*Please note: If you enroll in this plan, you are eligible to enroll in a Health Savings Account (HSA) through Optum Bank. Please sign up in Employee Navigator.
In-Network Services -
Deductible (Individual/Family): $5,500/$11,000
Out-of-Pocket Maximum (Individual/Family): $6,500/$13,000
Primary Care Visit: 30% coinsurance after deductible
Specialist Visit: 30% coinsurance after deductible
Urgent Care: 30% coinsurance after deductible
Prescription Drugs -
Generic: $10 copay after deductible
Preferred Brand: $35 copay after deductible
Non-Preferred Brand: $70 copay after deductible