MEDICAL COVERAGE OPTIONS: IN-NETWORK BENEFITS*

All options cover certain medical services and prescription drugs. Note that carriers can differ by price, in-network doctors/facilities, and more. Before you enroll, use the online tools to help you decide which coverage and carrier option combination work best for you and your family. And, if you have ongoing treatment and your enrollment will result in a carrier change, ask the new carrier about their transition-of-care policy.

Coverage Option

$1,000 Deductible

$2,000 Deductible

$3,000 Deductible

$4,500 Deductible

Contribution Amount

$$

$$

$

$

Note: If applicable, the current contribution amount you pay is on MyBenefits Online

Preventive Care

◄ Covered 100% when you use in-network providers (no deductible) ►

You Pay

Deductible (Individual / Family)

$1,000 / $2,000

$2,000 / $4,000

$3,000 / $6,000

$4,500 / $9,000

Coinsurance (After Deductible)

10%

20%

30%

30%

Out-of-Pocket Maximum (Individual / Family; Includes Deductible)

$2,500 / $5,000

$4,000 / $6,850

$6,000 / $12,000

$6,000 / $12,000

Deductible and Out-of-Pocket Maximum Type

Aggregate

Aggregate

Embedded

Embedded

* Out-of-network benefits are also available, but benefits are lower and your costs are higher. So, it’s worth it to stay in-network. For details, access MyBenefits Online.

$1,000 Deductible Coverage Option

Contribution Amount: $$ Note: If applicable, the current contribution amount you pay is on MyBenefits Online

Preventive Care: Covered 100% when you use in-network providers (no deductible)

You Pay:

  • Deductible (Individual / Family) = $1,000 / $2,000
  • Coinsurance (After Deductible) = 10%
  • Out-of-Pocket Maximum (Individual / Family; Includes Deductible) = $2,500 / $5,000
  • Deductible and Out-of-Pocket Maximum Type = Aggregate

$2,000 Deductible Coverage Option

Contribution Amount: $$ Note: If applicable, the current contribution amount you pay is on MyBenefits Online

Preventive Care: Covered 100% when you use in-network providers (no deductible)

You Pay:

  • Deductible (Individual / Family) = $2,000 / $4,000
  • Coinsurance (After Deductible) = 20%
  • Out-of-Pocket Maximum (Individual / Family; Includes Deductible) = $4,000 / $6,850
  • Deductible and Out-of-Pocket Maximum Type = Aggregate

$3,000 Deductible Coverage Option

Contribution Amount: $ Note: If applicable, the current contribution amount you pay is on MyBenefits Online

Preventive Care: Covered 100% when you use in-network providers (no deductible)

You Pay:

  • Deductible (Individual / Family) = $3,000 / $6,000
  • Coinsurance (After Deductible) = 30%
  • Out-of-Pocket Maximum (Individual / Family; Includes Deductible) = $6,000 / $12,000
  • Deductible and Out-of-Pocket Maximum Type = Embedded

$4,500 Deductible Coverage Option

Contribution Amount: $ Note: If applicable, the current contribution amount you pay is on MyBenefits Online

Preventive Care: Covered 100% when you use in-network providers (no deductible)

You Pay:

  • Deductible (Individual / Family) = $4,500 / $9,000
  • Coinsurance (After Deductible) = 30%
  • Out-of-Pocket Maximum (Individual / Family; Includes Deductible) = $6,000 / $12,000
  • Deductible and Out-of-Pocket Maximum Type = Embedded

* Out-of-network benefits are also available , but benefits are lower and your costs are higher. So, it’s worth it to stay in-network. For details, access MyBenefits Online.

More information

Access a detailed comparison of the coverage options on MyBenefits Online (posted under the Resource Library).