Preventive care |
Covered 100%, no deductible |
Covered 100%, no deductible |
Covered 100%, no deductible |
Covered 100%, no deductible |
Covered 100%, no deductible |
Doctor's office visit |
You pay 25% after deductible |
You pay 25% after deductible |
You pay 25% after deductible |
You pay $25 for PCP visit and $40 for specialist visit, no deductible |
You pay $25 for PCP visit and $40 for specialist visit, no deductible |
Emergency room |
You pay 25% after deductible |
You pay 25% after deductible |
You pay 25% after deductible |
You pay 25% after deductible |
You pay 15% after deductible |
Urgent care |
You pay 25% after deductible |
You pay 25% after deductible |
You pay 25% after deductible |
You pay 25% after deductible |
You pay 15% after deductible |
Inpatient care |
You pay 25% after deductible |
You pay 25% after deductible |
You pay 25% after deductible |
You pay 25% after deductible |
You pay 15% after deductible |
Outpatient care |
You pay 25% after deductible |
You pay 25% after deductible |
You pay 25% after deductible |
If not an office visit, you pay 25% after deductible
|
You pay 15% after deductible |