Summary of Coverage
Coverage Details |
NS-EEH System Plan(Endeavor Health ONLY) |
|---|---|
Annual Deductible |
$250/person $500/family |
Annual Out-of-Pocket Maximum |
$4,000/person $8,000/family |
Coinsurance |
You pay 10% |
HSA Company Match |
No |
Service Costs |
NS-EEH System Plan(Endeavor Health ONLY) |
|---|---|
Well Child Exam |
No cost |
Routine Adult Physical Exam |
No cost |
Primary Care Office Visit |
$25 copay |
Specialist Office Visit |
$40 copay |
Hospital Inpatient/Outpatient |
You pay 10% |
Urgent Care |
$40 copay |
Emergency Department |
$250 copay |
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