AV Calculator Output Number
1.0
Begin Primary Care Deductible Coinsurance After Number Of Copays
0
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance
0.00%
Inpatient Copayment Maximum Days
0
Medical Drug Deductibles Integrated
No
Medical Drug Maximum Out of Pocket Integrated
Yes
Medical EHB Deductible, In Network (Tier 1), Default Coinsurance
0.00%
SBC Scenario, Having a Baby, Coinsurance
$0
SBC Scenario, Having a Baby, Copayment
$0
SBC Scenario, Having a Baby, Deductible
$0
SBC Scenario, Having Diabetes, Coinsurance
$0
SBC Scenario, Having Diabetes, Copayment
$0
SBC Scenario, Having Diabetes, Deductible
$0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance
$0
SBC Scenario, Treatment of a Simple Fracture, Copayment
$0
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
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group
$0 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person
$0 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual
$0
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