Benefits   Utilization Cost            
  HMO FFS HDHP     Events per event  
Deductible   Physician Office Visit    
Coinsurance   Outpatient Procedure (3)    
OP Max   Hospital Admission (3)    
OV Copay          
Premium (month)          
Employer share   Total Cost of Services    
                 
Your OOP spend          
Actuarial Value (1)          
                     
Your Total Spend              
As % of Cost of              
Services (2)                    
                 
NOTES                
1. Actuarial value is the percent the total costs of care that are paid by the insurer  
2. Premiums plus out-of-pocket spending divided by cost of care. If this is less than 1, the value of the insurance is more than your total spending.  
3. Be sure to include both the hospital bill and any physician bills    
                   
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