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← Back to All Plans Value Limited, HSA-Compatible – In-Network Only

1750 VL HSA

The same budget-friendly, limited-benefit design as the 1000 VL plan, with a higher deductible that qualifies for HSA contributions.

Annual Deductible (Ind / Family)
$1,750 / $3,500
Out-of-Pocket Max (Ind / Family)
$8,500 / $17,000
Network
In-network only (except true emergencies)
BenefitWhat You Pay
Primary Care & Specialist Visits$50 copay after deductible (10 visits/plan year combined)
Telemedicine (MYMDNOW)$0 copay
Emergency Room$1,000 copay after deductible (limited annual visits)
Inpatient Hospital Care$2,500 copay/admission after deductible (limited stays/year, 10-day max each)
HSA ContributionEmployer contribution amount is employer-determined

Prescription Drug Benefits

Drug TierWhat You Pay
Preventive Medicine Rx — Generic$0 copay
Generic Drugs — Urgent Care$0 copay
Generic Drugs — Maintenance$0 copay
Brand & Specialty DrugsNot covered (patient assistance programs may be available)
This plan has annual visit, admission, and surgery limits by design to keep premiums low.

Want the Full Plan Details?

This page summarizes the key benefits only. For the complete Summary of Benefits, exclusions, and plan documentation, return to your plan overview page and schedule time with the benefits advisor affiliated with your association.

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