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 |