Compare health plan details

Check out what’s covered — and the benefit amounts — with  each different  plan. 

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Plan highlights

Network coverage

Does this plan cover both network and out-of-network providers?

No — covers network doctors and facilities only

Yes — covers both network and out-of-network doctors and providers

Primary Care Provider

Is a Primary Care Provider (PCP) required with this plan?

No — this plan does not require a PCP    

No — this plan does not require a PCP    

Savings account option

Does this plan offer a savings or reimbursement account that can be used toward health expenses?

No

No

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Search for providers

Find out if your doctor, clinic or facility is in the network

Medical annual deductibles and out-of-pocket limits

Deductible amounts

Individual

Network

$175
$175

Out-of-network

Not Applicable
$500

Family

Network

$350
$350

Out-of-network

Not Applicable
$1,000

Out-of-pocket limits

Individual

Network

$6,350
$6,350

Out-of-network

Not Applicable
$12,700

Family

Network

$12,700
$12,700

Out-of-network

Not Applicable
$25,400

Medical costs - copays ($) and coinsurance (%)

Doctors and specialists

Preventive care visit

Network

$0
$0

Out-of-network

Not Applicable
40%

after deductible

Primary care visit (illness or injury)

Network

$35
$40

Out-of-network

Not Applicable
40%

after deductible

Primary care kids visit

Network

$35
$40

Out-of-network

Not Applicable
40%

after deductible

Mental health visit (outpatient)

Network

$0
$0

Out-of-network

Not Applicable
40%

after deductible

Specialist visit

Network

$50
$55

Out-of-network

Not Applicable
40%

after deductible

Virtual, urgent and emergency care

24/7 Virtual Visit (online doctor)

Network

$0
$0

Urgent care visit

Network

$50

after deductible

$50

after deductible

Out-of-network

Not Applicable
$50

after deductible

Emergency room

Network

$200

after deductible

$200

after deductible

Out-of-network

Not Applicable
$200

after deductible