|  | | |
| Plan | Silver 70 HMO 2950/65 (shop) | Silver 70 HMO 2500/55 (shop) | Gold 80 HMO 250/35 (shop) |
| Metal | Silver | Silver | Gold |
| Network | Kaiser Permanente | Kaiser Permanente | Kaiser Permanente |
| Deductible | $2900/$5800 family | $2500/$5000 family | $250 ($500 family) |
| Coinsurance | 55% coverage for most services | Fixed copays 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 | 55% coverage (after ded) | 65% coverage (ded applies) | $250 copay (after ded) |
| Chiropractor | $15 copay (20 visits ann max) | $65 copay (physciain referral) | $35 copay (accupuncture only) |
| Durable Med Equip | 65% cov (ded waived) | 65% coverage (ded applies) | 80% coverage |
| Emergency Room | 55% coverage (ded applies) | 65% coverage (ded applies) | $250 copay (after ded) |
| Hospital | 55% coverage (ded applies) | 65% coverage (ded applies) | $600 per day 1st 5 days |
| Infertility | Optional | Optional | Optional |
| Lab & X-Ray | $30 lab after ded/$75 X-ray after ded | $55 lab/$90 X-ray | $35 lab/$55 X-ray |
| Office Visit | $65 copayment | $55 copayment | $35 copayment |
| Specialist | $100 copayment | $90 copayment | $55 copayment |
| Outpatient Surgery | 55% coverage (ded applies) | 65% coverage (after ded) | $335 copay (after ded) |
| Physical Therapy | $65 copayment | $55 copayment | $35 copayment |
| Inpatient Psych | 55% coverage (ded applies) | 65% coverage (ded applies) | $600 per day 1st 5 days |
| Outpatient Psych | $65 copayment | $55 copayment | $35 copayment |
| Rx Tier 1 | $20 copay | $19 copay | $15 copayment |
| Rx Tier 2 | $100 copay (after med ded) | $85 copay (after $300 Rx ded) | $40 copayment |
| Rx Tier 3 | $100 copay (after med ded) | $85 copay (after $300 Rx ded) | $40 copayment |
| Rx Tier 4 | 55% coverage to $250 (med ded applies) | 70% cov $250 max (after $300 Rx ded) | 80% coverage to $250 |
| Links | Brochure Formulary Providers | Brochure Formulary Providers | Brochure Formulary Providers |
| Ryan Laurence | 603.3 fam 1818.2 | 618.81 fam 1864.21 | 754.01 fam 2265.4 |
| Total | 603.30 w deps 1818.20 | 618.81 w deps 1864.21 | 754.01 w deps 2265.40 |