Begin Primary Care Deductible Coinsurance After Number Of Copays
0
Inpatient Copayment Maximum Days
0
Medical Drug Deductibles Integrated
Yes
Medical Drug Maximum Out of Pocket Integrated
Yes
SBC Scenario, Having a Baby, Coinsurance
$0
SBC Scenario, Having a Baby, Copayment
$1,100
SBC Scenario, Having a Baby, Deductible
$2,000
SBC Scenario, Having Diabetes, Coinsurance
$0
SBC Scenario, Having Diabetes, Copayment
$1,800
SBC Scenario, Having Diabetes, Deductible
$0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance
$0
SBC Scenario, Treatment of a Simple Fracture, Copayment
$800
SBC Scenario, Treatment of a Simple Fracture, Deductible
$1,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group
per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person
per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual
Not Applicable
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance
50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance
50.00%
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group
$11700 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person
$5850 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual
$5,850
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group
$11700 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person
$5850 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual
$5,850
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group
per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person
per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual
Not Applicable