CDHP #1 Hendricks Regional Health In - Network Out - of - Network Embedded Deductible (Single/Family) $3,500 / $7,000 $4,500 / $9,000 $6,000 / $12,000 Out - of - Pocket Maximum (Single/Family) $4,500 / $9,000 $6,000 / $12,000 $10,000 / $20,000 Coinsurance 10% 20% 40% Preventive Care 100% covered 100% covered Ded. + Coins. Primary Care Ded. + Coins. Ded. + Coins. Ded. + Coins. Specialist Visit Ded. + Coins. Ded. + Coins. Ded. + Coins. Hospital Services Ded. + Coins. Ded. + Coins. Ded. + Coins. Urgent Care & Emergency Room Ded. + Coins. Ded. + Coins. Ded. + Coins. Diagnostics & Labs Ded. + Coins. Ded. + Coins. Ded. + Coins. View the Summary of Benefits & Coverage D ocuments to see out - of - network costs for different services.