Plan highlights
Plan Details | In-network only (nationwide network) |
---|---|
Deductible | $100 Individual $200 Family |
Annual out-of-pocket maximum | $1,100 Individual $3,600 Family |
Office Visits | $15 copay – Primary Care Physician $15 copay – Specialist |
Preventive Care | 100% covered, deductible waived |
Inpatient Hospital | 100% covered, after deductible |
Urgent Care | $35 copay |
Emergency Room | $75 copay |
Ambulance | 100% covered, deductible waived |
Chiropractor | $15 copay |
Short-Term Rehabilitation (150 visits per year) |
$15 copay |