content row
PPO
| Deductible/Co-Pay | Amount |
|---|---|
| Preventive Care | The plan pays 100% |
| Primary Physician Co-Pay | $30 |
| Specialist Office Visit Co-Pay | $40 |
| Facility Inpatient Co-Pay | $300 |
| Facility Outpatient Co-Pay | $300 |
| Emergency Room Facility Co-Pay | $300 |
| Calendar Year Deductible (limit of 3 per family) | $500 per individual / 3-member family maximum |
| Out-of-Pocket Maximum (Individual) | $12,000 |
| Out-of-Pocket Maximum (Family) | $24,000 |
HDHP
| Deductible/Co-Pay | Amount |
|---|---|
| Preventive Care | The plan pays 100% |
| Deductible | $2,500 single / $5,000 non-single |
| Coinsurance | The plan pays 80% after the deductible is met. |
| Out-of-Pocket Maximum (Individual) | $5,000 |
| Out-of-Pocket Maximum (Family) | $10,000 |
