Archives: Cards & Charts
OPTION 1
Primary + Child(ren)
Your Monthly Premium
$1,989.54
Individual Deductible
N/A for no cost services
Individual Out-of-Pocket Max
$6,000
Family Deductible
$12,000
Family Out-of-Pocket Max
$12,000
Office Visit
No charge
Specialist Visit
No charge
OPTION 1
Family
Your Monthly Premium
$3,141.30
Individual Deductible
N/A for no cost services
Individual Out-of-Pocket Max
$6,000
Family Deductible
$12,000
Family Out-of-Pocket Max
$12,000
Office Visit
No charge
Specialist Visit
No charge
OPTION 2
Primary Only
Your Monthly Premium
$991.94
Individual Deductible
N/A for no cost services
Individual Out-of-Pocket Max
$8,500
Family Deductible
$17,000
Family Out-of-Pocket Max
$17,000
Office Visit
No Charge
Specialist Visit
No Charge
OPTION 2
Primary + Spouse
Your Monthly Premium
$2,083.11
Individual Deductible
N/A for no cost services
Individual Out-of-Pocket Max
$8,500
Family Deductible
$17,000
Family Out-of-Pocket Max
$17,000
Office Visit
No Charge
Specialist Visit
No Charge
OPTION 2
Primary + Child(ren)
Your Monthly Premium
$1,884.33
Individual Deductible
N/A for no cost services
Individual Out-of-Pocket Max
$8,500
Family Deductible
$17,000
Family Out-of-Pocket Max
$17,000
Office Visit
No Charge
Specialist Visit
No Charge
OPTION 2
Family
Your Monthly Premium
$2,975.15
Individual Deductible
N/A for no cost services
Individual Out-of-Pocket Max
$8,500
Family Deductible
$17,000
Family Out-of-Pocket Max
$17,000
Office Visit
No Charge
Specialist Visit
No Charge
HSA Eligible
OPTION 3
Primary Only
Your Monthly Premium
$890.19
Individual Deductible
$5,000
Individual Out-of-Pocket Max
$6,500
Family Deductible
$10,000
Family Out-of-Pocket Max
$13,000
Office Visit
20% after deductible
Specialist Visit
20% after deductible
HSA Eligible
OPTION 3
Primary + Spouse
Your Monthly Premium
$1,869.45
Individual Deductible
$5,000
Individual Out-of-Pocket Max
$6,500
Family Deductible
$10,000
Family Out-of-Pocket Max
$13,000
Office Visit
20% after deductible
Specialist Visit
20% after deductible
HSA Eligible
OPTION 3
Primary + Child(ren)
Your Monthly Premium
$1,691.05
Individual Deductible
$5,000
Individual Out-of-Pocket Max
$6,500
Family Deductible
$10,000
Family Out-of-Pocket Max
$13,000
Office Visit
$0 After Deductible
Specialist Visit
$0 After Deductible
HSA Eligible
OPTION 3
Family
Your Monthly Premium
$2,669.99
Individual Deductible
$5,000
Individual Out-of-Pocket Max
$6,500
Family Deductible
$10,000
Family Out-of-Pocket Max
$13,000
Office Visit
20% after deductible
Specialist Visit
20% after deductible