$3,000 (I) / $6,000 (F)
Annual Deductible
$6,000 (Individual) / $12,000 (Family)
Out-of-Pocket Maximum
Primary Care/Office Visit
Specialist Visit

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$3,000 (I) / $6,000 (F)
Annual Deductible
$6,000 (Individual) / $12,000 (Family)
Out-of-Pocket Maximum
Primary Care/Office Visit
Specialist Visit
$0
Annual Deductible
$6,850 (Individual) / $13,700 (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
Lenses
$150
Frames
$150
Contacts