CDHP OPEN ACCESS

HDHP Booklet

Individual annual deductible: $3,000.00

Family annual deductible: $6,000.00

Coinsurance: $0 after deductible

Payment Limit: Individual: $2,800 Family: $5,600

Office visit co-pay: Negotiated rate then $0 after deductible

Preventive care: Up to $500.00 not subject to deductible

Prescription co-pay: Negotiated rate then $0 after deductible

Maintenance medications: Generic $10 Preferred: $35 Non-preferred: $55 $0 after deductible.

MONTHLY RATES

EE: $73.00

EE/S $627.00

EE/C: $538.00

EE/F: $1,170.00

BOTH EE: $457.00