Benefits
Physician Office Visit
Primary CarePPO: $10 per visit co-payment
Non-PPO: 50% UCR after deductible
Specialist
PPO: $15 per visit co-payment
Non-PPO: 50% UCR after deductible
PPO: $10 per visit co-payment
Non-PPO: 50% UCR after deductible
Specialist
PPO: $15 per visit co-payment
Non-PPO: 50% UCR after deductible