| Calendar Year Deductible |
$500 per Individual
$1,000 per Family |
| Maximum Benefits |
Unlimited |
| Annual Co-Payment Maximum |
$4,500 per Individual
$9,000 per Family |
| Hospital Benefits |
80% after deductible has been met |
Emergency Services
Co-payment waived if admitted |
$100 co-payment; deductible does not apply |
Urgently Needed Services
Medically Necessary services required outside geographic area service by Primary Medical Group |
$50 co-payment; deductible does not apply |
| Pre-existing Conditions |
All Medically Necessary conditions are covered provided they are a covered benefit. |