2019 Benefits

Option #2 Deductible: Coverage requires the deductible to be met before coinsurance applies.

Single $1,250 Family $2,500

80% after deductible

Co-Insurance

Single $3,000 Family $6,000

Max Out of Pocket

Unlimited

Life Max

$30 each visit

Office/Specialist Visit

100% no cost to associate

Preventative Care: Routine or periodic exams, well baby exams, well child exams, adult physical exams, pelvic examinations, routine EKG, immunizations, screening examinations

$250

Emergency Room

$75

Urgent Care

20% after deductible

Lab/Diagnostic

30 day supply $10/$30/$50/$100 90 day supply $25/$75/$125/$250

RX Retail

RX Mail Order