	HMO Hybrid 23	Standard HMO Copayment 20
In-Network Deductible	Individual: $750 Family: $1,500	Individual: $600 Family: $1,200
Preventive Care	$0	$0
Office Visit	$20	$25
Live Video Doctor Visits	$20	$25
Specialist Visit	$40	$40
Prescription Drugs	Tier 1: $1 Tier 2: 20% Tier 3: 50%	Tier 1: $10 Tier 2: $35 Tier 3: $70
Urgent Care	$50	$60
Emergency Room	20%	$150
Inpatient Hospital	20%	$1,000
Outpatient Surgery	20%	$100
Plan Documents	Summary of Benefits & Coverage Health Plan Contract	Summary of Benefits & Coverage Health Plan Contract

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