SOLO PPO 1200
| Plan Type |
PPO |
| Co-insurance |
70% In-network |
50% Out-of-network |
Deductible
(individual/family) |
$1,200/$2,400 In-network |
$2,400/$4,800 Out-of-network |
Out-of-Pocket Max
(individual/family) |
$5,200/$10,400 In-network |
$10,400/$20,800 Out-of-network |
| Prescription coverage |
Generic $15
Preferred $30
Non-preferred $50 |
| HSA |
No |
| More information |
Summary of Benefits (pdf) |
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