Compare All Plans

Benefits shown here are In-Network benefits. Plans also include Out-of-Network Coverage. For a complete benefit listing, please refer to the Summary of Benefits.

BENEFITS	PPO 20%	PPO 30%	HDHP 0%	HDHP 20%
Annual Deductible Deductible must be met before Coinsurance applies.	$500, $750, $1,000, $2,000, $2,500, $3,500, $5,000	$1,000, $2,000, $2,500, $3,500, $5,000, $7,500, $10,000	$3,500, $5,000	$2,500, $5,000
Coinsurance Out-of-Pocket Maximum	$2,000, $4,000	$4,500	$3,500, $5,000	$2,500, $5,000
Lifetime Maximum Benefit	Unlimited
Preventive Care Services	No Charge
Medical Office Visits
Non-Specialist	$20	$25	0%	20%
Specialist	$40	$50	0%	20%
Emergency Care	$200	$200	0%	20%
Urgent Care	$40	$50	0%	20%
Hospital Services - Inpatient & Outpatient	20%	30%	0%	20%
Acupuncture	20%	30%	0%	20%
Chiropractic	20%	30%	0%	20%
Prescription Drug Benefits (Prescription Drugs on the HDHP Plans are subject to the plan's Annual Deductible)
Generic	$10		0%	20%
Brand Name Preferred	$35		0%	20%
Brand Name Non-Preferred	$55		0%	20%
Specialty Medications	20%		0%	20%

Click here for a complete summary of benefits for a specific plan.

This summary contains highlights only and is subject to change. The specific terms of coverage are listed in the Evidence of Coverage Handbook, including details on Limitations and Exclusions. Additionally, some services require Prior Authorization.