Choosing Your Plan* In-Network* DEDUCTIBLE (Many covered at 100%) COINSURANCE OOP MAX OFFICE VISIT $1,000 (1) coeres t $3,00925100510 $275055.500$2,750/5.50 $500/$1,000 500/$1,000 $2,750/$5,500 $2,750/$5,500 20% 25% 35% $6,650/$13,300 Deductible & Coinsurance Deductible, then 20/40/65% Deductible, then 100% $500/$1,000 Employee - $500 50% 20% $6,250/$12,500 $7,350/$14,700 $6,650/$13,300$5,500/$11,000 $40/50/60 Copay 20/40/65% Covered 100% Deductible & Coinsurance Deductible, then 20/40/65% Deductible, then 100% Deductible & Coinsurance Deductible, then 20/40/65% Deductible, then 100% Deductible & Coinsurance Deductible, then 20/40/65% Deductible, then 100% Rx COINSURANCE LAB SERVICES (Preferred Provider)' HQ REWARDS* Discount Only $500/$1,000 s00/$1,000 $500/$1,000 Annual Employer HSA/HRA Contribution Full-Time)* Employee - $1,000 N/A N/A N/A EE+Children-$1,750 EE+Children- $875 EE+Sp/Family-$1,250 EE+Sp/Family $625 Choosing Your Plan* In-Network* DEDUCTIBLE (Many covered at 100%) COINSURANCE OOP MAX OFFICE VISIT $1,000 (1) coeres t $3,00925100510 $275055.500$2,750/5.50 $500/$1,000 500/$1,000 $2,750/$5,500 $2,750/$5,500 20% 25% 35% $6,650/$13,300 Deductible & Coinsurance Deductible, then 20/40/65% Deductible, then 100% $500/$1,000 Employee - $500 50% 20% $6,250/$12,500 $7,350/$14,700 $6,650/$13,300$5,500/$11,000 $40/50/60 Copay 20/40/65% Covered 100% Deductible & Coinsurance Deductible, then 20/40/65% Deductible, then 100% Deductible & Coinsurance Deductible, then 20/40/65% Deductible, then 100% Deductible & Coinsurance Deductible, then 20/40/65% Deductible, then 100% Rx COINSURANCE LAB SERVICES (Preferred Provider)' HQ REWARDS* Discount Only $500/$1,000 s00/$1,000 $500/$1,000 Annual Employer HSA/HRA Contribution Full-Time)* Employee - $1,000 N/A N/A N/A EE+Children-$1,750 EE+Children- $875 EE+Sp/Family-$1,250 EE+Sp/Family $625