$1,700 (Individual) / $3,400 (Family)
Annual Deductible
$8,000 (Individual) / $16,000 (Family)
Out-of-Pocket Maximum
Primary Care/Office Visit
Specialist Visit

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$1,700 (Individual) / $3,400 (Family)
Annual Deductible
$8,000 (Individual) / $16,000 (Family)
Out-of-Pocket Maximum
Primary Care/Office Visit
Specialist Visit
$0
Annual Deductible
$3,000 (Individual) / $6,000 (Family)
Out-of-Pocket Maximum
Primary Care/Office Visit
Specialist Visit
$0
Annual Deductible
$2,000 (Individual) / $4,000 (Family)
Out-of-Pocket Maximum
Primary Care/Office Visit
Specialist Visit

$50 (I) / $150 (F)
Annual Deductible
$1,000/person
Calendar Year Maximum
You pay 20% after deductible
Basic Services
Orthodontic Services

$10
Eye Exam Copay
$25
Lenses
$100
Frames
Contacts