Premium $39 PCP  $0 Inpatient Hospital $335 (days 1-6) Rx Deductible $195

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Premium $19 PCP  $0 Inpatient Hospital $335 (days 1-6) Rx Deductible $195

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Premium $0 PCP  $0 Inpatient Hospital $335 (days 1-6) Rx Deductible $195

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Premium $0 PCP  $0 Inpatient Hospital $335 (days 1-6) Rx Deductible $195

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Premium $0 MOOP  $3,400 PCP $0 Specialist $35 Inpatient Hospital $200 days

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