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HSA Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 750 Plan

Network

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 1250 Plan

Network

Primary Care:
$25 copayment
Specialist:
$40 copayment
Medicare: 20% coinsurance after deductiblwe

Non-Network

40% coinsurance after deductible

One hearing test per year. Additional hearing tests are covered if recommended by provider.


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