YOURJOURNEYTO HEALTH MEDICAL Medical insurance helps you pay for preventive care, routine health needs, prescriptions, and advanced procedures by cost-sharing with your insurance provider. Hover over the insurance terms below to learn what they mean! OAP HDHP HSA $1,500 HDHP HSA $3,500 Individual: $2,000 Individual: $1,500 Individual: $3,500 DEDUCTIBLE Family: $4,000 Individual with Family: $2,800 Family: $7,000 Family: $3,000 Primary Care: $30 Primary Care: *30% Coinsurance Primary Care: *30% Coinsurance OFFICE VISITS Specialist: $50 Specialist: *30% Coinsurance Specialist: *30% Coinsurance REVIEW PLAN Urgent Care: $50 Urgent Care: *30% Coinsurance Urgent Care: *30% Coinsurance Inpatient: *30% Coinsurance Inpatient: *30% Coinsurance Inpatient: *30% Coinsurance SBC & SUMMARY PROCEDURES Outpatient: *30% Coinsurance Outpatient: *30% Coinsurance Outpatient: *30% Coinsurance Emergency Room: $200 Emergency Room: *30% Coinsurance Emergency Room: *30% Coinsurance Tier 1: $10 Tier 1: $10 after deductible Tier 1: $15 after deductible OAP PRESCRIPTIONS Tier 2: $35 Tier 2: $35 after deductible Tier 2: $35 after deductible Tier 3: 60 Tier 3: $60 after deductible Tier 3: $60 after deductible HSA $1,500 OUT-OF-POCKET Individual: $4,000 Individual: $4,000 Individual: $5,000 MAXIMUM Family: $8,000 Family: $8,000 Family: $10,000 HSA $3,500 RATES PER Employee: $132.24 Employee: $92.96 Employee: $44.72 BIWEEKLY Employee + Spouse: $268.31 Employee + Spouse: $188.61 Employee + Spouse: $90.74 PAY PERIOD Employee + Children: $253.64 Employee + Children: $178.29 Employee + Children: $85.78 Save on Family: $389.71 Family: $273.94 Family: $131.79 Prescriptions! * D e d u ct i b l e A p p l i e s Fi r st The rates and benefit plan information shown in this guide are illustrative only. To the extent the rates or the benefit plan information summarized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases. The insurance carrier will determine the actual rates based upon the final member enrollment, plan selection, funding, type, and eligibility criteria. Until that time, and the carrier's final communication, the rates will be subject to change.