Comparison Chart

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Plan Comparison

Please select two or more plans to compare

Features

Annual Deductible

Out-of-Pocket Limit
(includes discounts)

Total Out-of-Pocket Limit
(includes all applicable discounts)

Preventive Care

Exam

Non-Urgent Services

Routine Care

Primary Care visits

Specialist

Mental Care

Outpatient

Inpatient

Copay Plan

$XXX/individual

$XXXX/family

$XXXX/individual
$XXXX/family

$XXXX/individual
$XXXX/family

XXX%, no deductible

$XXX copayment
$XXX copayment

$XX copayment

$XX copayment

$XXXX/individual
$XXXX/family

$XXXX/individual
$XXXX/family

HSA Plan

$XXXX/individual;

$XXXX/family*

$XXXX/individual
$XXXX/family

$XXXX/individual
$XXXX/family

XXX%, no deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

HMO Plan

$XXXX/individual;

$XXXX/family*

$XXXX/individual
$XXXX/family

$XXXX/individual
$XXXX/family

XXX%, no deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

Option One

$XXXX/individual;

$XXXX/family*

$XXXX/individual
$XXXX/family

$XXXX/individual
$XXXX/family

XXX%, no deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

Option Two

$XXXX/individual;

$XXXX/family*

$XXXX/individual
$XXXX/family

$XXXX/individual
$XXXX/family

XXX%, no deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

Option Three

$XXXX/individual;

$XXXX/family*

$XXXX/individual
$XXXX/family

$XXXX/individual
$XXXX/family

XXX%, no deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

XX%, after deductible

Please note that the information provided in this medical table is for general reference purposes only and should not be considered as medical advice. Always consult with a qualified healthcare professional for personalized guidance and recommendations regarding your specific medical condition or situation.

Plan Comparison – Gap Variant

Please select two or more plans to compare

Copay Plan

$XXX/individual

$XXXX/family

$XXXX/individual
$XXXX/family

$XXXX/individual
$XXXX/family

Preventive Care

XXX%, no deductible

$XXX copayment
$XXX copayment

Routine Care

$XX copayment

$XX copayment

Mental Care

$XXXX/individual
$XXXX/family

$XXXX/individual
$XXXX/family

HSA Plan

$XXXX/individual;

$XXXX/family*

$XXXX/individual
$XXXX/family

$XXXX/individual
$XXXX/family

Preventive Care

XXX%, no deductible

XX%, after deductible

Routine Care

XX%, after deductible

XX%, after deductible

Mental Care

XX%, after deductible

XX%, after deductible

HMO Plan

$XXXX/individual;

$XXXX/family*

$XXXX/individual
$XXXX/family

$XXXX/individual
$XXXX/family

Preventive Care

XXX%, no deductible

XX%, after deductible

Routine Care

XX%, after deductible

XX%, after deductible

Mental Care

XX%, after deductible

XX%, after deductible

Option One

$XXXX/individual;

$XXXX/family*

$XXXX/individual
$XXXX/family

$XXXX/individual
$XXXX/family

Preventive Care

XXX%, no deductible

XX%, after deductible

Routine Care

XX%, after deductible

XX%, after deductible

Mental Care

XX%, after deductible

XX%, after deductible

Option Two

$XXXX/individual;

$XXXX/family*

$XXXX/individual
$XXXX/family

$XXXX/individual
$XXXX/family

Preventive Care

XXX%, no deductible

XX%, after deductible

Routine Care

XX%, after deductible

XX%, after deductible

Mental Care

XX%, after deductible

XX%, after deductible

Option Three

$XXXX/individual;

$XXXX/family*

$XXXX/individual
$XXXX/family

$XXXX/individual
$XXXX/family

Preventive Care

XXX%, no deductible

XX%, after deductible

Routine Care

XX%, after deductible

XX%, after deductible

Mental Care

XX%, after deductible

XX%, after deductible

Please note that the information provided in this medical table is for general reference purposes only and should not be considered as medical advice. Always consult with a qualified healthcare professional for personalized guidance and recommendations regarding your specific medical condition or situation.

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