HCGH DPC Plan — 2023
Medical Deductibles
Sorry, no results.
| EHP Preferred Network Provider | EHP Network Provider | Out of Network Provider | |
|---|---|---|---|
| Calendar Year Deductible | |||
| Individual | $150 (under $50K) / $200 ($50K to $119,999K) / $300 ($120K and over) | $150 (under $50K) / $200 ($50K to $119,999K) / $300 ($120K and over) | $750 |
| Family | $300 (under $50K) / $400 ($50K to $119,999K) / $600 ($120K and over) | $300 (under $50K) / $400 ($50K to $119,999K) / $600 ($120K and over) | $1500 |
| Co-Insurance Out of Pocket | |||
| Individual | $1500 (under $50K) / $2000 ($50K to $119,999K) / $3000 ($120K and over) | $1500 (under $50K) / $2000 ($50K to $119,999K) / $3000 ($120K and over) | $3500 |
| Family | $3000 (under $50K) / $4000 ($50K to $119,999K) / $6000 ($120K and over) | $3000 (under $50K) / $4000 ($50K to $119,999K) / $6000 ($120K and over) | $7000 |
| Lifetime Maximum | |||
| Individual | Unlimited | Unlimited | Unlimited |
| Family | Unlimited | Unlimited | Unlimited |
