In-Network Deductible (Individual/Family)
None
In-Network Out-of-Pocket Maximum (Individual/Family)
$3,000/$6,000
Office Visits (PCP/Specialist)
$30 copay
Prescription Drugs
Generic: $10 copay
Preferred Brand: $35 copay
Non-Preferred Brand: $35 copay
Specialty: $35 copay
