Employee Cost Per Pay Period

Employee Only - 9.96% of gross wages (not to exceed $147.29 per pay period)

Employee + Child(ren) - Employee cost + $276.95

Network: S - FIND A DOCTOR (click to search)

Deductible $3,500

Out of Pocket Max $7,500

Coinsurance 50%

Office Visit Ded/Coin

Wellcare Services Covered at 100% at in network provider

Virtual Care Services Covered at 100% at in network provider

Outpatient Surgery Ded/Coin

Emergency Room Ded/Coin

Rx Ded then $10/$45/$90 Copay

Urgent Care Ded/Coin

Teledoc Health $10 Copay

HSA Eligible? Yes