-network? (Y/N)
Expected use (L/M/H)
Est. total yearly cost ($)
Worst-case yearly cost ($)
Notes

Official resources for this worksheet

Educational only — Your employer plan documents and official government sources govern your actual benefits.