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Suburban Hospital PPO Plan — 2023

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EHP Preferred Network ProviderEHP Network ProviderOut 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
IndividualUnlimitedUnlimitedUnlimited
FamilyUnlimitedUnlimitedUnlimited
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