Preventive Care
- 100% Preventive Care Coverage
Preventive Care
- 100% Preventive Care Coverage
Preventive Care
- 100% Preventive Care Coverage
Deductible
- Network - $750 individual and $1,500 family
- Non-Network - $1,500 individual and $3,000 family
Deductible
- Network and Non-Network combined - $3,200 individual and $6,400 family
Deductible
- Network and Non-Network combined - $0 individual and $0 family
Out-of-Pocket Maximum
- Network - $4,500 individual and $9,000 family
- Non-Network - $9,000 individual and $18,000 family
Out-of-Pocket Maximum
- Network - $5,000 individual and $10,000 family
- Non-Network - $10,000 individual and $20,000 family
Out-of-Pocket Maximum
- Network - $4,000 individual and $8,000 family
- Non-Network - $8,000 individual and $16,000 family
Co-Insurance
- Network - 80% / 20%
- Non-Network - 60% / 40%
Co-Insurance
- Network - 80% / 20%
- Non-Network - 60% / 40%
Co-Insurance
- Network - 0%
- Non-Network - 0%
Prescription Benefits
- Retail Pharmacies (30-day supply): $10 Tier 1; $40 Tier 2; $60 Tier 3
- Mail Order (90-day supply): $20 Tier 1; $80 Tier 2; $120 Tier 3
- Tier 4 $150 30-day supply, mail order only
Prescription Benefits
- Retail Pharmacies (30-day supply): Plan pays 80% after deductible
- Mail Order (90-day supply): 80% after deductible
- Use or to find the best prices on prescriptions
Prescription Benefits
- Retail Pharmacies (30-day supply): $5 Tier 1; $20 Tier 2; $40 Tier 3
- Mail Order (90-day supply): $15 Tier 1; $50 Tier 2; $100 Tier 3
- Tier 4 $100-150 30-day supply, mail order only
No HSA Included
University HSA Contributions
- Individual - $750 (Initial funding of $282 and a monthly contribution of $39)
- Family - $1,500 (Initial funding of $564 and a monthly contribution of $78)