| COVERAGE |
70/30 coverage if in network area for PPO with a $20 co-payment, $3,333 co-insurance.
60/40 coverage if not in the network area, $10,000 co-insurance
PPO Deductible: Single $750, Family $1,500
Max out of pocket: Single $1,250, Family $2,500
Non-PPO Deductible: Single $1,500, Family $3,000
Drug Prescription Card: $10/$30/$60 |