Plan	Silver 70 HDHP HMO 2500/20 (shop)	Silver 70 HMO 1800/55 (shop)	Silver 70 HMO 2250/50 (shop)	Gold 80 HRA	Trio Platinum 90 HMO 0/15 w Child Dental (shop)	Gold Local Access HMO 1500/35 OffEx	Gold Local Access HMO 1000/35 OffEx	Silver Full PPO Savings 2500/35% OffEx	Platinum 90 HMO 0/15 (shop)
Metal	Silver	Silver	Silver	Gold	Platinum	Gold	Gold	Silver	Platinum
Network	Kaiser Permanente	Kaiser Permanente	Kaiser Permanente	Kaiser Permanente	Trio ACO Network	Local Access Network	Local Access Network	Full PPO Network	Kaiser Permanente
Deductible	$2500 (fam cov $2800 ind or $5000 fam)	$1800/$3600 family	$2250/$4500 family	$2250/$4500 family	None	$1500/$3000 family	$1000/$2000 family	$2500 or $2800/$5000 family	None
Coinsurance	80% coverage for most services	55% coverage for most services	80% coverage for most services	75% coverage for most services	Fixed copays for most services	80% coverage for most services	80% coverage for most services	65% coverage for most services	Fixed copays for most services
Out of Pocket Mzx	$6850/13,700 family	$7800/15,600 family	$7800/15,600 family	$7800/15,600 family	$4500/9000 family	$7800/$15,600 family	$2000/$4000 family	$6850/$13,700 family	$4500/$9000 family
Ambulance	80% coverage (ded applies)	55% coverage (after deductible)	$250 (after deductible)	75% coverage (after deductible)	$150 copayment	$175 copayment (after ded)	$175 copayment	65% coverage after ded	$150 copayment
Chiropractor	Not covered	Not covered	Not covered	Not covered	Not covered	$15 copayment (15 visits max)	$15 copayment (15 visits max)	65% coverage after ded	Not covered
Durable Med Equip	80% coverage (ded applies)	55% coverage (after deductible)	80% coverage (ded applies)	50% coverage (ded applies)	90% coverage	50% coverage (after deductible)	50% coverage (after deductible)	50% coverage (after deductible)	90% coverage
Emergency Room	80% coverage (ded applies)	55% coverage (after deductible)	$250 copay after ded	75% coverage after ded	$150 copayment	$300 copayment (after ded)	$300 copayment (ded applies)	$150 copay then 65% cov after ded	$150 copay
Hospital	80% coverage (ded applies)	55% coverage (after deductible)	80% coverage (after deductible)	75% coverage after ded	$250 per day 1st 5 days	80% coverage (after deductible)	80% coverage (after deductible)	65% coverage after ded	$150 copay
Infertility	Optional	Optional	Optional	Optional	Not covered	Not covered	Not covered	Not covered	Optional
Lab & X-Ray	80% coverage (ded applies)	rabaLy $25 after ded/X-ray $55 after ded	$40 lab/$85 X-ray	75% coverage after ded	Lab $15 copay / X-ray $30 copay	$40 lab/$60 X-ray	$40 lab/$60 X-ray	65% coverage after ded	$15 lab/$30 X-ray
Office Visit	80% coverage (ded applies)	$55 copayment	$50 copayment	$35 copayment	$15 copayment	$35 copayment	$35 copayment	65% coverage after ded	$15 copayment
Specialist	80% coverage (ded applies)	$75 copayment	$85 copayment	$50 copayment	$30 copayment	$60 copayment	$60 copayment	65% coverage after ded	$30 copayment
Outpatient Surgery	80% coverage (ded applies)	55% coverage (after deductible)	80% coverage (after deductible)	75% coverage (after deductible)	$100 copayment	$150 or $300 per surgery (after deductible)	$150 or $300 per surgery (after deductible)	$150 copayment (then 65% coverage) after ded	$125 copayment (per procedure)
Physical Therapy	80% coverage (ded applies)	$65 copayment	$50 copayment	$35 copayment (ded applies)	$15 copayment	$35 copayment	$35 copayment	65% coverage after ded	$15 copayment
Inpatient Psych	80% coverage (ded applies)	55% coverage (after deductible)	80% coverage (after deductible)	75% coverage after ded	$250 per day 1st 5 days	80% coverage (after deductible)	80% coverage (after deductible)	65% coverage after ded	$150 copay
Outpatient Psych	80% coverage (ded applies)	$55 copayment	$50 copayment	$35 copayment	$15 copayment	$35 copayment	$35 copayment	65% coverage after ded	$15 copayment
Rx Tier 1	80% coverage to $250 max ben (ded applies)	$20 copay	$500 Rx ded then $17 ded per Rx	$15 copayment	$5 copayment	$15 copayment (after $100 Rx ded)	$15 copayment (after $100 Rx ded)	65% cov up to $250 per Rx after ded	$5 copayment
Rx Tier 2	80% coverage to $250 max ben (ded applies)	$75 copay (after $350 Rx ded)	$65 copay (after $300 Rx ded)	$30 copayment (aftr $100 Rx ded)	$15 copayment	$35 copayment (after $100 Rx ded)	$35 copayment (after $100 Rx ded)	65% cov up to $250 per Rx after ded	$15 copayment
Rx Tier 3	80% coverage to $250 max ben (ded applies)	$75 copay (after $350 Rx ded)	$65 copay (after $300 Rx ded)	$30 copayment (aftr $100 Rx ded)	$25 copayment	$55 copayment (after $100 Rx ded)	$55 copayment(after $100 Rx ded)	65% cov up to $250 per Rx after ded	$15 copayment
Rx Tier 4	80% coverage to $250 max ben (ded applies)	80% cov $250 max ben (after $350 Rx ded)	80% cov $250 max ben (after $300 Rx ded)	80% cov up to $250 per Rx after $100 Rx ded	90% coverage (up to $250 per Rx)	80% coverage up to $250 per Rx (after $100 Rx ded)	80% coverage up to $250 per Rx after $100 Rx ded	65% cov up to $250 per Rx after ded	90% cov up to $250 per Rx
Links	Brochure Formulary Providers	Brochure Formulary Providers	Brochure Formulary Providers	Brochure Formulary Providers	Brochure Formulary Providers	Brochure Formulary Providers	Brochure Formulary Providers	Brochure Formulary Providers	Brochure Formulary Providers
Al Pacino	414.7	441.39	464.18	484.44	515.2	530.94	542.92	546.36	616.53
Audrey Hepurn	618.99	658.84	692.85	723.09	769	792.5	810.39	815.52	920.25
Bette Davis	414.7	441.39	464.18	484.44	515.2	530.94	542.92	546.36	616.53
Carol Burnett	566.46 fam 1335.89	602.92 fam 1421.88	634.05 fam 1495.29	661.72 fam 1560.54	703.74 fam 1659.64	725.24 fam 1710.34	741.61 fam 1748.95	746.31 fam 1760.03	842.15 fam 1986.05
Cary Grant	676.04 fam 1440.16	719.56 fam 1532.87	756.71 fam 1612.02	789.73 fam 1682.36	839.87 fam 1789.17	865.53 fam 1843.84	885.07 fam 1885.46	890.68 fam 1897.41	1005.06 fam 2141.07
Charlie Chaplin	288.4 fam 1490.3	306.97 fam 1586.24	322.82 fam 1668.14	336.9 fam 1740.93	358.3 fam 1851.48	369.24 fam 1908.04	377.58 fam 1951.12	379.97 fam 1963.48	428.77 fam 2215.63
Cindy Lauffer	324.22	345.09	362.91	378.75	402.8	415.1	424.47	427.16	482.02
Clark Gable	762.26	811.34	853.22	890.46	947	975.93	997.97	1004.29	1133.25
Clint Eastwood	278.06 fam 481.03	295.96 fam 512	311.24 fam 538.43	324.82 fam 561.92	345.44 fam 597.6	356 fam 615.86	364.03 fam 629.76	366.34 fam 633.75	413.38 fam 715.13
Dustin Hoffman	690.63	735.09	773.04	806.77	858	884.21	904.18	909.9	1026.75
Emlily Post	266.38	283.53	298.17	311.18	330.94	341.05	348.75	350.96	396.03
Gary Cooper	618.99	658.84	692.85	723.09	769	792.5	810.39	815.52	920.25
Gene Hackman	345.45 fam 697	367.68 fam 741.86	386.67 fam 780.17	403.54 fam 814.21	429.17 fam 865.92	442.28 fam 892.37	452.26 fam 912.51	455.13 fam 918.3	513.57 fam 1036.22
Gregory Peck	326.34	347.35	365.29	381.23	405.43	417.82	427.25	429.96	485.17
Harrison Ford	690.63	735.09	773.04	806.77	858	884.21	904.18	909.9	1026.75
Helen Mirren	317.85 fam 700.97	338.32 fam 746.11	355.78 fam 784.62	371.31 fam 818.86	394.88 fam 870.85	406.95 fam 897.46	416.14 fam 917.73	418.77 fam 923.53	472.55 fam 1042.14
Henry Fonda	326.34	347.35	365.29	381.23	405.43	417.82	427.25	429.96	485.17
Humphrey Bogart	330.59	351.87	370.04	386.19	410.71	423.25	432.81	435.55	491.48
Ingrid Bergman	345.45	367.68	386.67	403.54	429.17	442.28	452.26	455.13	513.57
Jack Lemmon	541.25	576.1	605.84	632.28	672.42	692.97	708.61	713.1	804.68
Jack Nicholson	433.8	461.72	485.56	506.75	538.93	555.39	567.93	571.53	644.93
James Stewart	414.7	441.39	464.18	484.44	515.2	530.94	542.92	546.36	616.53
Jane Doe	324.22 fam 621.11	345.09 fam 661.1	362.91 fam 695.23	378.75 fam 725.57	402.8 fam 771.64	415.1 fam 795.21	424.47 fam 813.17	427.16 fam 818.32	482.02 fam 923.41
Jodie Foster	414.7 fam 1429.55	441.39 fam 1521.57	464.18 fam 1600.13	484.44 fam 1669.96	515.2 fam 1776	530.94 fam 1830.26	542.92 fam 1871.57	546.36 fam 1883.43	616.53 fam 2125.31
John Wayne	676.04	719.56	756.71	789.73	839.87	865.53	885.07	890.68	1005.06
Johnny Depp	414.7	441.39	464.18	484.44	515.2	530.94	542.92	546.36	616.53
Judi Dench	433.8	461.72	485.56	506.75	538.93	555.39	567.93	571.53	644.93
Judy Garland	326.34 fam 656.93	347.35 fam 699.22	365.29 fam 735.33	381.23 fam 767.42	405.43 fam 816.14	417.82 fam 841.07	427.25 fam 860.06	429.96 fam 865.51	485.17 fam 976.65
Julie Andrews	397.98	423.6	445.47	464.91	494.43	509.54	521.04	524.34	591.68
Katherine Hepburn	265.32	282.4	296.98	309.94	329.62	339.69	347.36	349.56	394.45
Lawrence Olivier	351.55	374.18	393.5	410.67	436.75	450.09	460.25	463.17	522.65
Lisa Page	414.7 fam 1486.06	441.39 fam 1581.72	464.18 fam 1663.39	484.44 fam 1735.98	515.2 fam 1846.21	530.94 fam 1902.61	542.92 fam 1945.56	546.36 fam 1957.89	616.53 fam 2209.32
Marlon Brandoe	313.87 fam 719.81	334.08 fam 766.15	351.33 fam 805.71	366.66 fam 840.87	389.94 fam 894.26	401.85 fam 921.58	410.93 fam 942.39	413.53 fam 948.36	466.63 fam 1070.14
Merryl Streep	383.12 fam 728.57	407.79 fam 775.47	428.84 fam 815.51	447.55 fam 851.09	475.97 fam 905.14	490.51 fam 932.79	501.59 fam 953.85	504.76 fam 959.89	569.59 fam 1083.16
Michael Caine	271.69	289.18	304.11	317.38	337.53	347.84	355.7	357.95	403.92
Morgan Freeman	745.55	793.54	834.51	870.93	926.23	954.53	976.08	982.26	1108.4
Paul Newman	266.38	283.53	298.17	311.18	330.94	341.05	348.75	350.96	396.03
Phyllis Diller	676.04	719.56	756.71	789.73	839.87	865.53	885.07	890.68	1005.06
Ray Lewis	414.7	441.39	464.18	484.44	515.2	530.94	542.92	546.36	616.53
Robert Brooks	334.83 fam 740.77	356.39 fam 788.46	374.79 fam 829.17	391.14 fam 865.35	415.98 fam 920.3	428.69 fam 948.42	438.37 fam 969.83	441.14 fam 975.97	497.8 fam 1101.31
Robert Dd Niro	317.85 fam 631.72	338.32 fam 672.4	355.78 fam 707.11	371.31 fam 737.97	394.88 fam 784.82	406.95 fam 808.8	416.14 fam 827.07	418.77 fam 832.3	472.55 fam 939.18
Robert Duvall	360.04	383.22	403	420.59	447.29	460.96	471.37	474.35	535.27
Robin Williams	676.04	719.56	756.71	789.73	839.87	865.53	885.07	890.68	1005.06
Roger Stevens	345.45	367.68	386.67	403.54	429.17	442.28	452.26	455.13	513.57
Sean Connery	414.7 fam 760.15	441.39 fam 809.07	464.18 fam 850.85	484.44 fam 887.98	515.2 fam 944.37	530.94 fam 973.22	542.92 fam 995.18	546.36 fam 1001.49	616.53 fam 1130.1
Sharon Tate	266.38	283.53	298.17	311.18	330.94	341.05	348.75	350.96	396.03
Spencer Tracey	326.34 fam 1306.17	347.35 fam 1390.26	365.29 fam 1462.04	381.23 fam 1525.84	405.43 fam 1622.71	417.82 fam 1672.29	427.25 fam 1710.05	429.96 fam 1720.89	485.17 fam 1941.88
Susan Sanders	618.99	658.84	692.85	723.09	769	792.5	810.39	815.52	920.25
Tom Hanks	326.34	347.35	365.29	381.23	405.43	417.82	427.25	429.96	485.17
Ursela Andress	783.22	833.64	876.68	914.94	973.04	1002.76	1025.41	1031.9	1164.42
Vivien Leigh	345.45	367.68	386.67	403.54	429.17	442.28	452.26	455.13	513.57
Total	22198.56 w deps 31381.82	23627.56 w deps 33401.99	24847.47 w deps 35126.57	25931.80 w deps 36659.44	27578.34 w deps 38987.16	28420.90 w deps 40178.26	29062.50 w deps 41085.31	29246.60 w deps 41345.59	33002.47 w deps 46655.17