Small business benefit packages
Our small business plans are offered in simplified, easy-to-understand packages that are compliant with health care reform and available at a full range of price points.
All plans:
- Include tiered copay structure for PCP, specialist and urgent care services. These services are not subject to deductible. Learn more about tiered copays. (This does not apply to HSA plans.)
- Include coinsurance (PriorityValue plans) or a $150 copay after deductible (all other plans) for advanced diagnostic imaging (preferred/in-network only), emergency room and ambulance services. Copay applies after member meets the deductible. (This does not apply to HSA plans.)
- Include the 3-Tier Pharmacy with Specialty Drug Management plan. An option has already been selected for each plan (see below). Get 3-Tier Pharmacy with Specialty Drug Management copay details.
- Have optional contraceptive coverage
Note: Click the plan name to open a benefit summary document for that plan option.
Benefit packages
Go to:
PriorityHMO plan packages
| Plans | Co-insurance | Indiv./family
deductible | PCP/specialist/
urgent care copays | Prescription drugs | Out-of-pocket max |
|---|
| HMO 100-4 |
100% |
$250/$500 |
$20/$35/$75 |
$10/$40/$80/20%/20% |
N/A |
| HMO 100-5 |
100% |
$500/$1000 |
$20/$35/$75 |
$15/$50/$80/20%/20% |
N/A |
| HMO 100-1 |
100% |
$1000/$2000 |
$20/$35/$75 |
$15/$50/$80/20%/20% |
N/A |
| HMO 100-2 |
100% |
$2000/$4000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
N/A |
| HMO 100-3 |
100% |
$3000/$6000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
N/A |
| HMO 80-5 |
80% |
$250/$500 |
$20/$35/$75 |
$10/$40/$80/20%/20% |
$1500/$3000 |
| HMO 80-1 |
80% |
$500/$1000 |
$20/$35/$75 |
$15/$50/$80/20%/20% |
$1500/$3000 |
| HMO 80-2 |
80% |
$1000/$2000 |
$20/$35/$75 |
$15/$50/$80/20%/20% |
$1500/$3000 |
| HMO 80-3 |
80% |
$2000/$4000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
$1500/$3000 |
| HMO 80-4 |
80% |
$3000/$6000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
$1500/$3000 |
| HMO 70-1 |
70% |
$1000/$2000 |
$20/$35/$75 |
$15/$50/$80/20%/20% |
$2500/$5000 |
| HMO 70-2 |
70% |
$2000/$4000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
$2500/$5000 |
| HMO 70-3 |
70% |
$3000/$6000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
$2500/$5000 |
PriorityPOS plan packages
| Plans | Coinsurance | Individual/family
deductible | PCP/specialist/urgent care copays | Prescription drugs | Out-of-pocket maximum |
|---|
POS 100-4
|
Preferred benefits 100% |
$500/$1000 |
$20/$35/$75 |
$15/$50/$80/20%/20% |
N/A |
| Alternate benefits 70% |
$1000/$2000 |
30% |
$2500/$5000 |
| POS 100-1 |
Preferred benefits 100% |
$1000/$2000 |
$20/$35/$75 |
$15/$50/$80/20%/20% |
N/A |
| Alternate benefits 70% |
$2000/$4000 |
30% |
$2500/$5000 |
| POS 100-2 |
Preferred benefits 100% |
$2000/$4000
|
$30/$45/$75
|
$20/$60/$80/20%/20% |
N/A |
| Alternate benefits 70% |
$4000/$8000 |
30% |
$2500/$5000 |
| POS 100-3 |
Preferred benefits 100% |
$3000/$6000 |
$30/$45/$75
|
$20/$60/$80/20%/20% |
N/A |
| Alternate benefits 70% |
$6000/$12,000 |
30% |
$2500/$5000 |
| POS 80-5 |
Preferred benefits 80% |
$250/$500 |
$20/$35/$75 |
$10/$40/$80/20%/20% |
$1500/$3000 |
| Alternate benefits 60% |
$500/$1000 |
40% |
$3000/$6000 |
| POS 80-1 |
Preferred benefits 80% |
$500/$1000 |
$20/$35/$75 |
$15/$50/$80/20%/20% |
$1500/$3000 |
| Alternate benefits 60% |
$1000/$2000 |
40% |
$3000/$6000 |
| POS 80-2 |
Preferred benefits 80% |
$1000/$2000 |
$20/$35/$75
|
$15/$50/$80/20%/20% |
$1500/$3000 |
| Alternate benefits 60% |
$2000/$4000 |
40% |
$3000/$6000 |
| POS 80-3 |
Preferred benefits 80% |
$2000/$4000 |
$30/$45/$75
|
$20/$60/$80/20%/20% |
$1500/$3000 |
| Alternate benefits 60% |
$4000/$8000 |
40% |
$3000/$6000 |
| POS 80-4 |
Preferred benefits 80% |
$3000/$6000 |
$30/$45/$75
|
$20/$60/$80/20%/20%
|
$1500/$3000 |
| Alternate benefits 60% |
$6000/$12,000 |
40% |
$3000/$6000 |
| POS 70-1 |
Preferred benefits 70% |
$1000/$2000 |
$20/$35/$75
|
$15/$50/$80/20%/20% |
$2500/$5000 |
| Alternate benefits 50% |
$2000/$4000 |
50% |
$5000/$10000 |
| POS 70-2 |
Preferred benefits 70% |
$2000/$4000 |
$30/$45/$75
|
$20/$60/$80/20%/20% |
$2500/$5000 |
| Alternate benefits 50% |
$4000/$8000 |
50% |
$5000/$10000 |
| POS 70-3 |
Preferred benefits 70% |
$3000/$6000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
$2500/$5000 |
| Alternate benefits 50% |
$6000/$12,000 |
50% |
$5000/$10000 |
Back to top PriorityPPO plan packages
| Plans | Coinsurance | Individual/family
deductible | PCP/specialist/urgent care copays | Prescription drugs | Out-of-pocket maximum |
|---|
| PPO 100-1 |
In-network
100% |
$1000/$2000
|
$20/$35/$75
|
$15/$50/$80/20%/20% |
N/A
|
| Out-of-network 70% |
$2000/$4000 |
30% |
$2500/$5000 |
| PPO 100-2 |
In-network
100% |
$2000/$4000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
N/A |
| Out-of-network 70% |
$4000/$8000 |
30% |
$2500/$5000 |
| PPO 100-3 |
In-network
100% |
$3000/$6000
|
$30/$45/$75 |
$20/$60/$80/20%/20% |
N/A
|
| Out-of-network 70% |
$6000/$12000 |
30% |
$2000/$5000 |
| PPO 80-6 |
In-network 80% |
$250/$500 |
$20/$35/$75 |
$10/$40/$80/20%/20% |
$1500/$3000 |
| Out-of-network 60% |
$500/$1000 |
40% |
$3000/$6000 |
| PPO 80-1 |
In-network 80% |
$500/$1000 |
$20/$35/$75 |
$15/$50/$80/20%/20% |
$1500/$3000 |
| Out-of-network 60% |
$1000/$2000 |
40% |
$3000/$6000 |
| PPO 80-2 |
In-network 80% |
$1000/$2000 |
$20/$35/$75 |
$15/$50/$80/20%/20% |
$1500/$3000 |
| Out-of-network 60% |
$2000/$4000 |
40% |
$3000/$6000 |
| PPO 80-3 |
In-network 80% |
$2000/$4000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
$1500/$3000 |
| Out-of-network 60% |
$4000/$8000 |
40% |
$3000/$6000 |
| PPO 80-4 |
In-network 80% |
$3000/$6000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
$1500/$3000 |
| Out-of-network 60% |
$6000/$12000 |
40% |
$3000/$6000 |
| PPO 70-1 |
In-network 70% |
$1000/$2000 |
$20/$35/$75 |
$15/$50/$80/20%/20% |
$2500/$5000 |
| Out-of-network 50% |
$2000/$4000 |
50% |
$5000/$10,000 |
| PPO 70-2 |
In-network 70% |
$2000/$4000
|
$30/$45/$75 |
$20/$60/$80/20%/20% |
$2500/$5000 |
| Out-of-network 50% |
$4000/$8000 |
50% |
$5000/$10,000 |
| PPO 70-3 |
In-network 70% |
$3000/$6000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
$2500/$5000 |
| Out-of-network 50% |
$6000/$12000 |
50% |
$5000/$10,000 |
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PriorityValue HMO plan packages
| Plans | Coinsurance | Individual/family
deductible | PCP/specialist/urgent care copays | Prescription drugs | Out-of-pocket maximum |
|---|
| HMO VP 80-1 |
80% |
$500/$1000 |
0%/20%/20% |
$15/$50/$80/20%/20% |
$2500/$5000 |
| HMO VP 80-2 |
80% |
$1000/$2000 |
0%/20%/20% |
$15/$50/$80/20%/20% |
$2500/$5000 |
| HMO VP 80-3 |
80% |
$2000/$4000 |
0%/20%/20% |
$20/$60/$80/20%/20% |
$2500/$5000 |
| HMO VP 70-1 |
70% |
$1000/$2000 |
0%/30%/30% |
$15/$50/$80/20%/20% |
$2500/$5000 |
| HMO VP 70-2 |
70% |
$2000/$4000 |
0%/30%/30% |
$20/$60/$80/20%/20% |
$2500/$5000 |
| HMO VP 70-3 |
70% |
$3000/$6000 |
0%/30%/30% |
$20/$60/$80/20%/20% |
$2500/$5000 |
PriorityValue POS plan packages
| Plans | Coinsurance | Individual/family
deductible | PCP/specialist/urgent care copays | Prescription drugs | Out-of-pocket maximum |
|---|
| POS VP 80-1 |
Preferred benefits 80% |
$500/$1000 |
0%/20%/20% |
$15/$50/$80/20%/20% |
$2500/$5000
|
| Alternate benefits 60% |
$1000/$2000 |
40%/40%/40% |
$5000/$10,000 |
| POS VP 80-2 |
Preferred benefits 80% |
$1000/$2000 |
0%/20%/20% |
$15/$50/$80/20%/20% |
$2500/$5000
|
| Alternate benefits 60% |
$2000/$4000 |
40%/40%/40% |
$5000/$10,000 |
| POS VP 80-3 |
Preferred benefits 80% |
$2000/$4000 |
0%/20%/20% |
$20/$60/$80/20%/20% |
$2500/$5000
|
| Alternate benefits 60% |
$4000/$8000 |
40%/40%/40% |
$5000/$10,000 |
| POS VP 70-1 |
Preferred benefits 70% |
$1000/$2000 |
0%/30%/30%
|
$15/$50/$80/20%/20% |
$2500/$5000
|
| Alternate benefits 50% |
$2000/$4000 |
50%/50%/50% |
$5000/$10,000 |
| POS VP 70-2 |
Preferred benefits 70% |
$2000/$4000 |
0%/30%/30%
|
$20/$60/$80/20%/20% |
$2500/$5000
|
| Alternate benefits 50% |
$4000/$8000 |
50%/50%/50% |
$5000/$10,000 |
| POS VP 70-3 |
Preferred benefits 70% |
$3000/$6000 |
0%/30%/30% |
$20/$60/$80/20%/20% |
$2500/$5000
|
| Alternate benefits 50% |
$6000/$12,000 |
50%/50%/50% |
$5000/$10,000 |
PriorityValue PPO plan packages
| Plans | Coinsurance | Individual/family
deductible | PCP/specialist/urgent care copays | Prescription drugs | Out-of-pocket maximum |
|---|
| PPO VP 80-1 |
In-network
80% |
$500/$1000 |
0%/20%/20% |
$15/$50/$80/20%/20% |
$2500/$5000 |
| Out-of-network 60% |
$1000/$2000 |
40%/40%/40% |
$5000/$10,000 |
| PPO VP 80-2 |
In-network
80% |
$1000/$2000 |
0%/20%/20% |
$15/$50/$80/20%/20% |
$2500/$5000 |
| Out-of-network 60% |
$2000/$4000 |
40%/40%/40% |
$5000/$10,000 |
| PPO VP 80-3 |
In-network
80% |
$2000/$4000 |
0%/20%/20% |
$20/$60/$80/20%/20% |
$2500/$5000 |
| Out-of-network 60% |
$4000/$8000 |
40%/40%/40% |
$5000/$10,000 |
| PPO VP 70-1 |
In-network
70% |
$1000/$2000 |
0%/30%/30% |
$15/$50/$80/20%/20% |
$1500/$3000 |
| Out-of-network 50% |
$2000/$4000 |
50%/50%/50% |
$3000/$6000 |
| PPO VP 70-2 |
In-network
70% |
$2000/$4000 |
0%/30%/30% |
$20/$60/$80/20%/20% |
$2500/$5000 |
| Out-of-network 50% |
$4000/$8000 |
50%/50%/50% |
$5000/$10,000 |
| PPO VP 70-3 |
In-network
70% |
$3000/$6000 |
0%/30%/30% |
$20/$60/$80/20%/20% |
$2500/$5000 |
| Out-of-network 50% |
$6000/$12,000 |
50%/50%/50% |
$5000/$10,000 |
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PriorityHSA HMO plan packages
| Plans | coinsurance | Individual/family
deductible | PCP/specialist/urgent care copays | Prescription drugs | Out-of-pocket maximum |
|---|
| HSA HMO 100-1 |
100% |
$2000/$4000 |
Coinsurance after deductible |
$20/$60/$80/20%/20% |
$4000/$8000 |
| HSA HMO 100-2 |
100% |
$3000/$6000 |
Coinsurance after deductible |
$20/$60/$80/20%/20% |
$5000/$10000 |
| HSA HMO 80-1 |
80% |
$1200/$2400 |
Coinsurance after deductible |
$15/$50/$80/20%/20% |
$3000/$6000 |
| HSA HMO 80-2 |
80% |
$2000/$4000 |
Coinsurance after deductible |
$20/$60/$80/20%/20% |
$4000/$8000 |
| HSA HMO 80-3 |
80% |
$3000/$6000 |
Coinsurance after deductible |
$20/$60/$80/20%/20% |
$5000/$10000 |
PriorityHSA POS plan packages
| Plans | coinsurance | Individual/family
deductible | PCP/specialist/urgent care copays | Prescription drugs | Out-of-pocket maximum |
|---|
| HSA POS 100-1 |
Preferred benefits
100% |
$2000/$4000 |
Coinsurance after deductible |
$20/$60/$80/20%/20% |
$4000/$8000 |
| Alternate benefits 70% |
$4000/$8000 |
$6000/$12,000 |
| HSA POS 100-2 |
Preferred benefits
100% |
$3000/$6000 |
Coinsurance after deductible |
$20/$60/$80/20%/20% |
$5000/$10000 |
| Alternate benefits 70% |
$5000/$10,000 |
$8000/$16,000 |
| HSA POS 80-1 |
Preferred benefits
80% |
$1200/$2400 |
Coinsurance after deductible |
$15/$50/$80/20%/20% |
$3000/$6000 |
| Alternate benefits 60% |
$3000/$6000 |
$5000/$10,000 |
| HSA POS 80-2 |
Preferred benefits
80% |
$2000/$4000 |
Coinsurance after deductible |
$20/$60/$80/20%/20% |
$4000/$8000 |
| Alternate benefits 60% |
$4000/$8000 |
$6000/$12,000 |
| HSA POS 80-3 |
Preferred benefits
80% |
$3000/$6000 |
Coinsurance after deductible |
$20/$60/$80/20%/20% |
$5000/$10000 |
| Alternate benefits 60% |
$6000/$12,000 |
$8000/$16,000 |
PriorityHSA PPO plan packages
| Plans | coinsurance | Individual/family
deductible | PCP/specialist/urgent care copays | Prescription drugs | Out-of-pocket maximum |
|---|
| HSA PPO 100-1 |
In-network100% |
$2000/$4000 |
Coinsurance after deductible |
$20/$60/$80/20%/20% |
$4000/$8000 |
| Out-of-network 70% |
$4000/$8000 |
$6000/$12,000 |
| HSA PPO 100-2 |
In-network
100% |
$3000/$6000 |
Coinsurance after deductible |
$20/$60/$80/20%/20% |
$5000/$10000 |
| Out-of-network 70% |
$5000/$10000 |
$8000/$16,000 |
| HSA PPO 80-1 |
In-network
80% |
$1200/$2400 |
Coinsurance after deductible |
$15/$50/$80/20%/20% |
$3000/$6000 |
| Out-of-network 60% |
$3000/$6000 |
$5000/$10,000 |
| HSA PPO 80-2 |
In-network
80% |
$2000/$4000 |
Coinsurance after deductible |
$20/$60/$80/20%/20% |
$4000/$8000 |
| Out-of-network 60% |
$4000/$8000 |
$6000/$12,000 |
| HSA PPO 80-3 |
In-network
80% |
$3000/$6000 |
Coinsurance after deductible |
$20/$60/$80/20%/20% |
$5000/$10000 |
| Out-of-network 60% |
$5000/$10000 |
$8000/$16,000 |
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PriorityHRA HMO plan packages
| Plans | coinsurance | Individual/family
deductible | PCP/specialist/urgent care copays | Prescription drugs | Out-of-pocket maximum |
|---|
| HRA HMO 80-1 |
80% |
$1000/$2000 |
$20/$35/$75 |
$15/$50/$80/20%/20% |
$1500/$3000 |
| HRA HMO 80-2 |
80% |
$2000/$4000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
$1500/$3000 |
| HRA HMO 80-3 |
80% |
$3000/$6000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
$1500/$3000 |
PriorityHRA POS plan packages
| Plans | coinsurance | Individual/family
deductible | PCP/specialist/urgent care copays | Prescription drugs | Out-of-pocket maximum |
|---|
| HRA POS 80-1 |
Preferred benefits 80% |
$1000/$2000 |
$20/$35/$75 |
$15/$50/$80/20%/20% |
$1500/$3000 |
| Alternate benefits 60% |
$2000/$4000 |
$3000/$6000 |
| HRA POS 80-2 |
Preferred benefits 80% |
$2000/$4000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
$1500/$3000 |
| Alternate benefits 60% |
$4000/$8000 |
$3000/$6000 |
| HRA POS 80-3 |
Preferred benefits 80% |
$3000/$6000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
$1500/$3000 |
| Alternate benefits 60% |
$6000/$12,000 |
$3000/$6000 |
PriorityHRA PPO plan packages
| Plans | coinsurance | Individual/family
deductible | PCP/specialist/urgent care copays | Prescription drugs | Out-of-pocket maximum |
|---|
| HRA PPO 80-1 |
In-network
80% |
$1000/$2000 |
$20/$35/$75 |
$15/$50/$80/20%/20% |
$1500/$3000 |
| Out-of-network 60% |
$2000/$4000 |
$3000/$6000 |
| HRA PPO 80-2 |
In-network
80% |
$2000/$4000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
$1500/$3000 |
| Out-of-network 60% |
$4000/$8000 |
$3000/$6000 |
| HRA PPO 80-3 |
In-network 80% |
$3000/$6000 |
$30/$45/$75 |
$20/$60/$80/20%/20% |
$1500/$3000 |
| Out-of-network 60% |
$6000/$12,000 |
$3000/$6000 |
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HealthbyChoice Achievements HMO plan packages
| Plans |
Coinsurance
| Individual/family
deductible | PCP/specialist/urgent care copays | Prescription drugs | Out-of-pocket maximum |
|---|
HBCA HMO 90-1 |
Standard 70% |
$1000/$2000 |
$30/$45/$75 |
$10/$40/$80/20%/20% |
$1500/$3000 |
| Choice 90% |
$250/$500 |
$20/$35/$75 |
$1000/$2000 |
| HBCA HMO 80-1 |
Standard 70% |
$1500/$3000 |
$35/$50/$75 |
$15/$50/$80/20%/20% |
$3000/$6000 |
| Choice 80% |
$500/$1000 |
$25/$40/$75 |
$2000/$4000 |
| HBCA HMO 80-2 |
Standard 60% |
$2000/$4000 |
$40/$55/$75 |
$20/$60/$80/20%/20% |
$4000/$8000 |
| Choice 80% |
$1000/$2000 |
$30/$45/$75 |
$3000/$6000 |
HealthbyChoice Achievements POS plan packages
| Plans | Coinsurance | Individual/family
deductible | PCP/specialist/urgent care copays | Prescription drugs | Out-of-pocket maximum |
|---|
| HBCA POS 90-1 |
Standard Preferred 70% |
$1000/$2000 |
$30/$45/$75 |
$10/$40/$80/20%/20% |
$1500/$3000 |
| Standard Alternate 50% |
$2000/$4000 |
50%/50%/50% |
$3000/$6000 |
| Choice Preferred 90% |
$250/$500 |
$20/$35/$75 |
$1000/$2000 |
| Choice Alternate 70% |
$500/$1000 |
30%/30%/30% |
$2000/$4000 |
| HBCA POS 80-1 |
Standard Preferred 70% |
$1500/$3000 |
$35/$50/$75 |
$15/$50/$80/20%/20% |
$3000/$6000 |
| Standard Alternate 50% |
$3000/$6000 |
50%/50%/50% |
$6000/$12,000 |
| Choice Preferred 80% |
$500/$1000 |
$25/$40/$75 |
$2000/$4000 |
| Choice Alternate 60% |
$1000/$2000 |
40%/40%/40% |
$4000/$8000 |
| HBCA POS 80-2 |
Standard Preferred 60% |
$2000/$4000 |
$40/$55/$75 |
$20/$60/$80/20%/20% |
$4000/$8000 |
| Standard Alternate 50% |
$4000/$8000 |
50%/50%/50% |
$8000/$16,000 |
| Choice Preferred 80% |
$1000/$2000 |
$30/$45/$75 |
$3000/$6000 |
| Choice Alternate 60% |
$2000/$4000 |
40%/40%/40% |
$6000/$12,000 |
HealthbyChoice Achievements PPO plan packages
| Plans | Coinsurance | Individual/family
deductible | PCP/specialist/urgent care copays | Prescription drugs | Out-of-pocket maximum |
|---|
| HBCA PPO 90-1 |
Standard In-Network 70% |
$1000/$2000 |
$30/$45/$75 |
$10/$40/$80/20%/20% |
$1500/$3000 |
| Standard Out-Network 50% |
$2000/$4000 |
50%/50%/50% |
$3000/$6000 |
| Choice In-Network 90% |
$250/$500 |
$20/$35/$75 |
$1000/$2000 |
| Choice Out-Network 70% |
$500/$1000 |
30%/30%/30% |
$2000/$4000 |
| HBCA PPO 80-1 |
Standard In-Network 70% |
$1500/$3000 |
$35/$50/$75 |
$15/$50/$80/20%/20% |
$3000/$6000 |
| Standard Out-Network 50% |
$3000/$6000 |
50%/50%/50% |
$6000/$12,000 |
| Choice In-Network 80% |
$500/$1000 |
$25/$40/$75 |
$2000/$4000 |
| Choice Out-Network 60% |
$1000/$2000 |
40%/40%/40% |
$4000/$8000 |
| HBCA PPO 80-2 |
Standard In-Network 60% |
$2000/$4000 |
$40/$55/$75 |
$20/$60/$80/20%/20% |
$4000/$8000 |
| Standard Out-Network 50% |
$4000/$8000 |
50%/50%/50% |
$8000/$16,000 |
| Choice In-Network 80% |
$1000/$2000 |
$30/$45/$75 |
$3000/$6000 |
| Choice Out-Network 60% |
$2000/$4000 |
40%/40%/40% |
$6000/$12,000 |
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3-tier pharmacy with specialty drug management copays
| 3-tier pharmacy with specialty drug management tiers |
|---|
| Generic |
Preferred brand |
Non-preferred brand |
Preferred specialty |
Non-preferred specialty |
Specialty annual OOP max per member2 |
| $10 |
$40 |
$80 |
20%
$100 max |
20%
$200 max |
$2,400 |
| $15 |
$50 |
$80 |
20%
$150 max |
20%
$300 max |
$3,600 |
| $20 |
$60 |
$80 |
20%
$200 max |
20%
$400 max |
$4,800 |
Note: Contraceptive coverage is optional for all plans.
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