| Plan Name |
|
|
|
|
|
|
|
| Comprehensive OR Catastrophic |
Comprehensive |
Catastrophic |
Catastrophic |
Catastrophic |
Catastrophic |
Catastrophic |
Catastrophic |
| Annual Deductible |
Option A: $500 per person/$1,500 per family Option B: $1,500 per person/$4,500 per family |
Option A: $1,000 per person/$3,000 per family Option B: $3,000 per person/$9,000 per family |
Option A: $2,500 per person/$7,500 per family Option B: $5,000 per person/$15,000 per family |
$1,750 per person/$5,250 per family |
$1,750 per person/$5,250 per family |
$2,500 |
$5,000 |
| Individual Out-of-Pocket Maximum |
Option A: $2,500 Option B: $2,500 |
Option A: $5,000 Option B: $15,000 |
Option A: $10,000 Option B: $10,000 |
$3,500 |
$3,500 |
$5,000 |
N/A |
| Family Out-of-Pocket Maximum |
Option A: $7,500 Option B: $7,500 |
Option A: $5,000 Option B: $15,000 |
Option A: $30,000 Option B: $30,000 |
$10,500 |
$10,500 |
N/A |
$10,000 |
| Lifetime Maximum |
$2 Million |
$2 Million |
$2 Million |
$1 Million |
$1 Million |
$1 Million |
$1 Million |
| Office Visits |
$20 co-pay |
$30 co-pay |
You pay 50% after deductible |
$15 co-pay + 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
| Alternative Care (i.e. Acupuncture or Chiropractic) |
You pay 20% after deductible |
You pay 30% after deductible |
You pay 50% after deductible |
$15 co-pay + 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
| Preventive Care |
Covered in full up to $400 |
Covered in full up to $200 |
You pay 50% after deductible |
$15 co-pay + 20% after deductible |
You pay 20% after deductible |
Covered in full up to $300 |
Covered in full up to $300 |
| Outpatient Lab & X-ray |
You pay 20% after deductible |
You pay 30% after deductible |
You pay 50% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
| Hospital Services - Inpatient |
You pay 20% after deductible |
You pay 30% after deductible |
You pay 50% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
| Maternity Services |
You pay 20% after deductible |
You pay 30% after deductible |
Not Covered |
Not Covered |
Not Covered |
Not Covered |
Not Covered |
| Prescription Drugs |
$10 co-pay generic/ you pay 30% preferred brand/ you pay 50% non-preferred, Rx max of $3,000 |
$10 co-pay generic/ you pay 30% preferred brand/ you pay 50% non-preferred, Rx max of $3,000 |
Rx Discount Program Included |
Not Covered |
Not Covered |
Not Covered |
Not Covered |
| Vision Exam |
$20 co-pay |
$30 co-pay |
Not Covered |
Not Covered |
Not Covered |
Not Covered |
Not Covered |
| Vision Hardware |
Up to $400 |
Up to $200 |
Not Covered |
Not Covered |
Not Covered |
Not Covered |
Not Covered |
| |
View Rates |
View Rates |
View Rates |
View Rates |
View Rates |
View Rates |
View Rates |
| Ready to Enroll? Click here to APPLY ONLINE! |