In-Network Deductible
(Individual/Family)
$1,500/$3,000
In-Network Out-of-Pocket Maximum
(Individual/Family)
$6,000/$12,000
Office Visits (PCP/Specialist)
$30/$30
Diagnostic Testing
Lab: 30% X-ray: 30%
Urgent Care:
$30
Prescription Drugs
Copays for 34 day supply (retail)
Generic: $20
Brand-Name: $40
Non- preferred brand: $60
Specialty: $20
Click here to view Silver Plan SBC