Benefit cost sharing

Here you’ll find your cost share for certain covered benefits. For more information, view your 2018 Summary of Benefits.



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)