PPO Plan In-Network Out-of-Network Embedded Deductible (Single/Family) $2,000 / $4,000 $2,600 / $7,800 Out-of-Pocket Maximum (Single/Family) $5,050 / $10,750 $12,150 / $29,250 Coinsurance 20% 50% Preventive Care 100% covered 50% after deductible Primary Care Visit 20% after deductible 50% after deductible Specialist Visit 20% after deductible 50% after deductible Urgent Care 20% after deductible 50% after deductible Emergency Room 20% after deductible 50% after deductible Hospital Services 20% after deductible 50% after deductible