Please select the tab below (PPO or HDHP for additional information on medical deductibles and co-pays for 2024.
|
Deductible/Co-Pay |
Amount |
|---|---|
|
Preventive Care |
The plan pays 100%. |
|
Primary Physician Co-Pay |
$30 |
|
Specialist Office Visit Co-Pay |
$40 |
|
Facility Inpatient Co-Pay |
$300 |
|
Facility Outpatient Co-Pay |
$300 |
|
Emergency Room Facility Co-Pay |
$300 |
|
Calendar Year Deductible (limit of 3 per family) |
$500 per individual |
|
Out-of-Pocket Maximum (Individual) |
$9,450 |
|
Out-of-Pocket Maximum (Family) |
$18,900 |
|
Deductible/Co-Pay |
Amount |
|---|---|
|
Preventive Care |
The plan pays 100%. |
|
Deductible |
$2,500 single/$5,000 non-single |
|
Coinsurance |
The plan pays 80% after the deductible is met. |
|
Out-of-Pocket Maximum (Individual) |
$5,000 |
|
Out-of-Pocket Maximum (Family) |
$10,000 |
Last updated: 08/31/2023
