Embedded Deductible (Single/Family) $600 / $1,200 $2,000 / $4,000 $3,400 / $6,800 $6,000 / $12,000 Out-of-Pocket Max (Single/Family) $3,000 / $6,000 $6,000 / $12,000 $3,400 / $6,800 $6,000 / $12,000 Coinsurance 10% 20% 0% 0% Preventive Care 100% covered 100% covered 100% covered 100% covered Physician Office Visit $40 copay $40 copay Deductible + coinsurance Deductible + coinsurance Specialist Visit $45 copay $45 copay Deductible + coinsurance Deductible + coinsurance Emergency Room $100 copay + coinsurance $200 copay + coinsurance Deductible + coinsurance Deductible + coinsurance Urgent Care Centers $40 copay $40 copay Deductible + coinsurance Deductible + coinsurance Inpatient Services $150 copay + coinsurance $200 copay + coinsurance Deductible + coinsurance Deductible + coinsurance Outpatient Services Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance Deductible + coinsurance PPO PLAN A PPO PLAN B HDHP C HDHP D Out-of-network benefits: PPO A out-of-pocket max is $5,000 / $9,000 and PPO B out-of-pocket max is $10,000 / $20,000. Coinsurance for Plans A & B is 30%. No coinsurance for Plans C & D All four plans are available to eligible employees