Benefit cost sharing

Here you’ll find your cost share for certain covered benefits. For more information, view your 2019 summary of benefits.

Hand weights and note pads with check lists
divider line

 


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)