HMO

Level	Office Visit Copay	ER Copay	Hospital Copay	Spinal Manipulation Coverage	Product Sheet
Premium	$10	$50	None	Yes	Product Sheet
Value	$15	$50	$250	Yes
Basic	$20	$75	$500	Yes
Basic	$20	$100	$750	Yes
Basic	$35	$100	$1,000	Yes
Basic	$50	$200	$1,000	Yes
Choice Copay	$15 PCP $25 Specialist	$100	None	Yes

Advantage $250	$15	$100	Covered in full after $250 deductible	Yes	Product Sheet
Advantage 500	$20	$100	Covered in full after $500 deductible	Yes
Advantage 1000	$20	$100	Covered in full after $1,000 deductible	Yes
Advantage $1500	$20	$100	Covered in full after $1,500deductible	Yes
Advantage $2000	$20	$100	Covered in full after $2,000 deductible	Yes
Advantage $2500	$25	$200	Covered in full after $2,500 deductible	Yes




Advantage Saver	$20	Covered in full after $1,500 deductible	Covered in full after $1,500 deductible	Yes	Product Sheet
Advantage Saver	$25	Covered in full after $2,000 deductible	Covered in full after $2,000 deductible	Yes
Advantage Saver	$25	Covered in full after $2,500 deductible	Covered in full after $2,500 deductible	Yes
Advantage Saver	$25	Covered in full after $3,000 deductible	Covered in full after $3,000 deductible	Yes
Healthpact	$10 Advantage $30 Basic	$200	$500 Advantage $1000 Basic	No