Benefit cost sharing

Here you’ll find your cost share for certain covered benefits.

For more information, download your summary of benefits.

Hand weights and note pads with check lists
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Type of costCost
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)