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2017 benefit cost sharing

Here you’ll find your share of costs for certain covered benefits. For more information on your covered benefits, view your 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)