Health Coverage: G653CHC Blue Choice Gold PPO
Deductible: $1500 In-Network Individual, $4500 In-Network Family, $3000 Out-of-Network Individual, $9000 Out-of-Network Family
Max Out-of-Pocket: $6,000 In-Network Individual, $12,000 In-Network Family & Unlimited Out-of-Network (Individual & Family)
Copays: Office Co-Pay $30/$60 RX Co-pay $10/20/70/120/150/250
Dental Coverage: Principal Life
Coverage: 100% Preventative coverage, 80% Minor, 50% Major
Copays: See Summary of Benefits below.
Vision Coverage: Principal Life
For a complete listing of benefits and covered services, please see the Summary of Benefits below.
Max Benefit: $50,000
Max Spouse Benefit: $10,000
Max Dependent Benefits: $10,000
For a complete listing of benefits and coverage, please see the Summary of Benefits below.