|  | |
| Plan | Bronze 60 HMO 6300/65 (shop) | Silver 70 HMO 1650/55 (shop) |
| Metal | Bronze | Silver |
| Network | Kaiser Permanente | Kaiser Permanente |
| Deductible | $6300/$12,600 family | $1650/$3300 family |
| Coinsurance | 60% coverage for most services | 60% coverage for most services |
| Out of Pocket Mzx | $8200/16,400 family | $8200/16,400 family |
| Ambulance | 60% coverage (after ded) | 60% coverage (after ded) |
| Chiropractor | Not covered | Not covered |
| Durable Med Equip | 60% coverage (after ded) | 60% coverage (after ded) |
| Emergency Room | 60% coverage (after ded) | 60% coverage (after ded) |
| Hospital | 60% coverage (after ded) | 60% coverage (after ded) |
| Infertility | Optional | Optional |
| Lab & X-Ray | Lab $40/X-ray 60% coverage (after ded) | $30 lab/$75 X-ray after ded |
| Office Visit | $65 copayment first 3 visits then deductible applies | $55 copayment |
| Specialist | $95 copayment first 3 visits then deductible applies | $80 copayment |
| Outpatient Surgery | 60% coverage (after ded) | 60% coverage (after ded) |
| Physical Therapy | $65 copayment | $65 copayment |
| Inpatient Psych | 60% coverage (after ded) | 60% coverage (after ded) |
| Outpatient Psych | $65 copayment first 3 visits then deductible applies | $55 copayment |
| Rx Tier 1 | $500 Rx ded then $18 ded per Rx | $20 copay |
| Rx Tier 2 | 60% coverage to $500 (med ded applies) | $75 copay (after $350 Rx ded) |
| Rx Tier 3 | 60% coverage to $500 (med ded applies) | $75 copay (after $350 Rx ded) |
| Rx Tier 4 | 60% coverage to $500 (med ded applies) | 80% cov $250 max ben (after $350 Rx ded) |
| Links | Brochure Formulary Providers | Brochure Formulary Providers |
| Jeff W | 813.36 | 960.26 |
| Sparky H | 702.05 | 828.84 |
| Tina O | 325.95 | 384.82 |
| Will L | 614.43 | 725.4 |
| Total | 2455.79 | 2899.32 |