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