Card Category: Medical
OPTION 3
Primary + Spouse
Your Monthly Premium
$1,919.73
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 + Child(ren)
Your Monthly Premium
$1,736.53
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 4
Primary + Spouse
Your Monthly Premium
$2,020.76
Individual Deductible
$0
Individual Out-of-Pocket Max
$5,000
Family Deductible
$0
Family Out-of-Pocket Max
$10,000
Office Visit
No Cost
Specialist Visit
No Cost
OPTION 4
Primary + Child(ren)
Your Monthly Premium
$1,827.91
Individual Deductible
$0
Individual Out-of-Pocket Max
$5,000
Family Deductible
$0
Family Out-of-Pocket Max
$10,000
Office Visit
No Cost
Specialist Visit
No Cost
OPTION 4
Primary Only
Your Monthly Premium
$962.24
Individual Deductible
$0
Individual Out-of-Pocket Max
$5,000
Family Deductible
$0
Family Out-of-Pocket Max
$10,000
Office Visit
No Cost
Specialist Visit
No Cost
OPTION 4
Family
Your Monthly Premium
$2,886.08
Individual Deductible
$0
Individual Out-of-Pocket Max
$5,000
Family Deductible
$0
Family Out-of-Pocket Max
$10,000
Office Visit
No Cost
Specialist Visit
No Cost