|  | |
| Plan | Silver PPO 50/2200/40 6BPK | Silver PPO 55/1950/35 6BQV |
| Metal | Silver | Silver |
| Network | Prudent Buyer PPO | Prudent Buyer PPO |
| Deductible | $2250/$4500 family | $1950/$3900 family |
| Coinsurance | 70% coverage for most services | 65% coverage for most services |
| Out of Pocket Mzx | $8600/$17,200 family | $8700/$17,400 family |
| Ambulance | 70% coverage (ded applies) | 65% coverage (ded applies) |
| Chiropractor | 20 visits max (other limitations apply) | 20 visits max (other limitations apply) |
| Durable Med Equip | 70% coverage | 50% coverage (ded applies) |
| Emergency Room | 70% coverage (ded applies) | $350 copay then 65% coverage (ded applies) |
| Hospital | 70% coverage (ded applies) | 65% coverage (ded applies) |
| Infertility | Optional | Optional |
| Lab & X-Ray | $50 lab/$85 X-ray copayment | $20 lab/X-ray $100 then 65% coverage |
| Office Visit | $50 copayment | $55 copayment |
| Specialist | $85 copayment | $90 copayment |
| Outpatient Surgery | 70% coverage (ded applies) | $200 copay then 65% coverage |
| Physical Therapy | $50 copayment | $55 copayment |
| Inpatient Psych | 70% coverage (ded applies) | 65% coverage (ded applies) |
| Outpatient Psych | $50 copayment | $55 copayment |
| Rx Tier 1 | $17 copayment | $15 copayment |
| Rx Tier 2 | $70 copayment after $300 Rx ded | $70 copay after $300 Rx ded |
| Rx Tier 3 | $100 copayment after $300 Rx ded | $110 copay after $300 Rx ded |
| Rx Tier 4 | 70% coverage to $250 max $300 Rx ded | 70% coverage to $250 max after $300 Rx ded |
| Links | Brochure Formulary Providers | Brochure Formulary Providers |
| Konrad | 938.8 | 950.37 |
| Shauna | 1071.6 | 1084.81 |
| Total | 2010.40 | 2035.18 |