AV Calculator Output Number
0.948771022912547
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
$900
SBC Scenario, Having a Baby, Copayment
$0
SBC Scenario, Having a Baby, Deductible
$0
SBC Scenario, Having Diabetes, Coinsurance
$200
SBC Scenario, Having Diabetes, Copayment
$200
SBC Scenario, Having Diabetes, Deductible
$0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance
$700
SBC Scenario, Treatment of a Simple Fracture, Copayment
$100
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
$6000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person
$3000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual
$3,000
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance
20.00%
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group
$2000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person
$1000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual
$1,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group
$4000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person
$2000 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual
$2,000