HSA Eligible

V2500

Primary + Child(ren)

Your Monthly Premium

$

Individual Deductible
$2,500
Individual Out-of-Pocket Max
$2,500
Family Deductible
$5,000
Family Out-of-Pocket Max
$5,000
Office Visit
100% after Deductible
Specialist Visit
100% after Deductible
Dental
Included
Vision
Included

Plan Summary Details

View Rx Formulary