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HMO Hybrid 23

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In-Network Deductible
Individual: $750  |  Family: $1,500
Preventive Care
$0
Office Visit
$20
Live Video Doctor Visits
$20
Specialist Visit 
$40
Prescription Drugs
Tier 1: $1 Tier 2: 20% Tier 3: 50%
Urgent Care
$50
Emergency Room
20%
Inpatient Hospital
20%
Outpatient Surgery
20%
Plan Documents
2018 Summary of Benefits & Coverage
2018 Health Plan Contract

Standard HMO Copayment 20

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In-Network Deductible
Individual: $600  |  Family: $1,200
Preventive Care
$0
Office Visit
$25
Live Video Doctor Visits
$25
Specialist Visit 
$40
Prescription Drugs
Tier 1: $10 Tier 2: $35 Tier 3: $70
Urgent Care
$60
Emergency Room
$150
Inpatient Hospital
$1,000
Outpatient Surgery
$100
Plan Documents
2018 Summary of Benefits & Coverage
2018 Health Plan Contract