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Silver 2600 HDHP PPO
Zip: 92804
| Subscriber (55) | 1,168.70 |
| Spouse (53) | 1,069.12 |
| Total | 2237.82 |
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| Deductible | $2600 or 3400 ($5200 family) |
| Coinsurance | 65% coverage for most services |
| Office Visit | 65% coverage (ded applies) |
| Specialist Visit | 65% coverage (ded applies) |
| Out of Pocket Max | $7350 ($14,700 family) |
| Lab & X-ray | 65% coverage (ded applies) |
| Rx - Tier 1 | 65% cov to $250 per Rx (med ded applies) |
| Rx - Tier 2 | 65% cov to $250 per Rx (med ded applies) |
| Rx - Tier 3 | 65% cov to $250 per Rx (med ded applies) |
| Rx - Tier 4 | 65% cov to $250 per Rx (med ded applies)
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Silver 1750 PPO
Zip: 92804
| Subscriber (55) | 1,209.60 |
| Spouse (53) | 1,106.54 |
| Total | 2316.13 |
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| Deductible | $1750 ($3500 per family) |
| Coinsurance | 65% coverage for most services |
| Office Visit | $55 copayment |
| Specialist Visit | $85 copayment |
| Out of Pocket Max | $9250 (18,500 family) |
| Lab & X-ray | Lab $50 copay / X-Ray 65% cov after ded |
| Rx - Tier 1 | $20 copay after $300 Rx deductible |
| Rx - Tier 2 | $75 copayment (after $300 Rx ded) |
| Rx - Tier 3 | $90 copayment (after $300 Rx ded) |
| Rx - Tier 4 | 65% coverage up to $250 per Rx (after $300 Rx ded)
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Silver 70 PPO Off Exchange
Zip: 92804
| Subscriber (55) | 1,262.16 |
| Spouse (53) | 1,154.62 |
| Total | 2416.78 |
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| Deductible | $5200 ($10,400 family) |
| Coinsurance | 70% coverage for most services |
| Office Visit | $50 copayment |
| Specialist Visit | $90 copayment |
| Out of Pocket Max | $9800 (19,600 family) |
| Lab & X-ray | $50 lab/$95 x-ray |
| Rx - Tier 1 | $19 copayment |
| Rx - Tier 2 | $60 copayment (after $50 Rx ded) |
| Rx - Tier 3 | $90 copayment (after $50 Rx ded) |
| Rx - Tier 4 | 80% coverage up to $250 per Rx (after $50 Rx ded)
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