b'MEDICALCOVERAGE TO HELP YOU STAY HEALTHYBoth medical plan options provide you and your dependents with:$0 in-network Coverage Prescription Visit anypreventive care for children drug in-networkup to age 26 coverage providerYoull pay less if you use in-network providers. Find a list on myuhc.com.BEK PPO MEDICAL PLAN BEK HSA MEDICAL PLANPreventive carePlan pays 100% for in-network preventive care and 50% for non-network careDeductible In-network: $1,000 individual / $3,000 family In-network: $2,800 individual / $5,600 familyNon-network: $2,000 individual / $6,000 family Non-network: $5,600 individual / $11,200 familyCoinsurance 30% in-network / 50% non-network*Out-of-pocket max In-network: $3,000 individual / $6,000 family In-network: $6,450 individual / $12,900 familyNon-network: $6,000 individual / $12,000 family Non-network: $12,900 individual / $25,800 familyDoctor office visits$35 primary care visit Meet your deductible and pay 30% coinsuranceNon-network coinsurance$50 specialist visit until your reach your out-of-pocket maximumis 50% for either plan$20 virtual doctor visit Virtual doctor visits are $49Non-Maintenance prescription drugs $75 annual calendar year deductible per person and: 30% coinsurance after you meet yourUse any pharmacy except for CVS to receive lower $15 genericannual deductible; use money in your HSAin-network prices. Not covered if you use a$35 preferred brand-name non-network pharmacy$75 non-preferred brand-nameor pay out of your own pocketMaintenance$30 generic30% coinsurance after you meet yourprescription drugs$70 preferred brand-nameannual deductible; use money in your HSA(90-day supply) Use Walgreens or Optum$150 non-preferred brand-nameor pay out of your own pocketmail order to receive lower in-network prices *Non-network ER care is covered at 30% coinsurance'