Card Category: Member Health
HSA Eligible
APA V2500
Family
Your Monthly Premium
$
Individual Deductible
$2,500
Individual Out-of-Pocket Max
$2,500
Family Deductible
$5,000
Family Out-of-Pocket Max
$5,000
Office Visit
100% after Deductible
Specialist Visit
100% after Deductible
HSA Eligible
APA V5000
Family
Your Monthly Premium
$
Individual Deductible
$5,000
Individual Out-of-Pocket Max
$5,000
Family Deductible
$10,000
Family Out-of-Pocket Max
$10,000
Office Visit
100% after Deductible
Specialist Visit
100% after Deductible
APA V10000
Family
Your Monthly Premium
$
Individual Deductible
$10,000
Individual Out-of-Pocket Max
$10,000
Family Deductible
$20,000
Family Out-of-Pocket Max
$20,000
Office Visit
100% after Deductible
Specialist Visit
100% after Deductible
HSA Eligible
APA V2500
Primary + Child(ren)
Your Monthly Premium
$
Individual Deductible
$2,500
Individual Out-of-Pocket Max
$2,500
Family Deductible
$5,000
Family Out-of-Pocket Max
$5,000
Office Visit
100% after Deductible
Specialist Visit
100% after Deductible
HSA Eligible
APA V5000
Primary + Child(ren)
Your Monthly Premium
$
Individual Deductible
$5,000
Individual Out-of-Pocket Max
$5,000
Family Deductible
$10,000
Family Out-of-Pocket Max
$10,000
Office Visit
100% after Deductible
Specialist Visit
100% after Deductible
APA V10000
Primary + Child(ren)
Your Monthly Premium
$
Individual Deductible
$10,000
Individual Out-of-Pocket Max
$10,000
Family Deductible
$20,000
Family Out-of-Pocket Max
$20,000
Office Visit
100% after Deductible
Specialist Visit
100% after Deductible
HSA Eligible
APA V2500
Primary + Spouse
Your Monthly Premium
$
Individual Deductible
$2,500
Individual Out-of-Pocket Max
$2,500
Family Deductible
$5,000
Family Out-of-Pocket Max
$5,000
Office Visit
100% after Deductible
Specialist Visit
100% after Deductible
HSA Eligible
APA V5000
Primary + Spouse
Your Monthly Premium
$
Individual Deductible
$5,000
Individual Out-of-Pocket Max
$5,000
Family Deductible
$10,000
Family Out-of-Pocket Max
$10,000
Office Visit
100% after Deductible
Specialist Visit
100% after Deductible
APA V10000
Primary + Spouse
Your Monthly Premium
$
Individual Deductible
$10,000
Individual Out-of-Pocket Max
$10,000
Family Deductible
$20,000
Family Out-of-Pocket Max
$20,000
Office Visit
100% after Deductible
Specialist Visit
100% after Deductible
HSA Eligible
APA V2500
Primary Only
Your Monthly Premium
$
Individual Deductible
$2,500
Individual Out-of-Pocket Max
$2,500
Family Deductible
$5,000
Family Out-of-Pocket Max
$5,000
Office Visit
100% after Deductible
Specialist Visit
100% after Deductible