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Actuarial Value Calculator
Enter between one and three network tiers per benefit plan, one at a time. Start by entering the details of your benefit design here:
Basic Information
Your Email Address
Client Name
Plan Name
Network Tier Name
Average Claims PMPM
Best guess of the plan's metal level
% Enrolled in Employee Only
$410
60%
Enter a valid name
Employer-Funded Accounts
Is there an HRA, an HSA, or neither?
What is the value of the EE Only account?
How much does the employee have to spend until the HRA begins?
$0
$0
Enter a valid email
Deductible
Are medical and Rx separate or integrated?
Is the deductible embedded or non-embedded?
Out-of-Pocket Maximum (OOPM)
Employee Only
Integrated
Medical
$0
$2,400
Rx
$0
$0
$4,800
$0
Rx
Medical
Family
$4,800
Coverage by Type of Service
Subject to deductible?
Set All To:
Subject to coinsurance?
Plan Coinsurance
(Enter % as Whole Number)
%
Copay, if separate
Medical
%
$
Emergency Room Services
All IP Hospital Services (incl. MH/SUD)
PCP Visit (excl. Preventive and X-rays)
Specialist Visit
MH/SUD Outpatient Services
Imaging (CT/PET Scans, MRIs)
Occupational and Physical Therapy
Laboratory Services
X-rays and Diagnostic Imaging
Outpatient Facility Fees
Outpatient Surgery
Prescription Drugs
%
$
Generics
Preferred Brand
Non-Preferred Brand
Specialty Drugs