Deductible*$0/Calendar Year Type 1, 2, 3 No Family Maximum |
Max Benefit*$2,000 per calendar year |
Schedule of Benefits*Type 1- Preventive
Coinsurance IN/OUT Network: 100% Type 2- Basic
Coinsurance In Network: 100% OUT OF NETWORK: 80% Type 3 - Major Coinsurance In Network: 60% OUT OF NETWORK: 50% |
* See full benefit summaries for details, exclusions, out of network co-pays, & other coverage. Covered expenses only. This web site is not a legal document. This web site is not a guarantee of coverage, eligibility, or provider status and is designed for informational illustration only. Benefits outlined on this web site are subject to change at any time. Please consult your benefit plan provider(s) or administrator(s) for legal documents regarding your plan and to check coverage and/or eligibility