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3500 Copay

A lower deductible version of our copay plan, with the same flat-dollar visit copays. Not HSA-eligible.

Annual Deductible (Ind / Family)
$3,500 / $7,000
Out-of-Pocket Max (Ind / Family)
$10,600 / $21,200
Network
In- and out-of-network coverage
BenefitWhat You Pay
Primary Care Visit$40 copay
Specialist Visit (incl. mental & behavioral health)$75 copay
Urgent Care$90 copay
Telemedicine (MYMDNOW)$0 copay
Emergency Room$1,000 copay
Inpatient Hospital CareDeductible & coinsurance

Prescription Drug Benefits

Drug TierWhat You Pay
Preventive Medicine Rx — Generic$0 copay
Generic Drugs — Maintenance$20 copay
Preferred Brand Name Drugs$65 copay
Non-Preferred Brand Name Drugs$95 copay
Specialty Drugs$200 copay
Out-of-network care is covered at deductible & coinsurance.

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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