|  | | |
| Plan | Bronze 60 HMO 6300/60 (shop) | Silver 70 HMO 1900/65 (shop) | Gold 80 HMO 250/35 (shop) |
| Metal | Bronze | Silver | Gold |
| Network | Kaiser Permanente | Kaiser Permanente | Kaiser Permanente |
| Deductible | $6300/$12,600 family | $1900/$3800 family | $250 ($500 family) |
| Coinsurance | 60% coverage for most services | 55% coverage for most services | Fixed copays for most services |
| Out of Pocket Mzx | $9100/18,200 family | $8750/17,500 family | $7800/15,600 family |
| Ambulance | 60% coverage (after ded) | 55% coverage (after ded) | $250 copay (after ded) |
| Chiropractor | $60 copay (physciain referral) | $15 copay (20 visits ann max) | $35 copay (physician referral) |
| Durable Med Equip | 60% coverage (after ded) | 55% coverage (after ded) | 80% coverage (after ded) |
| Emergency Room | 60% coverage (after ded) | 55% coverage (after ded) | $250 copay (after ded) |
| Hospital | 60% coverage (after ded) | 55% coverage (after ded) | $600 per day 1st 5 days |
| Infertility | Optional | Optional | Optional |
| Lab & X-Ray | Lab $40/X-ray 60% coverage (after ded) | $30 lab/$75 X-ray after ded | $35 lab/$55 X-ray |
| Office Visit | $60 copay (ded applies) | $65 copayment | $35 copayment |
| Specialist | $95 copayment (ded applies) | $100 copayment | $55 copayment |
| Outpatient Surgery | 60% coverage (after ded) | 55% coverage (after ded) | $335 copay (after ded) |
| Physical Therapy | $60 copayment | $65 copayment | $35 copayment |
| Inpatient Psych | 60% coverage (after ded) | 55% coverage (after ded) | $600 per day 1st 5 days |
| Outpatient Psych | $60 copay (ded applies) | $65 copayment | $35 copayment |
| Rx Tier 1 | $17 copayr after $500 Rx ded | $20 copay | $15 copayment |
| Rx Tier 2 | 60% coverage to $500 ($500 Rx ded applies) | $100 copayment | $40 copayment |
| Rx Tier 3 | 60% coverage to $500 ($500 Rx ded applies) | $100 copayment | $40 copayment |
| Rx Tier 4 | 60% coverage to $500 ($500 Rx ded applies) | 80% cov $250 max ben (after medical ded) | 80% coverage to $250 |
| Links | Brochure Formulary Providers | Brochure Formulary Providers | Brochure Formulary Providers |
| Kelly Kann | 417.07 fam 1732.6 | 488.53 fam 2022.26 | 594.05 fam 2450.01 |
| Lauren Lanthier | 382.13 fam 1264.08 | 447.6 fam 1475.86 | 544.28 fam 1788.61 |
| Total | 799.20 w deps 2996.68 | 936.13 w deps 3498.12 | 1138.33 w deps 4238.62 |