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Please select the tab below (PPO or HDHP for additional information on medical deductibles and co-pays for 2024.
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 |
Out-of-Pocket Maximum (Individual) |
$9,450 |
Out-of-Pocket Maximum (Family) |
$18,900 |
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 |