01
Premiums by coverage tier and payroll frequency
PROTECTION DECISION SYSTEM
Health insurance: compare total annual exposure, not the premium.
A cheaper paycheck deduction can be the expensive plan after deductibles, networks and prescriptions. Model expected use and a bad year.
MEASURE THE EXPOSURE
Collect the inputs before shopping.
02
Deductible, coinsurance, copays and in-network out-of-pocket maximum
03
Network status for clinicians, facilities and required medications
04
Employer HSA/HRA funding and tax-account eligibility
DECISION MAP
Match the protection to the risk retained.
| Situation | Evidence | Action |
|---|---|---|
| Expected low use | Routine care and few prescriptions. | Compare annual premiums plus likely use, while confirming the bad-year maximum is affordable. |
| Ongoing specialists or medications | Network and formulary drive cost. | Verify providers and exact drugs directly with the plan before enrollment. |
| HDHP considered for HSA | IRS and plan eligibility requirements apply. | Compare total cost and cash exposure; confirm eligibility before contributing. |
ORDER OF OPERATIONS
Build the protection file.
Measure
Annualize every premium.
Translate
Model expected claims and the in-network maximum case.
Compare
Verify network, formulary and prior-authorization rules.
Document
Choose the plan and fund the deductible exposure deliberately.
Use the contract, not the pitch.
Policy language and state law control. Use licensed professionals for coverage details and qualified legal or tax counsel when ownership, business activity, dependents or estate consequences materially change the result.
PRIMARY REFERENCES
Verify current rules and contracts.
NEXT DECISION