Level
| Office Visit Copay
| ER Copay
| Hospital Copay
| Spinal Manipulation Coverage
| Pediatric Dental Coverage
| Product Sheet
|
|---|---|---|---|---|---|---|
| HMO | ||||||
$25-PCP $50-Specialist |
$100
|
$350-Community $1,000-Tertiary |
Yes
|
No
|
||
$15-PCP $25-Specialist |
$50
|
$0-Community $500-Tertiary |
Yes
|
No
|
||
POS |
||||||
$25-PCP $50-Specialist |
$100
|
$350-Community $1,000-Tertiary |
Yes
|
No
|
||
$15-PCP $25-Specialist |
$50
|
$0-Community $500-Tertiary |
Yes
|
No
|
||
$10-PCP $25-Specialist |
$50
|
$0-Community $350-Tertiary |
Yes
|
No
|
||