Plan Breakdown

High Deductible Plans (HSA Qualified)

    • HDHP Option 1

    • Deductible: $1,500
      Max. Out-of-Pocket: $1,500

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    • HDHP Option 2

    • Deductible: $2,500
      Max. Out-of-Pocket: $5,000

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    • HDHP Option 3

    • Deductible: $3,000
      Max. Out-of-Pocket: $6,000

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    • HDHP Option 4

    • Deductible: $3,500
      Max. Out-of-Pocket: $7,000

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    • HDHP Option 6

    • Deductible: $2,500
      Max. Out-of-Pocket: $5,000

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    • HDHP Option 7

    • Deductible: $5,000
      Max. Out-of-Pocket: $10,000

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    • HDHP Option 8

    • Deductible: $6,000
      Max. Out-of-Pocket: $12,000

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Major Medical

    • MM Choice Plus

    • Deductible: $500
      Max. Out-of-Pocket: $1,500

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    • MM HD 1000

    • Deductible: $1,000
      Max. Out-of-Pocket: $3,000

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    • MM HD 2000

    • Deductible: $2,000
      Max. Out-of-Pocket: $6,000

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    • MM HD 5000

    • Deductible: $5,000
      Max. Out-of-Pocket: $12,700

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Preferred Plans

    • Premier Plus

    • Deductible: $1,750
      Max. Out-of-Pocket: $3,500

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    • Prime Plus

    • Deductible: $2,750
      Max. Out-of-Pocket: $5,500

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    • Select Plus

    • Deductible: $3,250
      Max. Out-of-Pocket: $6,500

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    • Value

    • Deductible: $4,500
      Max. Out-of-Pocket: $9,000

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    • Value Plus

    • Deductible: $7,900
      Max. Out-of-Pocket: $15,800

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Dental Plan Benefits

    • Type B - Routine Restorative

    • Deductible: $50

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    • Type E - Major Restorative

    • Deductible: $50

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    • Type F - Orthodontics

    • Deductible: $50

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Plan details for HDHP Option 1
  • Deductible (In-Network)

  • $1,500 / $3,000
  • Coinsurance (In-Network)

  • 0%
  • Max OOP (In-Network)

  • $1,500 / $3,000
  • Deductible (Out-Network)

  • $3,000 / $6,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • Deductible
Plan details for HDHP Option 2
  • Deductible (In-Network)

  • $2500 / $5000
  • Coinsurance (In-Network)

  • 0%
  • Max OOP (In-Network)

  • $2,500 / $5,000
  • Deductible (Out-Network)

  • $5,000 / $10,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • Deductible
Plan details for HDHP Option 3
  • Deductible (In-Network)

  • $3,000 / $60,00
  • Coinsurance (In-Network)

  • 0%
  • Max OOP (In-Network)

  • $3,000 / $6,000
  • Deductible (Out-Network)

  • $6,000 / $12,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • Deductible
Plan details for HDHP Option 4
  • Deductible (In-Network)

  • $3,500 / $7,000
  • Coinsurance (In-Network)

  • 0%
  • Max OOP (In-Network)

  • $3,500 / $7,000
  • Deductible (Out-Network)

  • $7,000 / $14,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • Deductible
Plan details for HDHP Option 6
  • Deductible (In-Network)

  • $2,500 / $5,000
  • Coinsurance (In-Network)

  • 20%
  • Max OOP (In-Network)

  • $5,000 / $10,000
  • Deductible (Out-Network)

  • $5,000 / $10,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • Deductible
Plan details for HDHP Option 7
  • Deductible (In-Network)

  • $5,000 / $10,000
  • Coinsurance (In-Network)

  • 10%
  • Max OOP (In-Network)

  • $6,900 / $13,800
  • Deductible (Out-Network)

  • $10,000 / $30,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • Deductible
Plan details for HDHP Option 8
  • Deductible (In-Network)

  • $6,000 / $12,000
  • Coinsurance (In-Network)

  • 10%
  • Max OOP (In-Network)

  • $6,900 / $13,800
  • Deductible (Out-Network)

  • $10,000 / $30,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • Deductible
Plan details for MM Choice Plus
  • Deductible (In-Network)

  • $500 / $1,500
  • Coinsurance (In-Network)

  • 20%
  • Max OOP (In-Network)

  • $2,500 / $7,500
  • Deductible (Out-Network)

  • $1,000 / $3,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • $100
Plan details for MM HD 1000
  • Deductible (In-Network)

  • $1,000 / $3,000
  • Coinsurance (In-Network)

  • 20%
  • Max OOP (In-Network)

  • $3,000 / $9,000
  • Deductible (Out-Network)

  • $2,000 / $6,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • $100
Plan details for MM HD 2000
  • Deductible (In-Network)

  • $2,000 / $6,000
  • Coinsurance (In-Network)

  • 20%
  • Max OOP (In-Network)

  • $4,000 / $12,000
  • Deductible (Out-Network)

  • $4,000 / $12,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • $5 / $35 / $60
  • Doctor

  • $30 / $50
  • ER

  • $100
Plan details for MM HD 5000
  • Deductible (In-Network)

  • $5,000 / $12,700
  • Coinsurance (In-Network)

  • 20%
  • Max OOP (In-Network)

  • $6,850 / $13,700
  • Deductible (Out-Network)

  • $10,000 / $30,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • Deductible
  • Doctor

  • Deductible
  • ER

  • $100
Plan details for Premier Plus
  • Deductible (In-Network)

  • $1,750 / $3500
  • Coinsurance (In-Network)

  • 30%
  • Max OOP (In-Network)

  • $5,000 / $10,000
  • Deductible (Out-Network)

  • $3,500 / $7000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • $12 / $40 / $100
  • Doctor

  • $30 / $60
  • ER

  • $300
Plan details for Prime Plus
  • Deductible (In-Network)

  • $2,750 / $5,500
  • Coinsurance (In-Network)

  • 30%
  • Max OOP (In-Network)

  • $7,900 / $15,800
  • Deductible (Out- Network)

  • $5,000 / $10,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • $12 / $40 / $100
  • Doctor

  • $30 / $60
  • ER

  • $300
Plan details for Select Plus
  • Deductible (In-Network)

  • $3,250 / $6,500
  • Coinsurance (In-Network)

  • 30%
  • Max OOP (In-Network)

  • $7,900 / $15,800
  • Deductible (Out-Network)

  • $6,500 / $13,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • $12 / $40 / $100
  • Doctor

  • $30 / $60
  • ER

  • $300
Plan details for Value
  • Deductible (In-Network)

  • $4,500 / $9,000
  • Coinsurance (In-Network)

  • 20%
  • Max OOP (In-Network)

  • $7,900 / $15,800
  • Deductible (Out-Network)

  • $9,000 / $18,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • $12 / $40 / $100
  • Doctor

  • $30 / $60
  • ER

  • $300
Plan details for Value Plus
  • Deductible (In-Network)

  • $7,900 / $15,800
  • Coinsurance (In-Network)

  • 0%
  • Max OOP (In-Network)

  • $7,900 / $15,800
  • Deductible (Out-Network)

  • $10,000 / $30,000
  • Coinsurance (Out-Network)

  • 50%
  • Rx

  • $12 / $40 / $100
  • Doctor

  • $30 / $60
  • ER

  • $300
Plan details for Type A - Preventive
  • Payment Percentage

  • 100%
  • Maximum Dental Benefits

  • $1,000 per calendar year, per person
  • Preventive Care Limitations

  • Exams, Cleanings, X-rays

  • 2 per calendar year
  • Fluoride Treatment

  • 1 per calendar year up to age 19
  • Sealants

  • to age 17
  • Space Maintenance

  • to age 14
  • Panoramic

  • 1 in 36 months
  • Full Mouth X-rays

  • 1 in 36 months
Plan details for Type B - Routine Restorative
  • Payment Percentage

  • 80%
  • Individual Deductible

  • $50
  • Family Deductible

  • $150
  • Maximum Dental Benefits

  • $1,000 per calendar year per person
  • Full Mouth X-rays

  • 1 in 36 months
Plan details for Type C - Endodontic
  • Payment Percentage

  • 80%
  • Individual Deductible

  • $50
  • Family Deductible

  • $150
  • Maximum Dental Benefits

  • $1,000 per calendar year per person
  • Full Mouth X-rays

  • 1 in 36 months
Plan details for Type D - Periodontic
  • Payment Percentage

  • 80%
  • Individual Deductible

  • $50
  • Family Deductible

  • $150
  • Maximum Dental Benefits

  • $1,000 per calendar year per person
  • Full Mouth X-rays

  • 1 in 36 months
Plan details for Type E - Major Restorative
  • Payment Percentage

  • 50%
  • Individual Deductible

  • $50
  • Family Deductible

  • $150
  • Maximum Dental Benefits

  • $1,000 per calendar year per person
  • Full Mouth X-rays

  • 1 in 36 months
Plan details for Type F - Orthodontics
  • Payment Percentage

  • 50%
  • Individual Deductible

  • $50
  • Family Deductible

  • $150
  • Maximum Dental Benefits

  • $1,000 per lifetime (dependent children only)