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HSA Plan

Network

100% coverage* after deductible for 4 visits

Additional visits:
20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 750 Plan

Network

100% coverage*
for 4 visits

Additional visits:
20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 1250 Plan

Network

100% coverage*
for 4 visits

Additional visits:
20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

*For 100% coverage, visits must be taught by a Certified Diabetes Educator through a medical network provider. Visits must be ordered by a provider.


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