HSA Plan PPO Plan In-Network Out-of-Network In-Network Out-of-Network Embedded Deductible (Single/Family) $3,000 / $6,000 $3,000 / $6,000 $2,000 / $4,000 $2,600 / $7,800 Out-of-Pocket Maximum $5,250 / $9,000 $6,450 / $12,900 $5,050 / $10,750 $12,150 / $29,250 (Single/Family) Coinsurance 20% 50% 20% 50% Preventive Care 100% covered 50% after deductible 100% covered 50% after deductible Primary Care Visit 20% after deductible 50% after deductible 20% after deductible 50% after deductible Specialist Visit 20% after deductible 50% after deductible 20% after deductible 50% after deductible Urgent Care 20% after deductible 50% after deductible 20% after deductible 50% after deductible Emergency Room 20% after deductible 50% after deductible 20% after deductible 50% after deductible Hospital Services 20% after deductible 50% after deductible 20% after deductible 50% after deductible