Full-time employees may enroll in one of three health plans; Gold, Silver, or Bronze. Part-time employees may enroll in the Bronze health plan. Coverage marked with an asterisk (*) is the same rate, regardless of plan.

	Gold	Silver	Bronze
Deductible (Per calendar year)
Per covered person	$250	$500	$1,000
Per Family	$500	$1,000	$2,000

One member of the family must meet the individualdeductible amount, then a combination of covered individuals can collectively meet the family deductible.

Maximum out-of-pocket (Per calendar year)
Per covered person	$1,000	$1,500	$2,000
Per Family	$2,000	$3,000	$4,000

Co-insurance will be applied,but deductibles and co-pays do not applyto maximum out-of-pocket.

Physician Office Visit Co-pay
Gold	$15
Silver	$20
Bronze	$25

Co-pay applies to physician’s office visit charges, including; lab, x-ray and other charges billed by the physician during the office visit or on the same day of the visit.

Emergency Room Co-pay*
Gold	$50
Silver	$50
Bronze	$50

ER co-pay is waived if admitted as a result. ER benefit is paid at In-Network rates regardless of where treatment is received.

Urgent Care Co-pay*
Gold	$35
Silver	$35
Bronze	$35

Preventative Care Benefit * (Per calendar year - Per covered person)
Gold	$300
Silver	$300
Bronze	$300

Preventative Care expenses include:

• annual physical exam
• well-child care
• cancer screening
• mammograms
• pap smears
• prostate screening
• colorectal screening
• lab work
• blood tests
• x-rays
• immunizations (including flu shot)
  

Coverage for Hospital-Based Services*

• Services billed by PCRMC…100% no deductible applies
• Services billed by Network Providers…80% after deductible has been met
• Services billed byNon-Network Providers…50% after deductible has been met