AV Calculator Output Number
0.949762398252608
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
$1,800
SBC Scenario, Having a Baby, Copayment
$10
SBC Scenario, Having a Baby, Deductible
$0
SBC Scenario, Having Diabetes, Coinsurance
$0
SBC Scenario, Having Diabetes, Copayment
$600
SBC Scenario, Having Diabetes, Deductible
$0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance
$200
SBC Scenario, Treatment of a Simple Fracture, Copayment
$200
SBC Scenario, Treatment of a Simple Fracture, Deductible
$0
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
25.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance
25.00%
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group
$4700 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person
$2350 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual
$2,350
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group
$4700 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person
$2350 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual
$2,350
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group
$32000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person
$16000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual
$16,000