Card Category: Medical
HSA Eligible
OPTION 1
Family
Your Monthly Premium
$2,382.33
Individual Deductible
$3,500
Individual Out-of-Pocket Max
$6,900
Family Deductible
$7,000
Family Out-of-Pocket Max
$13,800
Office Visit
20% After Deductible
Specialist Visit
20% After Deductible
HSA Eligible
OPTION 1
Primary Only
Your Monthly Premium
$794.29
Individual Deductible
$3,500
Individual Out-of-Pocket Max
$6,900
Family Deductible
$7,000
Family Out-of-Pocket Max
$13,800
Office Visit
20% After Deductible
Specialist Visit
20% After Deductible
HSA Eligible
OPTION 1
Primary + Spouse
Your Monthly Premium
$1,668.03
Individual Deductible
$3,500
Individual Out-of-Pocket Max
$6,900
Family Deductible
$7,000
Family Out-of-Pocket Max
$13,800
Office Visit
20% After Deductible
Specialist Visit
20% After Deductible
HSA Eligible
OPTION 1
Primary + Child(ren)
Your Monthly Premium
$1,508.85
Individual Deductible
$3,500
Individual Out-of-Pocket Max
$6,900
Family Deductible
$7,000
Family Out-of-Pocket Max
$13,800
Office Visit
20% After Deductible
Specialist Visit
20% After Deductible
HSA Eligible
OPTION 2
Primary Only
Your Monthly Premium
$762.97
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 2
Primary + Spouse
Your Monthly Premium
$1,602.27
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 2
Primary + Child(ren)
Your Monthly Premium
$1,449.36
Individual Deductible
$5,000
Individual Out-of-Pocket Max
$6,500
Family Deductible
$10,000
Family Out-of-Pocket Max
$13,000
Office Visit
$0 After Deductible
Specialist Visit
$0 After Deductible
HSA Eligible
OPTION 2
Family
Your Monthly Premium
$2,288.39
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
OPTION 3
Family
Your Monthly Premium
$2,741.80
Individual Deductible
$0
Individual Out-of-Pocket Max
$7,900
Family Deductible
$0
Family Out-of-Pocket Max
$15,800
Office Visit
No Cost
Specialist Visit
No Cost
OPTION 3
Primary Only
Your Monthly Premium
$914.14
Individual Deductible
$0
Individual Out-of-Pocket Max
$7,900
Family Deductible
$0
Family Out-of-Pocket Max
$15,800
Office Visit
No Cost
Specialist Visit
No Cost