In-Network Services -
Deductible (Individual/Family): $0
Out-of-Pocket Maximum (Individual/Family): $2,500/$5,000
Primary Care Visit: $15 copay
Specialist Visit: $30 copay
Urgent Care: $50 copay
Prescription Drugs -
Generic: $10 copay
Preferred Brand: $35 copay
Non-Preferred Brand: $70 copay
