MOOP $7,550 PCP  $0 Specialist copay $0 Urgent Care $0 or 20%

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Premium$69PCP $10Inpatient Hospital$335 (days 1-6)Rx Deductible$0Tier 1 & Tier 6 Rx$0Lab / X-ray

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Premium$59PCP $10Inpatient Hospital$335 (days 1-6)Rx Deductible$0Tier 1 & Tier 6 Rx$0Lab / X-ray

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Premium $0 PCP  $0 / $35 Inpatient Hospital $335 (days 1-6) Rx

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Premium $0 Deposit $3,000 Deductible $8,000 Member Responsibility $5,000 Key Extra Benefits

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