ACO CDHP

ACO HDHP Plan Booklet

Individual annual deductible: $2,800

Family annual deductible: $5,600

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 not subject to deductible

Prescription co-pay: Generic: $10  Preferred: $35  Non-Preferred: $55 $0 after deductible

MONTHLY RATES

EE: $0.00

EE/S: $446.00

EE/C: $384.00

EE/F: $833.00

Both EE: $290.00