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Silver Plans

	HDHMO HSA-Qualified 33	Standard HMO Copayment 30	HMO Smart Deductible EPC 34	HDHMO HSA-Qualified 35
In-Network Deductible	Individual: $2,750 Family: $5,500	Individual: $1,300 Family: $2,600	Individual: $5,000 Family: $10,000	Individual: $2,000 Family: $4,000
Preventive Care**	$0	$0	$0	$0
Office Visit	15%*	$30*	0% EPC \| 15% non-EPC	$25*
Doctor on Demand Visits	0%*	$30*	0%*	$0*
Specialist Visit	15%*	$50*	15%*	$50*
Prescription Drugs**	Tier 1: $4 * Tier 2: 50%* Tier 3: 50%*	Tier 1: $10 Tier 2: $35 Tier 3: $70	Tier 1: $4 Tier 2: 30%* Tier 3: 50%*	Tier 1: $10* Tier 2: $50* Tier 3: $80*
Urgent Care	15%*	$70*	15%*	$75*
Emergency Room	15%*	$300*	15%*	$500*
Inpatient Hospital	15%*	$1,500*	15%*	$1,500*
Outpatient Surgery	15%*	$150*	15%*	$200*
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

*Subject to Deductible
**Preventive Care and Preventive Drugs Are Not Subject to Deductible