|  |  | |
| Plan | Capital 6300 Bronze 60 HMO | Bronze 60 HDHP 7000/0 (shop) | Gateway 7000 Bronze 60 HDHP HMO |
| Metal | Bronze | Bronze | Bronze |
| Network | HMO Network | Kaiser Permanente | HMO Network |
| Deductible | $6300/$12,600 family | $7000/$14,000 family | $7000/$14,000 family |
| Coinsurance | Fixed copays for most services | 100% coverage for most services | 100% coverage after ded for most services |
| Out of Pocket Mzx | $8200/$16,400 family | $7000/$14,000 family | $7000/$14,000 family |
| Ambulance | 60% coverage (after deductible) | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Chiropractor | $15 copayment (20 visits max) | Not covered | 100% coverage (after deductible) |
| Durable Med Equip | 60% coverage (after deductible) | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Emergency Room | 60% coverage (after deductible) | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Hospital | 60% coverage (after deductible) | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Infertility | Optional | Optional | Optional |
| Lab & X-Ray | Lab $40/X-ray 60% cov after ded | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Office Visit | $65 copay (ded applies) | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Specialist | $95 copay (ded applies) | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Outpatient Surgery | 60% coverage (after deductible) | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Physical Therapy | $65 copay | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Inpatient Psych | 60% coverage (after deductible) | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Outpatient Psych | $65 copay (ded applies) | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Rx Tier 1 | $18 copayment (after $500 Rx ded) | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Rx Tier 2 | 60% coverage up to $500 (after $500 Rx ded) | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Rx Tier 3 | 60% coverage up to $500 (after $500 Rx ded) | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Rx Tier 4 | 60% coverage up to $500 (after $500 Rx ded) | 100% coverage (after deductible) | 100% coverage (after deductible) |
| Links | Brochure Formulary Providers | Brochure Formulary Providers | Brochure Formulary Providers |
| Joe Walters | 331.88 fam 1508.75 | 332.51 fam 1553.57 | 340.46 fam 1547.74 |
| Total | 331.88 w deps 1508.75 | 332.51 w deps 1553.57 | 340.46 w deps 1547.74 |