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| Plan | Trio Gold 80 HMO 250/25 w Child Dental (shop) | Gold 80 EPO 0/30 (shop) | Gold 80 HMO 500/30 (shop) | Trio Platinum 90 HMO 0/15 w Child Dental (shop) | Gold 80 HMO 250/25 (shop) | Gold 80 EPO 250/25 (shop) | Platinum 90 HMO 0/15 (shop) | Gold 80 Value PPO 750/15 + Child Dental Alt (shop) | Platinum 90 HMO 0/10 (shop) | Platinum 90 EPO 0/15 (shop) | Gold 80 PPO 0/30 + Child Dental Alt (shop) | Platinum 90 PPO 0/15 + Child Dental (shop) |
| Metal | Gold | Gold | Gold | Platinum | Gold | Gold | Platinum | Gold | Platinum | Platinum | Gold | Platinum |
| Network | Trio ACO Network | Oscar EPO | Kaiser Permanente | Trio ACO Network | Kaiser Permanente | Oscar EPO | Kaiser Permanente | Full PPO | Kaiser Permanente | Oscar EPO | Full PPO | Full PPO |
| Deductible | $250/$500 family | None | $500 ($1000 family) | None | $250 ($500 family) | $250 ($500 family) | None | $750/$1500 family | None | None | None | None |
| Coinsurance | Fixed copays for most services | 70% coverage for most services | Fixed copays for most services | Fixed copays for most services | Fixed copays for most services | Fixed copayments for most services | Fixed copays for most services | 70% coverage for most services | Fixed copays for most services | Fixed copayments for most services | 70% coverage for most services | 90% coverage for most services |
| Out of Pocket Mzx | $7800/$15,600 family | $6000 ($12,000 family) | $7000/14,000 family | $4500/9000 family | $7800/15,600 family | $7800 ($15,600 fam) | $4500/$9000 family | $7600/$15,200 failily | $3000/$6000 family | $4500 ($9000 family) | $7400/$14,800 family | $4500/$9000 family |
| Ambulance | $250 copayment | Covered benefit | $250 copayment (after ded) | $150 copayment | $250 copayment (after ded) | Covered benefit | $150 copayment | $250 copayment (ded applies) | $150 copayment | Covered benefit | 70% coverage | $150 copaymet |
| Chiropractor | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Optional | Not covered | Not covered | Optional | Optional |
| Durable Med Equip | 80% coverage | Covered benefit | 80% coverage | 90% coverage | 80% coverage (after ded) | Covered benefit | 90% coverage | 70% coverage (ded applies) | 90% coverage | Covered benefit | 70% coverage | 90% coverage |
| Emergency Room | $250 copayment | $350 copayment | $250 copayment (after ded) | $150 copayment | $250 copayment (after ded) | $250 copay after ded | $150 copay | $250 copayment (ded applies) | $200 copay | $150 copayment | 70% coverage | $150 copayment |
| Hospital | $600 per day 1st 5 days | 70% coverage | $600 per day per admit ($3000 max) | $250 per day 1st 5 days | $600 per day per admit ($3000 max) | $300 or $600 copay (1st 5 days) | $150 copay | 70% coverage (ded applies) | $500 per admission | $100 or $250 copay (1st 5 days) | 70% coverage | 90% coverage |
| Infertility | Not covered | Optional | Optional | Not covered | Optional | Optional | Optional | Optional | Optional | Optional | Optional | Optional |
| Lab & X-Ray | $25 lab/$65 X-ray | $50 lab/$50 X-ray | $20 lab/$40 X-ray | Lab $15 copay / X-ray $30 copay | $25 lab/$65 X-ray | $25 lab/$65 X-ray | $15 lab/$30 X-ray | Lab: $25 copay (ded applies)/X-ray $25 copay(ded applies) | $20 lab/$40 X-ray | $15 lab/$30 X-ray | Lab: $30 copay/X-ray $40 copay | Lab: $15 copay/X-ray $30 copay |
| Office Visit | $25 copayment | $30 copayment | $30 copayment | $15 copayment | $25 copayment | $25 copayment | $15 copayment | $15 copayment | $10 copayment | $15 copayment | $30 copayment | $15 copayment |
| Specialist | $65 copayment | $50 copayment | $35 copayment | $30 copayment | $50 copayment | $50 copayment | $30 copayment | $30 copayment | $20 copayment | $30 copayment | $50 copayment | $30 copayment |
| Outpatient Surgery | $300 copayment | Covered benefit | $600 copayment (per procedure) | $100 copayment | $34 copayment (per procedure) | Covered benefit | $125 copayment (per procedure) | 70% coverage (ded applies) | $300 copayment (per procedure) | Covered benefit | 70% coverage | 90% coverage |
| Physical Therapy | $25 copayment | Covered benefit | $30 copayment | $15 copayment | $25 copayment | Covered benefit | $15 copayment | $50 copayment | $10 copayment | Covered benefit | $30 copayment | $15 copayment |
| Inpatient Psych | $600 per day 1st 5 days | 70% coverage | $600 per day per admit ($3000 max) | $250 per day 1st 5 days | $600 per day per admit ($3000 max) | $300 or $600 copay (1st 5 days) | $150 copay | 70% coverage (ded applies) | $500 per admission | $100 or $250 copay (1st 5 days) | 70% coverage | 90% coverage |
| Outpatient Psych | $25 copayment | $30 copayment | $30 copayment | $15 copayment | $25 copayment | $25 copayment | $15 copayment | $15 copayment | $10 copayment | $15 copayment | $30 copayment | $15 copayment |
| Rx Tier 1 | $15 copayment | $15 copayment | $15 copayment | $5 copayment | $15 copayment | $15 copayment | $5 copayment | $15 copayment | $5 copayment | $5 copayment | $15 copayment | $5 copayment |
| Rx Tier 2 | $50 copayment | $50 copayment | $50 copayment | $15 copayment | $50 copayment | $50 copayment | $15 copayment | $40 copayment (ded applies) | $15 copayment | $15 copayment | $40 copayment | $15 copayment |
| Rx Tier 3 | $80 copayment | $75 copayment | $50 copayment | $25 copayment | $50 copayment | $80 copayment | $15 copayment | $70 copayment (ded applies) | $15 copayment | $25 copayment | $70 copayment | $25 copayment |
| Rx Tier 4 | 80% coverage up to $250 per Rx | 80% cov after ded (up to $250 per Rx) | 80% coverage to $250 max ben (ded waived) | 90% coverage (up to $250 per Rx) | 80% coverage to $250 max ben (ded waived) | 80% cov after ded (up to $250 per Rx) | 90% cov up to $250 per Rx | 70% coverage (up to $250 per 30 day script after ded) | 90% cov up to $250 per Rx | 90% cov after ded (up to $250 per Rx) | 70% cov ($250 max per 30 day script) | 90% coverage (up to $250 per 30 day script) |
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| Marco Castellanos | 343.08 | 369.62 | 372.1 | 373.68 | 376.07 | 383.91 | 426.04 | 427.59 | 430.56 | 441.45 | 445.3 | 475.34 |
| Total | 343.08 | 369.62 | 372.10 | 373.68 | 376.07 | 383.91 | 426.04 | 427.59 | 430.56 | 441.45 | 445.30 | 475.34 |