Welcome to the Medical Plan Cost Estimator Tool. The purpose of this tool is to assist you in choosing a medical plan and understanding the advantages of tax-free accounts by helping you estimate your annual medical expenses.

We respect your privacy. None of the information you use to calculate your out-of-pocket costs can be collected or tracked, including your expected annual medical care expenses. When you navigate away from the Medical Plan Cost Estimator Tool, your information is automatically discarded. You can print your selections and criteria from the Medical Plan Cost Estimator Tool. Please keep your printouts secure and use caution when printing to shared printers.

This tool is designed to help you choose the medical plan that is right for you in two easy steps:

• The first is to tell us about you by selecting your level of coverage.
• The second is to tell us about your and your family's expected healthcare needs for the coming year by selecting whether you expect medical needs to be low, medium, or high for each family member.

Then, you'll be able to see an estimate of what you'll spend annually for the upcoming year under each medical plan option. You can also use the Health Savings Account section to consider how much you should contribute on a pre-tax basis to cover your expected medical expenses.

Optimal Viewing

This tool is designed for optimal performance in Internet Explorer 9 and later, and recent versions of Mozilla Firefox and Google Chrome. If you are using an earlier version or a web browser not listed, you may experience errors or be unable to use the tool correctly. In this case, please access the tool again using one of the listed web browser versions.

For optimal viewing, set the screen resolution to 1024 x 768 or higher.

The following cost assumptions were used in the tool:

Routine physical / GYN exam (ages 18 to 39)	$189
Diagnosis / treatment office visit	$204
Specialist office visit (minor problems)	$161
Blood test	$25
X-ray	$133
Emergency room visit	$2,416
MRI scan	$1,221
Two-day inpatient stay	$21,871
Retail - generic prescription (30-day supply)	$22
Retail - formulary brand name prescription (30-day supply)	$1,011
Mail order - formulary brand name prescription (30-day supply)	$5,680

Please select the group that applies to you.

Indicate whether you would like to include coverage for yourself, or for yourself and a spouse/domestic partner.

If you have more than five children, consider combining expenses for children to estimate your total family costs.

Please select the region that best represents where you live. While costs vary somewhat from region to region, the differences are generally not significant and may not affect your overall results.

Please indicate your salary band. Annual employee premiums will very based on your selection.

To qualify for favorable deductions, both of the following must be true for you:

• I have taken a well-being assessment by the deadline, and
• I have taken a health screening by the deadline.

A premium surcharge applies if any of the individuals use tobacco.

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[Information about the HSA and FSA accounts would go here.]