Plan Name
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|
Deductible |
Description |
Summary of Benefit Design |
|
HD-CH-3692 |
1500 |
Co-pay and Coinsurance after deductible is met, out of network benefits,
HSA-qualified |
HDHP CHOICE 1A; Rx $10/20/30/75 OC |
|
HD-CH-3693 |
1500 |
100% after deductible is met, out of network benefits, HSA-qualified |
HDHP CHOICE 1B; Rx - No Charge after Ded |
|
HD-OA-3688 |
1500 |
Co-pay only after deductible is met, HSA-qualified |
HDHP 1A; Rx $10/20/30/75 OC |
|
HD-OA-3689 |
1500 |
100% after deductible is met, HSA-qualified |
HDHP 1B; Rx - No Charge after Ded |
|
HD-CH-4079 |
2000 |
100% after deductible is met, out of network benefits, HSA-qualified |
HD-CH-4079 - POS12 - HDHP-CHOICE-1D; RX - NO CHARGE AFTER DED |
|
HD-OA-3691 |
2000 |
20% Coinsurance after Deductible is met, HSA-qualified |
HDHP 1D; Rx $10/20/30/75 OC |
|
HD-CH-3694 |
3000 |
100% after deductible is met, out of network benefits, HSA-qualified |
HDHP CHOICE 1C; Rx - No Charge after Ded |
|
HD-OA-3690 |
3000 |
100% after deductible is met, HSA-qualified |
HDHP 1C; Rx - No Charge after Ded |
|
HD-CH-5186 |
5000 |
100% after deductible is met, out of network benefits, HSA-qualified |
HDHP-CHOICE-4DD-08; RX - No Charge after Ded |
|
HD-OA-5187 |
5000 |
100% after deductible is met, HSA-qualified |
HDHP-1E-08; Rx - No Charge after Ded |