Medical Deductibles & Co-Pays

Calendar Year Deductible (limit of 3 per family)

$500 per individual

Facility Inpatient Co-Pay

$300

Facility Outpatient Co-Pay

$300

Emergency Room Facility Co-Pay

$300

Primary Physician Co-Pay

$30

Specialist Office Visit Co-Pay

$40

Out-of-Pocket Maximum (Individual)

$9,100

Out-of-Pocket Maximum (Family)

$18,200