PPO Plan HDHP #1 HDHP #2 Hancock & United Choice Hancock & United Choice Hancock & United Choice Community Plus Community Plus Community Plus Embedded Deductible $1,500 / $3,000 $3,000 / $6,000 N/A N/A $4,000 / $8,000 $5,500 / $11,000 (Single/Family) Non-Embedded Deductible N/A N/A $1,750 / $3,500 $3,300 / $6,600 N/A N/A (Single/Family) Out-of-Pocket Maximum $4,000 /$8,000 $5,000 / $10,000 $4,000 / $8,000 $5,000 / $10,000 $5,000 / $10,000 $6,500 / $13,000 (Single/Family) Coinsurance 10% 20% 10% 20% 10% 20% | Preventive Care | 100% covered | 100% covered | 100% covered | 100% covered | 100% covered | 100% covered | | Primary Care Visit | $30 | $60 | Ded. + Coins. | Ded. + Coins. | Ded. + Coins. | Ded. + Coins. | | Specialist Visit | $50 | $100 | Ded. + Coins. | Ded. + Coins. | Ded. + Coins. | Ded. + Coins. | | Urgent Care | $75 | Ded. + Coins. | Ded. + Coins. | Ded. + Coins. | Ded. + Coins. | Ded. + Coins. | | $250, then | $250, then | $250, then | $250, then | $250, then | $250, then | Emergency Room Ded. + Coins. Ded. + Coins. Ded. + Coins. Ded. + Coins. Ded. + Coins. Ded. + Coins. Out-of-Network PPO Plan HDHP #1 HDHP #2 Deductible (Single/Family) $6,000 / $12,000 $6,600 / $13,200 $11,000 / $22,000 Out-of-Pocket Maximum $12,000 / $24,000 $13,200 / $26,400 $22,000 / $44,000 (Single/Family) Coinsurance 50% 50% 50%