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Page 4 of 4 <br /> <br /> <br /> <br /> <br /> <br />A summary of the maximum costs (premium plus out-of-pocket) for each plan is shown below. <br />The two HSA plans are noted in the red box. <br /> <br /> <br /> <br />Attachments <br />A. Summary of HealthPartners HSA plan benefits <br />B. Summary of PEIP HSA plan benefits <br /> <br /> <br />Single Family <br />PEIP Advantage 7,961.52 20,753.76 <br />Max out of pocket 2,000.00 4,000.00 Tier 2 <br />Annual 9,961.52 24,753.76 <br />Monthly 830.13 2,062.81 <br />Value 7,179.84 18,669.36 <br />Max out of pocket 3,200.00 6,400.00 Tier 2 <br />Annual 10,379.84 25,069.36 <br />Monthly 864.99 2,089.11 <br />PEIP HSA 5,532.72 14,271.36 <br />Max out of pocket 3,000.00 6,000.00 Tier 2 <br />Annual 8,532.72 20,271.36 <br />Monthly 711.06 1,689.28 <br />Current Health Partners 8,027.48 21,988.92 Average of current employees <br />Max out of pocket 2,000.00 4,000.00 <br />Annual 10,027.48 25,988.92 <br />Monthly 835.62 2,165.74