2022 United Stated Benefits Options

Option #2- PPO Plan Deductible: Deductible must be met before coinsurance applies

Single $1,250 Family $2,500

Co-Insurance

80% after deductible* (changes may apply if it’s out of network)

Single $3,000 Family $6,000

Max Out of Pocket

Life Max

Unlimited

Office/Specialist Visit Preventative Care

$30 each visit

100% no cost to associate

Emergency Room

$250

Urgent Care

$75

Lab/Diagnostic

80% coverage after deductible

RX Retail

30 day supply $10/$30/$50/$100 (tiers)

RX Mail Order

90 day supply $25/$75/$125/$250

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