PLANS IN CART

Health Off-Exchange

$245.84/mo

Aetna Classic
Health Off-Exchange

Deductible $100
Max Benefit $2,500
Accidental Death COVERED
Dismemberment COVERED

Dental

$245.84/mo

Aetna Classic
Health Off-Exchange

Deductible $100
Max Benefit $2,500
Accidental Death COVERED
Dismemberment COVERED

Vision

$245.84/mo

Aetna Classic
Health Off-Exchange

Deductible $100
Max Benefit $2,500
Accidental Death COVERED
Dismemberment COVERED

Accident

$245.84/mo

Aetna Classic
Health Off-Exchange

Deductible $100
Max Benefit $2,500
Accidental Death COVERED
Dismemberment COVERED

Amount Due Today

$456.90/mo

Monthly Total

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Accident, Dental, Vision, Cancer, Short-Term

Off-Exchange

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of

medication(s) listed.

Medications:

Medicine Name Example 10 MG ORAL TAB
Medicine Name Example 10 MG ORAL TAB
Medicine Name Example 10 MG

Payment Method

Coverage Up to

Plan Name	Primary Care Visit	Inpatient Hospital Services	Deductible	EHB OOP Max	Premium
Bronze
Bronze 60 HDHP EnhancedCore PPO Benefit Brochure PPO HSA	40% after ded.	40% after ded.	$6,000 w/Rx	$6,650 w/Rx	$500.84
Bronze 60 HDHP EnhancedCore PPO Benefit Brochure epo bronze	40% after ded.	40% after ded.	$6,000 w/Rx	$6,650 w/Rx	$500.84
Silver
Bronze 60 HDHP EnhancedCore PPO Benefit Brochure PPO silver	40% after ded.	40% after ded.	$6,000 w/Rx	$6,650 w/Rx	$500.84
Bronze 60 HDHP EnhancedCore PPO Benefit Brochure PPO gold	40% after ded.	40% after ded.	$6,000 w/Rx	$6,650 w/Rx	$500.84

Plan Name	Primary Care Visit	Inpatient Hospital Services	Deductible	EHB OOP Max	Premium
Gold
Bronze 60 HDHP EnhancedCore PPO Benefit Brochure hmo platinum	40% after ded.	40% after ded.	$6,000 w/Rx	$6,650 w/Rx	$500.84
Platinum
Bronze 60 HDHP EnhancedCore PPO Benefit Brochure PPO	40% after ded.	40% after ded.	$6,000 w/Rx	$6,650 w/Rx	$500.84
Bronze 60 HDHP EnhancedCore PPO Benefit Brochure PPO	40% after ded.	40% after ded.	$6,000 w/Rx	$6,650 w/Rx	$500.84
Catastrophic
Bronze 60 HDHP EnhancedCore PPO Benefit Brochure PPO catastrophic	40% after ded.	40% after ded.	$6,000 w/Rx	$6,650 w/Rx	$500.84
Bronze 60 HDHP EnhancedCore PPO Save 15% Benefit Brochure PPO	40% after ded.	40% after ded.	$6,000 w/Rx	$6,650 w/Rx	$500.84
Deductible: $1 - $1000
Bronze 60 HDHP EnhancedCore PPO Benefit Brochure PPO catastrophic	40% after ded.	40% after ded.	$6,000 w/Rx	$6,650 w/Rx	$500.84
Deductible: $1001 - $3,500
Bronze 60 HDHP EnhancedCore PPO Benefit Brochure PPO catastrophic	40% after ded.	40% after ded.	$6,000 w/Rx	$6,650 w/Rx	$500.84
Deductible: $5,000 - $15,000
Bronze 60 HDHP EnhancedCore PPO Benefit Brochure PPO catastrophic	40% after ded.	40% after ded.	$6,000 w/Rx	$6,650 w/Rx	$500.84

Cancer

Dental

Vision

Accident

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