Zip: 92804	Apply	Apply	Apply
Monthly Total	2300.13	2416.78	2554.66
Plan Name	Platinum 90 HMO	Silver 70 PPO Off Exchange	Silver PPO Exchange
Deductible	None	$5200 ($10,400 family)	$5200 ($10,400 family)
Coinsurance	90% coverage most services	70% coverage for most services	70% coverage for most services
Out of Pocket Max	$5000 (10,000 family)	$9800 (19,600 family)	$8100 (16,200 family)
Ambulance	$150 copayment	$250 copayment	$250 copayment
Chiropractic	Not covered	Not covered	Not covered
Durable Medical Equipt	90% coverage	80% coverage	80% coverage
Emergency Room	$175 copay	$400 copay	$400 copay
Hospital Stay	90% coverage	70% coverage (ded applies)	70% coverage (ded applies)
Lab & X-ray	$15 lab/$30x-ray	$50 lab/$95 x-ray	$50 lab/$95 x-ray
Office Visit	$15 copayment	$50 copayment	$50 copayment
Specialist	$30 copayment	$90 copayment	$90 copayment
Physical Therapy	$15 copayment	$50 copayment	$50 copayment
Outpatient Surgery	90% coverage	70% coverage (ded waived)	70% coverage (ded waived)
Psych (Inpatient)	90% coverage	70% coverage	70% coverage
Psych (Outpatient)	$15 copayment	$50 copayment	$50 copayment
Rx Tier 1	$9 copayment	$19 copayment	$19 copayment
Rx Tier 2	$16 copayment	$60 copayment (after $50 Rx ded)	$55 copayment (after $50 Rx ded)
Rx Tier 3	$25 copayment	$90 copayment (after $50 Rx ded)	$85 copayment (after $50 Rx ded)
Rx Tier 4	90% coverage up to $250 per Rx	80% coverage up to $250 per Rx (after $50 Rx ded)	80% coverage up to $250 per Rx (after $50 Rx ded)
Links	Brochure Providers Formulary	Brochure Providers Formulary	Brochure Providers Formulary
Subscriber (55)	1201.23	1262.16	1334.16
Spouse (53)	1098.89	1154.62	1220.49
Annual Premium Tota	$ 27,601	$ 29,001	$ 30,656
Annual Max Exposure	$ 32,601Family: $ 37,601	$ 38,801Family: $ 48,601	$ 38,756Family: $ 46,856