Opinions

Best option? Opinions

PPO Plan Option 1 Blue Choice / MTBCP007 Deductible – $1,000 Ind / $3,000 Fam Coinsurance – 100% Max Out-of-Pocket – $3,000 Ind / $9,000 Fam PCP / SPC Copay – $30 / $60 Lab & X-ray – No Charge Advanced Imaging – $0 After Ded Inpatient – $0 After Ded Outpatient – SO After Ded Urgent Care Copay – $75 ER Copay – $500/Visit + $0 After Ded RX Preferred RX – $0 / $10 / $50 / $100 /$150 /5250 Non-Preferred – $10 / $20 / $70 / $120 / $150 / 5250 Deductible – $10,000 Ind / 520,000 Fam Coinsurance – 50% Max Out-of-Pocket – Unlimited Employee Emp + Spouse Emp + Child(ren! Family Cost Per Paychesk $180.62 (employee)

PPO Plan Option 2 Blue Choice / MTBCP035 PPO / HSA Plan Option 3 Blue Choice HSA / MTBCP008H Deductible – $4,000 Ind / $12,000 Fam Coinsurance – 80% Max Out-of-Pocket – $8,150 Ind / 516,300 Fam Deductible – $6,000 Ind / $12,000 Fam Coinsurance – 100% Max Out-of-Pocket • $6,000 Ind / $12,000 Fam PCP / SPC Copay – $35 / $70 Lab & X-ray – No Charge Advanced Imaging – 20% After Ded Inpatient – 20% After Ded PCP / SPC Copay – $0 After Ded Lab & X-ray – SO After Ded Advanced Imaging – $0 After Ded Inpatient – SO After Ded Outpatient – 20% After Ded Outpatient – SO After Ded Urgent Care Copay – $75 Urgent Care Copay – $0 After Ded ER Copay – $500/Visit + 20% After Ded RX Preferred RX-50 / $10 / 550 / 5100 /5150 15250 Non-Preferred – $10 / $20 / $70 / $120 / 5150 / 5250 ER Copay – $0 After Ded RX Preferred RX – $0 After Ded Non-Preferred – SO After Ded OUT-OF-NETWORK BENEFITS Deductible – $10,000 Ind / $20,000 Fam Deductible – $12,000 Ind / $24,000 Fam Coinsurance – 50% Coinsurance – 70% Max Out-of-Pocket – Unlimited Max Out-of-Pocket – Unlimited RATES Cost Per Paycheck Cost Per Paycheck Employee $104.47 Employee $34.00 Emp + Spouse $430.82 Emp + Spouse $275.79 Emp + Children) Family $349.23 5702.78 Emp + Child(ren) Family $215.34 §477.29