AV Calculator Output Number
0.815406299
Begin Primary Care Deductible Coinsurance After Number Of Copays
0
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance
50.00%
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
20.00%
SBC Scenario, Having a Baby, Coinsurance
$2,100
SBC Scenario, Having a Baby, Copayment
$10
SBC Scenario, Having a Baby, Deductible
$1,800
SBC Scenario, Having Diabetes, Coinsurance
$0
SBC Scenario, Having Diabetes, Copayment
$700
SBC Scenario, Having Diabetes, Deductible
$900
SBC Scenario, Treatment of a Simple Fracture, Coinsurance
$60
SBC Scenario, Treatment of a Simple Fracture, Copayment
$200
SBC Scenario, Treatment of a Simple Fracture, Deductible
$1,800
Specialty Drug Maximum Coinsurance
$500
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
$16300 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person
$8150 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual
$8,150
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