Active employees & non–Medicare–eligible retirees
| Plan Specifics | You Pay (In-Network Costs) |
|---|---|
| Plan-year deductible | $1,500 (individual), $3,000 (family) |
| Plan-year out-of-pocket maximum | $3,000 (individual), $6,000 (family) |
| Benefit | You Pay (In-Network Costs) |
| Preventive care, routine physicals, GYN, well child, routine hearing and vision exams, family planning | Nothing, no deductible |
| Office visits (sick care and non-preventive) | Nothing after deductible |
| Office visits (specialists) | Nothing after deductible |
| Urgent care | Nothing after deductible |
| Emergency room | Nothing after deductible |
| Inpatient hospital care | Nothing after deductible |
