AV Calculator Output Number
0.878273009
Inpatient Copayment Maximum Days
5
Medical Drug Deductibles Integrated
Yes
Medical Drug Maximum Out of Pocket Integrated
Yes
SBC Scenario, Having a Baby, Coinsurance
$400
SBC Scenario, Having a Baby, Copayment
$800
SBC Scenario, Having a Baby, Deductible
$750
SBC Scenario, Having Diabetes, Coinsurance
$10
SBC Scenario, Having Diabetes, Copayment
$800
SBC Scenario, Having Diabetes, Deductible
$750
SBC Scenario, Treatment of a Simple Fracture, Coinsurance
$0
SBC Scenario, Treatment of a Simple Fracture, Copayment
$900
SBC Scenario, Treatment of a Simple Fracture, Deductible
$700
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family
per person not applicable | per group 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
20.00%
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family
$2500 per person | $5000 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual
$2,500
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family
per person not applicable | per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual
Not Applicable