HM. Clause vs. Spouse Plan Full Coverage Comparison | 2027

How to Use This Worksheet

1. Select the HM. Clause plan you would enroll in if covering your spouse (and dependents, if applicable).
2. Enter the employee cost for spouse/dependent coverage under the spouse's employer plan(s).
3. Enter deductibles, out-of-pocket maximums, and any employer HSA/HRA funding for each plan.
4. Estimate known prescription and medical spending under each plan, if helpful for your own notes.
5. Compare the calculated Annual Net Employee Contribution and Worst-Case In-Network Annual Cost for each coverage tier.
6. Check networks, formularies, service area, and prior authorization requirements for each plan.
7. Confirm both HM. Clause's and the spouse's employer's open enrollment deadlines before making elections.

Tip: The Spouse Plan 1, 2, 3 and 4 columns in the comparison section below start at $0.00 so you can enter your own numbers. Click Load Sample Data in that section at any time to see what a completed example comparison looks like, or Reset to Defaults to clear everything back to $0.00. The Blue Shield Standard PPO, Blue Shield Choice PPO, Blue Shield HDHP and Blue Shield EPO (CA Only) columns are locked and reflect HM. Clause's actual plan designs — only the Spouse Plan columns can be edited.

Understanding the Calculations

• Annual Employee Contribution= Monthly employee contribution × 12
• Annual Net Employee Contribution= Annual employee contribution − Annual employer HSA/HRA funding
• Worst-Case In-Network Annual Cost= Annual employee contribution + In-network out-of-pocket maximum − Annual employer HSA/HRA funding

Assumption: Employee + Child(ren) uses the tier's own deductible and out-of-pocket limits because that tier may cover multiple children — if coverage is for employee + one child only, confirm whether a two-person limit applies instead. Worst-case figures exclude non-covered services, balance billing, and costs that do not count toward the plan maximum. Spouse Plan columns with no values entered are excluded from the best-value calculation.

Questions? Contact HM. Clause HR at hr.ampa@hmclause.com.

Compare Your Spouse’s Coverage Options

Enter up to four spouse-employer plans in the yellow cells below. The Blue Shield Standard PPO, Blue Shield Choice PPO, Blue Shield HDHP and Blue Shield EPO (CA Only) columns are locked to reflect HM. Clause's actual plan designs and cannot be edited. Compare HM. Clause and spouse-employer plans across all three coverage tiers. Each Spouse Plan column stays inactive and is left out of all calculations until you enter a value in any of its fields (even $0.00).

The four Spouse Plan columns start at $0.00. Click Load Sample Data to preview example figures for Spouse Plan 1, 2, 3 and 4, or clear them any time with Reset to Defaults.

Overall Summary — Best Plan by Coverage Tier

Cost is only part of the decision. Also weigh network access, continuity of care, prescription formularies, and enrollment timing before choosing a plan.

Reference Sources