Indemnity Plan IN NETWORK Deductible (Single/Family) $400 / $1,200 Out-of-Pocket Max (Single/Family) $1,500 / $5,600 Coinsurance 80% Preventive Care No charge Physician Office Visit 20% after deductible Specialist Visit 20% after deductible Emergency Room $200 copay, then 20% after deductible Urgent Care Centers 20% after deductible