<commit_before><div class="container-fluid">
    <div class="row">
        <h2>Individual and/or Family Form</h2>
    </div>
    <div class="row">
        <h4>Worksheet for comparing your current health care coverage to ColoradoCare</h4>
    </div>
    <div class="row">
        <div class="col-sm-5 calcside">
            <form>
                <div class="row">
                    <h4>Your current health care plan</h4>
                </div>

                <div class="form-group">
                    <label class="control-label" for="vmFormPremium">Your share of monthly health care premium</label>
                    <div class="row">
                        <div class="col-sm-6">
                            <input type="text" ng-currency class="form-control"
                                   aria-label="Amount (to the nearest dollar)" ng-model="vm.form.premium"
                                   min="0" id="vmFormPremium">
                        </div>
                    </div>
                </div>

                <div class="form-group">
                    <label class="control-label" for="vmFormDeductible">Annual deductible</label>
                    <div class="row">
                        <div class="col-sm-6">
                            <input type="text" ng-currency class="form-control"
                                   aria-label="Amount (to the nearest dollar)"
                                   ng-model="vm.form.deductible" min="0" id="vmFormDeductible">
                        </div>
                    </div>
                </div>

                <div class="form-group">
                    <label class="control-label" for="vmFormCopay">Estimated annual co-payments</label>
                    <div class="row">
                        <div class="col-sm-6">
                            <input type="text" ng-currency class="form-control"
                                   aria-label="Amount (to the nearest dollar)"
                                   ng-model="vm.form.copay" min="0" id="vmFormCopay">
                        </div>
                    </div>
                </div>

                <div class="form-group">
                    <label class="control-label" for="vmFormExpenses">Expenses for health care services not covered by
                        your plan</label>
                    <div class="row">
                        <div class="col-sm-6">
                            <input type="text" ng-currency class="form-control"
                                   aria-label="Amount (to the nearest dollar)"
                                   ng-model="vm.form.expenses" min="0" id="vmFormExpenses">
                        </div>
                    </div>
                </div>

                <div class="row">
                    <h4>ColoradoCare</h4>
                    <small>No deductibles, limited copays, and comprehensive coverage mean that Premium Tax is the only
                        major expense.</small>
                </div>

                <div class="form-group">
                    <label class="control-label" for="vmFormIncome">Your annual payroll (W-2) income</label>
                    <div class="row">
                        <div class="col-sm-6">
                            <input type="text" ng-currency class="form-control"
                                   aria-label="Amount (to the nearest dollar)"
                                   ng-model="vm.form.income" min="0" id="vmFormIncome">
                        </div>
                    </div>
                </div>

                <!-- setup for other income -->
                <div class="checkbox">
                    <label for="vmOther">
                        <input type="checkbox" ng-model="vm.other" id="vmOther"> If you have significant income besides
                        payroll, check here</label>
                </div>
                <div class="form-group" ng-show="vm.other">
                    <label class="control-label" for="vmGross">Non-payroll income (Income reported on IRS form 1040
                        lines 8a – 21)</label>
                    <div class="row">
                        <div class="col-sm-6">
                            <input type="text" ng-currency class="form-control"
                                   aria-label="Amount (to the nearest dollar)"
                                   ng-model="vm.form.gross" min="0" id="vmGross">
                        </div>
                    </div>
                </div>

                <!-- checkbox for social security income -->
                <div class="checkbox" ng-show="vm.other">
                    <label for="vmSocial">
                        <input type="checkbox" ng-model="vm.social" id="vmSocial"> If you have Social Security and/or
                        retirement income, check here</label>
                </div>

                <!-- radio for joint or single filing -->
                <div class="radio" ng-show="vm.social">
                    <strong>Check one box:</strong><br>
                    <label for="vmFilingSingle">
                        <input type="radio" ng-model="vm.filing" value="single" id="vmFilingSingle"> Single
                    </label>
                </div>
                <div class="radio" ng-show="vm.social">
                    <label for="vmFilingJoint">
                        <input type="radio" ng-model="vm.filing" value="joint" id="vmFilingJoint"> Joint
                    </label>
                </div>

                <!-- for single filing -->
                <div class="form-group" ng-show="vm.other && vm.filing === 'single'">
                    <label for="vmFormSingleMonthlySS">Your Monthly Social Security Income</label>
                    <div class="row">
                        <div class="col-sm-6">
                            <input type="text" ng-currency class="form-control"
                                   aria-label="Amount (to the nearest dollar)"
                                   ng-model="vm.form.you.monthlySS" min="0" id="vmFormSingleMonthlySS">
                        </div>
                    </div>
                </div><commit_msg>fix label changes #51<commit_after><div class="container-fluid">
    <div class="row">
        <h2>Individual and/or Family Form</h2>
    </div>
    <div class="row">
        <h4>Worksheet for comparing your current health care coverage to ColoradoCare</h4>
    </div>
    <div class="row">
        <div class="col-sm-5 calcside">
            <form>
                <div class="row">
                    <h4>Your current health care plan</h4>
                </div>

                <div class="form-group">
                    <label class="control-label" for="vmFormPremium">Your share of monthly health care premium</label>
                    <div class="row">
                        <div class="col-sm-6">
                            <input type="text" ng-currency class="form-control"
                                   aria-label="Amount (to the nearest dollar)" ng-model="vm.form.premium"
                                   min="0" id="vmFormPremium">
                        </div>
                    </div>
                </div>

                <div class="form-group">
                    <label class="control-label" for="vmFormDeductible">Annual deductible</label>
                    <div class="row">
                        <div class="col-sm-6">
                            <input type="text" ng-currency class="form-control"
                                   aria-label="Amount (to the nearest dollar)"
                                   ng-model="vm.form.deductible" min="0" id="vmFormDeductible">
                        </div>
                    </div>
                </div>

                <div class="form-group">
                    <label class="control-label" for="vmFormCopay">Estimated annual co-payments</label>
                    <div class="row">
                        <div class="col-sm-6">
                            <input type="text" ng-currency class="form-control"
                                   aria-label="Amount (to the nearest dollar)"
                                   ng-model="vm.form.copay" min="0" id="vmFormCopay">
                        </div>
                    </div>
                </div>

                <div class="form-group">
                    <label class="control-label" for="vmFormExpenses">Expenses for health care services not covered by
                        your plan</label>
                    <div class="row">
                        <div class="col-sm-6">
                            <input type="text" ng-currency class="form-control"
                                   aria-label="Amount (to the nearest dollar)"
                                   ng-model="vm.form.expenses" min="0" id="vmFormExpenses">
                        </div>
                    </div>
                </div>

                <div class="row">
                    <h4>ColoradoCare</h4>
                    <small>No deductibles, limited copays, and comprehensive coverage mean that Premium Tax is the only
                        major expense.</small>
                </div>

                <div class="form-group">
                    <label class="control-label" for="vmFormIncome">Your annual payroll (W-2) income</label>
                    <div class="row">
                        <div class="col-sm-6">
                            <input type="text" ng-currency class="form-control"
                                   aria-label="Amount (to the nearest dollar)"
                                   ng-model="vm.form.income" min="0" id="vmFormIncome">
                        </div>
                    </div>
                </div>

                <!-- setup for other income -->
                <div class="checkbox">
                    <label for="vmOther">
                        <input type="checkbox" ng-model="vm.other" id="vmOther"> If you have significant income besides payroll and itemize your taxes, check here</label>
                </div>
                <div class="form-group" ng-show="vm.other">
                    <label class="control-label" for="vmGross">Non-payroll income (Income reported on IRS form 1040 lines 8a – 21)</label>
                    <div class="row">
                        <div class="col-sm-6">
                            <input type="text" ng-currency class="form-control"
                                   aria-label="Amount (to the nearest dollar)"
                                   ng-model="vm.form.gross" min="0" id="vmGross">
                        </div>
                    </div>
                </div>

                <!-- checkbox for social security income -->
                <div class="checkbox" ng-show="vm.other">
                    <label for="vmSocial">
                        <input type="checkbox" ng-model="vm.social" id="vmSocial"> If you have Social Security and/or
                        retirement income, check here</label>
                </div>

                <!-- radio for joint or single filing -->
                <div class="radio" ng-show="vm.social">
                    <strong>Check one box:</strong><br>
                    <label for="vmFilingSingle">
                        <input type="radio" ng-model="vm.filing" value="single" id="vmFilingSingle"> File taxes individually
                    </label>
                </div>
                <div class="radio" ng-show="vm.social">
                    <label for="vmFilingJoint">
                        <input type="radio" ng-model="vm.filing" value="joint" id="vmFilingJoint"> File taxes jointly
                    </label>
                </div>

                <!-- for single filing -->
                <div class="form-group" ng-show="vm.other && vm.filing === 'single'">
                    <label for="vmFormSingleMonthlySS">Your Monthly Social Security Income</label>
                    <div class="row">
                        <div class="col-sm-6">
                            <input type="text" ng-currency class="form-control"
                                   aria-label="Amount (to the nearest dollar)"
                                   ng-model="vm.form.you.monthlySS" min="0" id="vmFormSingleMonthlySS">
                        </div>
                    </div>
                </div>
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