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Individual Health Plans

  HDHMO HSA-Qualified 44   Standard HDHMO HSA-Qualified 40   HDHMO HSA-Qualified 45   Standard HDHMO Non HSA-Qualified 60
In-Network Deductible   Individual: $6,250
Family: $12,500
  Individual: $6,100
Family: $12,200
  Individual: $6,900
Family: $13,800
  Individual: $4,700
Family: $9,400
Preventive Care   $0   $0   $0   $0
Office Visit   30%   50%   0%   $50 Copayment.
First 3 visits to a PCP/Specialist are not subject to the deductible
Live Video Doctor Visits   30%   50%   0%   50%
Specialist Visit   30%   50%   0%   $75 Copayment.
First 3 visits to a PCP/Specialist are not subject to the deductible
Prescription Drugs   Tier 1: 50% 
Tier 2: 50%
Tier 3: 50%
  Tier 1: $10
Tier 2: $35
Tier 3: $70
  Tier 1: 0%
Tier 2: 0%
Tier 3: 0%
  Tier 1: $10
Tier 2: $35
Tier 3: $70
Urgent Care   30%   50%   0%   50%
Emergency Room   30%   50%   0%   50%
Inpatient Hospital   30%   50%   0%   50%
Outpatient Surgery   30%   50%   0%   50%
Plan Documents   Summary of Benefits & Coverage
Health Plan Contract
  Summary of Benefits & Coverage
Health Plan Contract
  Summary of Benefits & Coverage
Health Plan Contract
  Summary of Benefits & Coverage
Health Plan Contract

 

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