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Standard Plan (80/20 PPO)

The Standard Plan offers a combination of copayments (a set dollar amount) and coinsurance (a percentage of the service cost). Your out-of-pocket expenses are kept low by choosing in-network providers; however, you have the flexibility to choose out-of-network care for a higher cost.

The City pays 100% of the cost of the employee premium and subsidizes a portion of dependent care premiums.

Plan highlights include (for in-network providers):

  • No deductible.

  • $25 copay for primary care visits/$50 copay for specialists

  • 20% coinsurance for diagnostic tests (such as x-rays and blood work) and imaging (CT/PET scans, MRIs, etc.)

  • 20% coinsurance for outpatient surgery

  • $50 copay per day for in-patient hospital stays

  • If you choose out-of-network care, your cost will be 40% coinsurance for most services.

Out-of-Pocket Maximums:
These are the limits for the most you will pay during a coverage period (usually one year) for your share of the costs of covered services. If you reach this limit in a plan year, any remaining service costs will be covered 100% by the plan (not including premiums).

  • $2,000 individual / $4,000 family for in-network care;

  • $4,000 individual / $8,000 family for out-of-network care .

  • Prescription Expenses: $1,000 individual / $3,000 for family.

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