ACO CORE Plan Booklet
Individual annual deductible: $750.00
Family annual deductible: $1,500.00
Coinsurance: 20%
Payment limit: Individual: $5,000 Family: $10,000
Office visit co-pay: Primary: $30 Specialist $55
Prescription co-pay: Generic: $10 Preferred: $35 Non-Preferred: $55
MONTHLY RATES
EE: $135.00
EE/S: $686.00
EE/C: $596.00
EE/F: $1,211.00
Both EE: $539.00