|  | | | |
| Plan | Silver 70 HMO 2950/65 (shop) | Silver 70 HMO 2300/65 (shop) | Silver 70 HMO 2500/55 (shop) | Silver 70 HMO 1900/65 (shop) |
| Metal | Silver | Silver | Silver | Silver |
| Network | Kaiser Permanente | Kaiser Permanente | Kaiser Permanente | Kaiser Permanente |
| Deductible | $2900/$5800 family | $2300/$4600 family | $2500/$5000 family | $1900/$3800 family |
| Coinsurance | 55% coverage for most services | 55% coverage for most services | Fixed copays for most services | 55% coverage for most services |
| Out of Pocket Mzx | $9100/18,200 family | $8750/17,500 family | $8750/17,500 family | $8750/17,500 family |
| Ambulance | 55% coverage (after ded) | 55% coverage (after ded) | 65% coverage (ded applies) | 55% coverage (after ded) |
| Chiropractor | $15 copay (20 visits ann max) | $15 copay (20 visits ann max) | $65 copay (physciain referral) | $15 copay (20 visits ann max) |
| Durable Med Equip | 65% cov (ded waived) | 55% coverage (ded applies) | 65% coverage (ded applies) | 55% coverage (after ded) |
| Emergency Room | 55% coverage (ded applies) | 55% coverage (ded applies) | 65% coverage (ded applies) | 55% coverage (after ded) |
| Hospital | 55% coverage (ded applies) | 55% coverage (ded applies) | 65% coverage (ded applies) | 55% coverage (after ded) |
| Infertility | Optional | Optional | Optional | Optional |
| Lab & X-Ray | $30 lab after ded/$75 X-ray after ded | $30 lab/$75 X-ray after ded | $55 lab/$90 X-ray | $30 lab/$75 X-ray after ded |
| Office Visit | $65 copayment | $65 copayment | $55 copayment | $65 copayment |
| Specialist | $100 copayment | $100 copayment | $90 copayment | $100 copayment |
| Outpatient Surgery | 55% coverage (ded applies) | 65% coverage (after ded) | 65% coverage (after ded) | 55% coverage (after ded) |
| Physical Therapy | $65 copayment | $55 copayment | $55 copayment | $65 copayment |
| Inpatient Psych | 55% coverage (ded applies) | 55% coverage (ded applies) | 65% coverage (ded applies) | 55% coverage (after ded) |
| Outpatient Psych | $65 copayment | $65 copayment | $55 copayment | $65 copayment |
| Rx Tier 1 | $20 copay | $20 copay | $19 copay | $20 copay |
| Rx Tier 2 | $100 copay (after med ded) | $100 copay (after $500 Rx ded) | $85 copay (after $300 Rx ded) | $100 copayment |
| Rx Tier 3 | $100 copay (after med ded) | $100 copay (after $500 Rx ded) | $85 copay (after $300 Rx ded) | $100 copayment |
| Rx Tier 4 | 55% coverage to $250 (med ded applies) | 80% cov $250 max (after $500 Rx ded) | 70% cov $250 max (after $300 Rx ded) | 80% cov $250 max ben (after medical ded) |
| Links | Brochure Formulary Providers | Brochure Formulary Providers | Brochure Formulary Providers | Brochure Formulary Providers |
| Basilio Salaices | 658.5 | 669.3 | 675.42 | 682.3 |
| John Parks | 658.5 fam 2002.61 | 669.3 fam 2035.23 | 675.42 fam 2053.72 | 682.3 fam 2074.49 |
| Jon Ethridge | 787.42 | 800.33 | 807.66 | 815.88 |
| Jordan Hunckler | 385.99 | 392.32 | 395.91 | 399.94 |
| Total | 2490.41 w deps 3834.52 | 2531.25 w deps 3897.18 | 2554.41 w deps 3932.71 | 2580.42 w deps 3972.61 |