Benefits
Inpatient/Out Surgical Services
In Doctor's Office
PPO: $15 co-payment
Non-PPO: 50% UCR after deductible
Outpatient Facility
PPO: $50 per visit co-payment
Non-PPO: 50% UCR after deductible
In Doctor's Office
PPO: $15 co-payment
Non-PPO: 50% UCR after deductible
Outpatient Facility
PPO: $50 per visit co-payment
Non-PPO: 50% UCR after deductible