Sibley DPC Plan — 2023
Medical Deductibles
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EHP Preferred Network Provider | EHP Network Provider | Out of Network Provider | |
---|---|---|---|
Calendar Year Deductible | |||
Individual | $150 (under $50K) / $200 ($50K to $119,999K) / $300 ($120K and over) | $150 (under $50K) / $200 ($50K to $119,999K) / $300 ($120K and over) | $750 |
Family | $300 (under $50K) / $400 ($50K to $119,999K) / $600 ($120K and over) | $300 (under $50K) / $400 ($50K to $119,999K) / $600 ($120K and over) | $1500 |
Co-Insurance Out of Pocket | |||
Individual | $1500 (under $50K) / $2000 ($50K to $119,999K) / $3000 ($120K and over) | $1500 (under $50K) / $2000 ($50K to $119,999K) / $3000 ($120K and over) | $3500 |
Family | $3000 (under $50K) / $4000 ($50K to $119,999K) / $6000 ($120K and over) | $3000 (under $50K) / $4000 ($50K to $119,999K) / $6000 ($120K and over) | $7000 |
Lifetime Maximum | |||
Individual | Unlimited | Unlimited | Unlimited |
Family | Unlimited | Unlimited | Unlimited |