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Health Plan Cost Estimator

Please enter whole numbers only (no commas, decimals, or special characters).

Step 1
Your Information (all fields are required)
Level of Coverage:
Employment Classification:
Full-time Career Service State Employee
Select Exempt Service (SES) or University Executive Service Employee
Senior Management Services (SMS) Employee
Part-time Career Service Employee (assumes .5 FTE)
Other Active State Employee (I pay no premium in 2010)
University Faculty, Staff and Administrative, or Professional Employee
Retiree or Surviving Spouse Under Age 65 (not Medicare-eligible)
COBRA Participant
Medicare Retiree or Surviving Spouse
If you are a Medicare Retiree or a Surviving Spouse in Medicare, please select an Eligibility Type:
Retiree or Surviving Spouse Only (Medicare Eligible)
Retiree + 1 (Not Medicare Eligible Dependent)
Retiree + 1 (Both Medicare Eligible)
Tax Filing Status:
Number of declared dependents on your tax return (do not include yourself or your spouse, or dependent children between ages 27 and 30):
Total annual income:
Enter estimated income for the year from all sources you would include on your tax form, including wages, bonus, investment income, etc. Include income for your spouse if your filing status is "Married (joint)".
$

 

Step 2

Estimate the number of times you and your family will be using each service during the year. For example, if you and your spouse will both be covered, and you estimate that you will each have 2 specialist office visits, enter 4 next to specialist office visits. Do not include expenses for children between ages 27 and 30.

Your Anticipated Medical Needs
Medical Service Cost* Total Number of Times Covered Individuals Will Use the Service
Outpatient Care
Routine physical exam/GYN exam**
Well baby office visit
Diagnostic treatment - office visit
Specialist office visit
Mammogram
Chest X-ray**
PSA Test**
Immunization**
Cholesterol screening**
Chiropractic visit
Maternity - normal delivery (not including hospital stay)
Maternity - Cesarean section delivery (not including hospital stay)
Sigmoidoscopy/Colonoscopy
Inpatient Care
Emergency room visit
2-day hospital stay
(hospital charges only)
Prescription Drugs
Estimate your total anticipated prescription drug needs for the year, including retail prescriptions for up to a 30-day supply and/or mail order prescription drugs for up to a 90-day supply. For example, if you and your spouse each have a maintenance prescription you take all year, please enter 24 30-day retail prescriptions, or 8 90-day mail order prescriptions.
Retail - generic (up to 30-day supply)
Retail - preferred*** (up to 30-day supply)
Retail - non-preferred (up to 30-day supply)
Mail order - generic (up to 90-day supply)
Mail order - preferred*** (up to 90-day supply)
Mail order - non-preferred (up to 90-day supply)
Additional Services
Total cost for additional covered services you don't see listed above, such as inpatient surgery, outpatient services, physical therapy, etc. (enter dollar amount) N/A $

Calculate and view results below, or reset the worksheet and model a new scenario. To modify a current scenario, simply adjust the numbers above and click the Calculate button.

     

* These reflect average medical costs in Florida, network and non-network. Allowed costs vary based on the procedure(s) as billed by the healthcare provider. Allowed costs do not include ancillary costs (for example, a chest X-ray allowed cost includes the X-ray image and not the facility or provider costs which are in addition and vary based on type of provider, type of facility and equipment used).
**For the estimator, preventive care services do not take into account age-related provisions or limitations, except for mammograms.
*** Cost average used for estimator does not reflect the cost of certain expensive medicines, such as those for multiple sclerosis, some cancers, HIV, and other specialty treatments because the cost of those drugs would unrealistically inflate the average cost.

The estimate of your total annual medical expenses is based on the costs shown above. The network columns assume you use network providers for all services, while the non-network columns assume you never use network providers - giving you best-case and worst-case scenarios.

Without coverage, your total medical expenses for the calendar year are estimated to be $

Your Results
Option Comparisons
Estimated Employee Expenses Standard PPO Health Investor PPO Standard HMO Health Investor HMO
  Network Non-Network Network Non-Network Network Only Network Only
Annual deductibles
Copayments (for medical care and prescription drugs, hospital stay deductibles)
Coinsurance
Expenses not covered
Your total cost of care (eligible for Medical Reimbursement Account or HSA)*
Your annual insurance premium (payroll deductions)**
Your estimated total annual expense (cost of care plus insurance premium)

*If you are eligible to participate; Medical Reimbursement Accounts are available only to active employees; HSAs have specific eligibility rules (see Who Is Eligible).

**Does not include cost to cover any dependent child between ages 27 and 30.

Save money with the HSA

The chart below shows your potential federal income tax savings for your network and non-network deductibles, copayments, coinsurance and other health out-of-pocket expenses, if you enroll in the Health Investor PPO or HMO Plan and use the Health Savings Account (HSA).

Active employees' who enroll in the Health Investor PPO or HMO Plan and an HSA: The state will make an annual contribution to your HSA of up to $500 if you select individual coverage or up to $1,000 if you select family coverage (contributions are made monthly and pro-rated for the portion of the year you are enrolled in the state's HSA). If you enroll in a Health Investor plan, you may make pre-tax contributions to:

  • an HSA that, in combination with the state’s contributions, can be up to $3,250 for individual coverage, or $6,450 for family coverage. Unused employee and employer HSA contributions carry forward.
  • a Limited Purpose Medical Reimbursement Account you can use to pay for out-of-pocket dental, vision and over-the-counter medication expenses. Based on Federal law, the Medical Reimbursement Account cannot be used to cover any health expenses when you are in a Health Investor plan and an HSA. Reimbursement Account balances do not carry over to the next year. Get more information on the Limited Purpose Medical Reimbursement Account.
  Health Investor PPO Plan Health Investor HMO Plan
  Network Non-Network Network
Total projected cost of care
Represents out-of-pocket health costs
Estimated HSA contributions from the state
Your potential HSA contribution*
Potential rollover balance (if you make the maximum HSA contribution)
Potential federal income tax and FICA
savings

*For those who are not Medicare eligible.

To calculate potential tax savings on using a Limited Purpose Medical Reimbursement Account for all your eligible healthcare expenses, go to the Limited Purpose Medical Reimbursement Account estimator. This is available to active employees only.

If you are an active employee and think you will be enrolling in the Standard PPO or a Standard HMO, use the Medical Reimbursement Account Estimator to calculate potential tax savings using that account.