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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)