Plan Summary

Deductible: $5,900 Individual / $11,000 Family

Out-of-Pocket: $6,350 Individual / $12,700 Family

Office Visit: Primary Care Physician $35 for first 3 visits / Specialist $35 for first 3 visits

Inpatient Hospital: 0% once medical deductible is satisfied

UC / ER/ Major Diag Copay: 0% once medical deductible is satisfied

Pharmacy: Tier 1 $15 / Tier 2 $40 / Tier 3 $60 / 2x Mail Order