HMO 20 POS 20

In network Benefits: In-network Benefits:

Open Access- No referrals required Open Access- No referrals required
Office Co-pay (primary & specialists) $20 Office Co-pay (primary & specialists) $20
Emergency Room Co-pay $50 Emergency Room Co-pay $50
Hospital Co-pay $500 Hospital Co-pay $500
Medical Group offices $0 Medical Group offices $0
PLUS
PLUS Out of Network Benefits
Deductible $2,000-$4,000
Co-insurance 70%-30%
Maximum out of pocket $5,000-$10,000
PLUS
Rx G Prescription plan: Rx G Prescription plan:
Deductible $0 Deductible $0
Generic Co-pay $7 Generic Co-pay $7
Formulary Co-pay $30 Formulary Co-pay $30
Non Formulary Co-pay $50 Non Formulary Co-pay $50
PLUS PLUS
Rewards Program Rewards Program
Dental, Vision & Rx Disount Plans Dental, Vision & Rx Disount Plans
Travel & Entertainment Discounts Travel & Entertainment Discounts
Auto Services Auto Services
Atlantis Online Shopping Mall Atlantis Online Shopping Mall