PriorityHMO tiered copay plans—West/North region

  • PriorityHMO 250 100%

    Deductible:
    $250 individual, $500 family
    Coinsurance:
    Employee pays 0%
    Out-of-pocket limit: $5,000 individual, $10,000 family
    Primary / specialist / urgent care:
    $10 / $35 / $75
  • PriorityHMO 250 90%

    Deductible:
    $250 individual, $500 family
    Coinsurance:
    Employee pays 10%
    Out-of-pocket limit: $5,000 individual, $10,000 family
    Primary / specialist / urgent care:
    $10 / $35 / $75

  • PriorityHMO 50%

    Deductible:
    $0 individual, $0 family
    Coinsurance:
    Employee pays 50%
    Out-of-pocket-limit: $7,350 individual, $14,700 family
    Primary / specialist / urgent care:
    $30 / $45 / $75
  • PriorityHMO 500

    Deductible:
    $500 individual, $1,000 family
    Coinsurance:
    Employee pays 20%
    Out-of-pocket limit: $7,350 individual, $14,700 family
    Primary / specialist / urgent care:
    $20 / $50 / $75
  • PriorityHMO 1000

    Deductible:
    $1,000 individual, $2,000 family
    Coinsurance:
    Employee pays 20%
    Out-of-pocket limit: $7,350 individual, $14,700 family
    Primary / specialist / urgent care:
    $20 / $50 / $75
  • PriorityHMO 1500

    Deductible:
    $1,500 individual, $3,000 family
    Coinsurance:
    Employee pays 20%
    Out-of-pocket limit: $7,350 individual, $14,700 family
    Primary / specialist / urgent care:
    $20 / $50 / $75
  • PriorityHMO 2000

    Deductible:
    $2,000 individual, $4,000 family
    Coinsurance:
    Employee pays 20%
    Out-of-pocket limit: $7,350 individual, $14,700 family
    Primary / specialist / urgent care:
    $20 / $50 / $75
  • PriorityHMO 2750

    Deductible:
    $2,750 individual, $5,500 family
    Coinsurance:
    Employee pays 30%
    Out-of-pocket limit: $7,260 individual, $14,520 family
    Primary / specialist / urgent care:
    $45 / $75 / $85
  • PriorityHMO 3500

    Deductible:
    $3,500 individual, $7,000 family
    Coinsurance:
    Employee pays 30%
    Out-of-pocket limit: $7,350 individual, $14,700 family
    Primary / specialist / urgent care:
    $35 / $65 / $75
  • PriorityHMO 4500

    Deductible:
    $4,500 individual, $9,000 family
    Coinsurance:
    Employee pays 30%
    Out-of-pocket limit: $7,350 individual, $14,700 family
    Primary / specialist / urgent care:
    $35 / $65 / $75