In-Network Services -
Deductible (Individual/Family): $6,000/$12,000
Out-of-Pocket Maximum (Individual/Family): $8,550/$17,100
Primary Care Visit: $35 copay
Specialist Visit: $70 copay
Urgent Care: $50 copay
Prescription Drugs -
Generic: $5 copay
Preferred Brand: $50 copay
Non-Preferred Brand: $100 copay
