Archives: Cards & Charts
HSA Eligible
OPTION 4
Primary Only
Your Monthly Premium
$744.78
Individual Deductible
$7,500
Individual Out-of-Pocket Max
$7,500
Family Deductible
$15,000
Family Out-of-Pocket Max
$15,000
Office Visit
$0 after deductible
Specialist Visit
$0 after deductible
HSA Eligible
OPTION 4
Primary + Spouse
Your Monthly Premium
$1,564.06
Individual Deductible
$7,500
Individual Out-of-Pocket Max
$7,500
Family Deductible
$15,000
Family Out-of-Pocket Max
$15,000
Office Visit
$0 after deductible
Specialist Visit
$0 after deductible
HSA Eligible
OPTION 4
Primary + Child(ren)
Your Monthly Premium
$1,414.80
Individual Deductible
$7,500
Individual Out-of-Pocket Max
$7,500
Family Deductible
$15,000
Family Out-of-Pocket Max
$15,000
Office Visit
$0 after deductible
Specialist Visit
$0 after deductible
HSA Eligible
OPTION 4
Family
Your Monthly Premium
$2,233.83
Individual Deductible
$7,500
Individual Out-of-Pocket Max
$7,500
Family Deductible
$15,000
Family Out-of-Pocket Max
$15,000
Office Visit
$0 after deductible
Specialist Visit
$0 after deductible