Benefit cost sharing

Your cost share for certain covered benefits.

For more information, download your summary of benefits.

Type of cost	Cost
Annual deductible ?	$0
Out of pocket limit: individual ?	$1,500
Out of pocket limit: family ?	$3,000
Hospitalization ?	$0
Primary care visit ?	$15
Preventive care visit ?	$0
Lab test	$0
ER visit	$50 (waived if admitted or held for observation)

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