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Health plan comparison worksheet

By Insure.com

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Last updated: Dec. 7, 2009

Under each plan you are comparing, note whether the benefit is offered and what your out-of-pocket expenses would be (co-payment and/or co-insurance).
Benefit or services [Let Insure.com help you find affordable health insurance now.]	Plan A	Plan B	Plan C
Premiums
Yearly deductible
Benefit or services
Annual maximum benefit
Alcohol and drug abuse Inpatient Outpatient
Allergy testing or treatment
Ambulance
Chiropractic
Durable medical equipment (crutches, beds, etc.)
Emergency care In area Out-of-area
Eye examinations Eyeglasses Contacts
Hearing testing Hearing aids
Hospice care
Immunizations
Mammograms
Maternity
Mental health Inpatient Outpatient
Occupational therapy
Pap test
Physician office visits
Physical therapy
Plastic/reconstructive surgery
Prescription drugs Generic Formulary Nonformulary
Skilled nursing facility
Well child care
Other:
Other:
Other:

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