|  |
| Plan | Bronze 60 HDHP 6900/0 (shop) |
| Metal | Bronze |
| Network | Kaiser Permanente |
| Deductible | $6900/$13,800 family |
| Coinsurance | 100% coverage for most services |
| Out of Pocket Mzx | $6900/$13,800 family |
| Ambulance | 100% coverage (after deductible) |
| Chiropractor | Not covered |
| Durable Med Equip | 100% coverage (after deductible) |
| Emergency Room | 100% coverage (after deductible) |
| Hospital | 100% coverage (after deductible) |
| Infertility | Optional |
| Lab & X-Ray | 100% coverage (after deductible) |
| Office Visit | 100% coverage (after deductible) |
| Specialist | 100% coverage (after deductible) |
| Outpatient Surgery | 100% coverage (after deductible) |
| Physical Therapy | 100% coverage (after deductible) |
| Inpatient Psych | 100% coverage (after deductible) |
| Outpatient Psych | 100% coverage (after deductible) |
| Rx Tier 1 | 100% coverage (after deductible) |
| Rx Tier 2 | 100% coverage (after deductible) |
| Rx Tier 3 | 100% coverage (after deductible) |
| Rx Tier 4 | 100% coverage (after deductible) |
| Links | Brochure Formulary Providers |
| Alsayadi Ahmed | 246.76 |
| Alvarado Evelyn | 251.98 |
| Briggs Clara | 339.81 fam 908.41 |
| Chavez Mayra | 218.28 |
| Cordova Elanorva | 243.28 fam 423.59 |
| Cornejo Cindy | 222.63 fam 402.94 |
| Garcia Jason | 236.32 |
| Graczyk Jaroslaaw | 257.2 |
| Jacquez Tiffany | 222.63 |
| Jessica Barajas | 227.85 |
| Juarez Abigail | 222.63 |
| Laolagi Tina | 251.98 |
| Martinez Alexis | 210.89 |
| Morales Denise | 222.63 fam 402.94 |
| Ornelas Karina Fatim | 251.98 |
| Torres Villanueva Al | 217.41 |
| Zavala Adriana | 227.85 |
| Zuniga Patricia | 218.28 fam 797.18 |
| Total | 4290.39 w deps 5978.82 |