Plan pays 100% in PPO Network
Plan pays 80% of first $5,000 outside PPO Network then 100%
Co-Insurance is the percentage of medical expenses, after the Medical Deductible, that are the responsibility of the insured.
CO-INSURANCE PER POLICY PERIOD:
In Network 100%.
Out of Network 80% OF THE FIRST $5,000 THEN 100% up to the Policy Maximum.
Out of USA up to 100%.
URGENT CARE CO-PAY:
$30 per Incident, if the $0 out of Network deductible is chosen, there is no Co-Pay.