| Plan Type |
PPO |
| Co-insurance |
80% In-network |
50% Out-of-network |
Deductible
(individual/family) |
$5,000/$10,000 In-network |
$10,000/$20,000 Out-of-network |
Out-of-Pocket Max
(individual/family) |
$10,000/$20,000 In-network |
$20,000/$40,000 Out-of-network |
| Prescription coverage |
Generic $15
Preferred $30
Non-preferred $50 |
| HSA |
No |
| More information |
Summary of Benefits (pdf) |
