In-Network Deductible (Individual/Individual in a Family/Family)
$2,800/$3,400/$5,600
In-Network Out-of-Pocket Maximum (Individual/Family)
$4,500/$4,500/$9,000
Office Visits (PCP/Specialist)
10% after deductible
Prescription Drugs
| Tier 1 | $10 copay after deductible |
| Tier 2 | $30 copay after deductible |
| Tier 3 | $50 copay after deductible |
| Tier 4 | 25% coinsurance up to $800 after deductible
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