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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

20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

Outpatient laboratory and x-ray services are covered when performed for a specific symptom and to detect or monitor a condition.

Professional charges for automated lab services performed by an out-of-network provider are not covered.


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