|  |
| Plan | Bronze 8150 EPO Option 2 |
| Metal | Bronze |
| Network | Oscar EPO |
| Deductible | $8150/$16,300 family |
| Coinsurance | 100% coverage (after ded) |
| Out of Pocket Mzx | $8150 ($16,300 fam) |
| Ambulance | 100% coverage (after ded) |
| Chiropractor | Not covered |
| Durable Med Equip | 100% coverage (after ded) |
| Emergency Room | 100% coverage (after ded) |
| Hospital | 100% coverage (after ded) |
| Infertility | Optional |
| Lab & X-Ray | 100% coverage (after ded) |
| Office Visit | 3 @ $50 then ded applies |
| Specialist | 100% coverage (after ded) |
| Outpatient Surgery | 100% coverage (after ded) |
| Physical Therapy | 100% coverage (after ded) |
| Inpatient Psych | 100% coverage (after ded) |
| Outpatient Psych | 3 @ $50 then ded applies |
| Rx Tier 1 | 100% coverage (after ded) |
| Rx Tier 2 | 100% coverage (after ded) |
| Rx Tier 3 | 100% coverage (after ded) |
| Rx Tier 4 | 100% coverage (after ded) |
| Links | Brochure Formulary Providers |
| Frank Araujo | 476.06 fam 1233.08 |
| Lupe Duarte | 415.86 |
| Tony Duarte Jr | 253.08 |
| Tony Duarte Sr | 435.26 |
| Total | 1580.26 w deps 2337.28 |