AV Calculator Output Number
1
Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Family
per person not applicable | per group not applicable
Maximum Out of Pocket for Drug EHB Benefits, Combined In/Out Network, Individual
Not Applicable
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance
0.00%
Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 1), Individual
$0
Maximum Out of Pocket for Drug EHB Benefits, In Network (Tier 2), Individual
$0 per person | $0 per group
Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Family
per person not applicable | per group not applicable
Maximum Out of Pocket for Drug EHB Benefits, Out of Network, Individual
Not Applicable
Medical Drug Deductibles Integrated
No
Medical Drug Maximum Out of Pocket Integrated
No
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family
per person not applicable | per group not applicable
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out
Not Applicable
Medical EHB Deductible, In Network (Tier 1), Default Coinsurance
0.00%
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family
$0 per person | $0 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual
$0
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family
per person not applicable | per group not applicable
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual
Not Applicable
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