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August 21, 2017

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HEALTH INSURANCE: COPPER
Print-friendly PDF of all plans (525k)
Major Medical BenefitsNetworkNon-Network
Individual
Family
$2,000
$4,000
$4,000
$8,000
Co-Insurance 80% / 20% 50% / 50%
Out-of-Pocket (including deductable)
Individual
Family

$4,000
$8,000

Unlimited
Unlimited
Inpatient Hospital Care 80% / 20%
after deductable
50% / 50%
after deductable
Emergency Room Treatment
(Limited to severe medical condition)
$150 co-pay 50% / 50%
after deductable
Outpatient Hospital Care 80% / 20%
after deductable
50% / 50%
after deductable
Office Visits 80% / 20%
after deductable
50% / 50%
after deductable
Inpatient Maternity Care 80% / 20%
after deductable
50% / 50%
after deductable
Lab and X-Ray 80% / 20%
after deductable
50% / 50%
after deductable
Therapy Services
(limited to 10 visits per year)
80% / 20%
after deductable
50% / 50%
after deductable
Life Insurance $10,000 Term
Urgent Care $55 co-pay
Lifetime Maximum $1,000,000
Retail Prescription Drugs Discount Prescription Card
Mail Order Prescription Drugs Discount Prescription Card
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This summary is intended to highlight your healthcare benefits and is not a contract of insurance. Please refer to your Summary Plan Description for a complete explanation of covered services, limitations, exclusions and a description of all terms and conditions of coverage.