2018 US Benefits

Option #3 Deductible: Coverage requires the deductible to be met before coinsurance applies.

Single $500 Family $1500

80% after deductible

Co-Insurance

Single $2,000 Family $4,000

Max Out of Pocket

Unlimited

Life Max

$20 each visit

Office Visit

100% no cost to associate

Preventative Care: Routine or periodic exams, well baby exams, well child exams, adult physical exams, pelvic examinations, routine EKG, immunizations, screening examinations

$250

Emergency Room

$75

Urgent Care

20% after deductible

Lab/Diagnostic

30 day supply $10/$30/$50/$100 90 day supply $25/$75/$125/$250

RX Retail

RX Mail Order