POS Plan PPO Out-of-Network Co-Pays, Deductibles & AllowancesEffective 7/1/25 | |
| Service | Co-Pay |
| Individual Deductible | Per Person Annual Deductible - $483 Maximum Medical Annual Out-of-Pocket (includes deductible) - $1,415 The medical out of pocket maximums for the out of network POS Plan only includes the medical deductible and the medical coinsurance. There is no out of pocket maximum for prescription drugs. Sample coverage examples can be found on page 6 on the Summary Benefit Comparison |
| Family Deductible | Per Family Annual Deductible - $1,448 Maximum Medical Annual Out-of-Pocket (includes deductible) - $4,211 The medical out of pocket maximums for the out of network POS Plan only includes the medical deductible and the medical coinsurance. There is no out of pocket maximum for prescription drugs. Sample coverage examples can be found on page 6 on the Summary Benefit Comparison |
| Vision Allowances | Exam - $61 Lenses (Single) - $50 Lenses (Bifocal) - $70 Lenses (Trifocal) - $91 Frames - $61 Contacts - $152 |