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["In-Network Benefit Comparison",null,"High Deductible Health Paln ","Co-pay Plan"]
["Benefit Plan Design"]
["Copay",null,"None",{"v":0,"d":"$0"}]
["Deductible ",null,{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Co-insurance",null,{"v":0,"d":"0%"},{"v":0,"d":"0%"}]
["Out-of-pocket maximum",null,{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Rx Deductible",null,{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Rx Copay",null,"None",0]
[]
["Annual Premium",null,{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
[null,"Difference",{"v":0,"d":"$0.00"}]
[]
["Annual Deductible"]
["Individual",null,{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Family",null,{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Individual","Difference",{"v":0,"d":"$0.00"}]
["Family","Difference",{"v":0,"d":"$0.00"}]
[]
["Annual Out-of-Pocket Limit Including Deductible"]
["Individual",null,{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Family",null,{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Individual","Difference",{"v":0,"d":"$0.00"}]
["Family","Difference",{"v":0,"d":"$0.00"}]
[]
["Estimated Copay Expense"]
["Physicians","Total Copays",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Rx","Total Copays",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
[null,"Difference",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
[]
["HSA Contributions"]
["By your employer",null,{"v":0,"d":"$0.00"}]
["By you",null,{"v":0,"d":"$0.00"}]
["Catch-up contribution",null,{"v":0,"d":"$0.00"}]
[null,"Total Contributions",{"v":0,"d":"$0.00"}]
[]
["Tax Savings from HSA Contributions"]
["Assumes 7.65% FICA & 15% Federal",{"v":0.2265,"d":"22.65%"},{"v":0,"d":"$0.00"}]
["Assumes 7.65% FICA & 25% Federal",{"v":0.3265,"d":"32.65%"},{"v":0,"d":"$0.00"}]
["Assumes 7.65% FICA & 35% Federal",{"v":0.4265,"d":"42.65%"},{"v":0,"d":"$0.00"}]
[]
["H.S.A. Savings"]
["Premium savings",null,{"v":0,"d":"$0.00"}]
["Company HSA contributions",null,{"v":0,"d":"$0.00"}]
["Tax savings",null,{"v":0,"d":"$0.00"}]
["Copay Savings",null,{"v":0,"d":"$0.00"}]
[null,"Total Savings",{"v":0,"d":"$0.00"}]
[]
["Out-of-Pocket Medical Costs",null,"You Pay","You Pay"]
["Routine exams","______ visits at 100% or $_____ copay",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Physician visits","_____ visits at $_____ per visit or $____copay",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Lab work","$________ per visit or $_______ copay",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Rx","_____ Rx @ $______ each or $___ co-pay",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Total claims subject to deductible or copays",null,{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Deductible Expenses","Surgeon",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
[null,"Facility",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
[null,"Anethesiologist",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
[null,"In-patient",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
[null,"Complex Imaging",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
[null,"Other Expenses",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Total deductible eligible claims",null,{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Deductible Maximum You Pay","$_________ ind. $________ family",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Co-insurance Maximum You Pay","_______% to $_________ ind. $________ family",{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
["Total Claims Out-of-pocket",null,{"v":0,"d":"$0.00"},{"v":0,"d":"$0.00"}]
[null,"Claims Difference",{"v":0,"d":"$0.00"}]
["Net Costs / Savings",null,{"v":0,"d":"$0.00"}]