MEDICAL PLANS

$3,400 HDHP PLAN 2	In-Network	Out-of-Network
Deductible Individual/ Family	$3,400 / $6,800	$3,400 / $6,800
Out-of-pocket maximum	$6,650 / $13,300	$13,300 / $26,600
Coinsurance	80%	60%
Preventative Care	$0	Deductible then Coinsurance
Primary care office visit	Deductible then Coinsurance	Deductible then Coinsurance
Specialty offcie visit	Deductible then Coinsurance	Deductible then Coinsurance
Urgent Care Visit	Deductible then Coinsurance	Deductible then Coinsurance
Inpatient hospital service / Outpatient surgery	Deductible then Coinsurance	Deductible then Coinsurance
Lab services	Deductible then Coinsurance	Deductible then Coinsurance
MRI, MRA, CT and PET scans	Deductible then Coinsurance	Deductible then Coinsurance
Emergency room	Deductible then Coinsurance	Deductible then Coinsurance
X-rays	Deductible then Coinsurance	Deductible then Coinsurance
Prescription drugs Tier 1 / Tier2 / Tier 3	Deductible then Coinsurance	Deductible then Coinsurance
Lifetime maximum	Unlimited	Unlimited

Bi-Weekly Cost	$20 AHY DISCOUNT	$10 AHY DISCOUNT	$5 AHY DISCOUNT	NO AHY DISCOUNT
EMPLOYEE	$19.94	$29.94	$34.94	$39.94
EMPLOYEE + SPOUSE	$132.99	$142.99	$147.99	$152.99
EMPLOYEE + CHILD(REN)	$87.12	$97.12	$102.12	$107.12
FAMILY	$213.92	$223.92	$228.92	$233.92