Plan Summary

Deductible: $1,250 Individual / $2,500 Family

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

Office Visit: Primary Care Physician $35 / Specialist $50

Inpatient Hospital: 30% once medical deductible is satisfied

UC / ER/ Major Diag Copay: UC $50 / ER $150 / MD N/A

Pharmacy: Tier 1 $10 / Tier 2 $35 / Tier 3 $60 / Tier 4 $100 / MailOrder 2.5x