Plan	Silver Full PPO 1800/55 OffEx	Silver Select PPO 50/2250/20% 4HZP	Silver 70 PPO 2250/50 Plus Child Dental	Silver 70 PPO 2250/50
Metal	Silver	Silver	Silver	Silver
Network	Full PPO Network	Select PPO	Full PPO Network	Kaiser PPO
Deductible	$1800/$3600 family	$2520/$4500 family	$2250/$4500 family	$2250/$4500 family
Coinsurance	65% coverage for most services	80% coverage for most services	80% coverage for most services	80% coverage for most services
Out of Pocket Mzx	$7800/$15,600 family	$7800/$15,600 family	$7800/$15,600 family	$7800/15,600 family
Ambulance	65% coverage (after deductible)	$250 copay	$250 copayment (after deductible)	$250 (after deductible)
Chiropractor	$15 per visit	Not covered	Not covered	Not covered
Durable Med Equip	50% coverage (after deductible)	80% coverage (ded waived)	80% coverage (after deductible)	80% coverage (ded applies)
Emergency Room	$350 per visit then 65% cov after ded	$400 copay	$400 copay (after ded)	$400 copay after ded
Hospital	65% coverage (after deductible)	80% coverage (ded applies)	80% coverage (after deductible)	80% coverage (after deductible)
Infertility	Not covered	Not covered	Not covered	Optional
Lab & X-Ray	Lab: $55 copay/X-ray: $80	$40 lab/$85 X-ray copayment	$40 lab/$85 X-ray	$40 lab/$85 X-ray
Office Visit	$55 copayment	$50 copayment	$50 copayment	$50 copayment
Specialist	$80 copayment	$85 copayment	$85 copayment	$85 copayment
Outpatient Surgery	65% coverage (after deductible)	80% coverage (ded applies)	80% coverage (after deductible)	80% coverage (after deductible)
Physical Therapy	65% coverage (after deductible)	$50 copayment	$50 copayment (after deductible)	$50 copayment
Inpatient Psych	65% coverage (after deductible)	80% coverage (ded applies)	80% coverage (after deductible)	80% coverage (after deductible)
Outpatient Psych	$55 copayment	$50 copayment	$50 copayment	$50 copayment
Rx Tier 1	$20 copayment	$17 copay after $300 Rx ded	$17 copayment (after $300 Rxd ed)	$300 Rx ded then $17 ded per Rx
Rx Tier 2	$75 copayment (after $300 Rx ded)	$65 copayment after $300 Rx ded	$65 copayment (after $300 Rx ded)	$65 copay (after $300 Rx ded)
Rx Tier 3	$115 copayment (after $300 Rx ded)	$90 copayment after $300 Rx ded	$90 copayment (after $300 Rxded)	$65 copay (after $300 Rx ded)
Rx Tier 4	70% coverage up to $250 per Rx (after $300 Rx ded)	80% coverage to $250 max $300 Rx ded	80% coverage up to $250 per Rx (after $300 Rxded)	80% cov $250 max ben (after $300 Rx ded)
Links	Brochure Formulary Providers	Brochure Formulary Providers	Brochure Formulary Providers	Brochure Formulary Providers
Jie Ma	438.3	460.99	472.22	642.2
Adriana Cendejas	370.5	389.68	399.17	542.86
Total	808.8	850.67	871.39	1185.06