OPTION 1

Primary Only

Your Monthly Premium

$996.44

Individual Deductible
$6,000
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

Primary + Spouse

Your Monthly Premium

$2,092.58

Individual Deductible
$6,000
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

Primary + Child(ren)

Your Monthly Premium

$1,892.86

Individual Deductible
$6,000
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

$2,988.65

Individual Deductible
$6,000
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

$960.04

Individual Deductible
$8,500
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

$2,016.12

Individual Deductible
$8,500
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

$1,823.73

Individual Deductible
$8,500
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

$2,879.47

Individual Deductible
$8,500
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

$804.36

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

$1,689.20

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