Premium $0 PCP  $20 Inpatient Hospital $335 (days 1-6) Lab / X-ray

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Premium $75 PCP  $0 Inpatient Hospital $335 (days 1-6) Rx Deductible $0

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Premium $49 PCP  $0 Inpatient Hospital $335 (days 1-6) Rx Deductible $0

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Premium $39 PCP  $0 Inpatient Hospital $335 (days 1-6) Rx Deductible $0

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Premium$0PCP $0Inpatient Hospital$335 (days 1-6)Rx Deductible$375 tier 4/tier 5Tier 6 Rx$0Lab / X-ray

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