Plan Specifics | You Pay (In-Network) |
---|---|
Calendar-year deductible | Nothing |
Calendar-year out-of-pocket max | $4,500 per member or $9,000 per family |
Benefit | You Pay (In-Network) |
---|---|
Preventive care, routine physicals, GYN, well child, routine hearing and vision exams, family planning | Nothing |
Office visits (sick care/non-preventive) | $20 |
Office visits (specialists) | $30 |
Emergency room | $100 |
Inpatient hospital care | $50* |
Outpatient surgery | $50* |
CT scan, MRI, and other imaging tests | $50* |
*Copayment limited to $50 per member per plan year.