| Benefits | |
|---|---|
| Deductible | |
| Out of Pocket Maximum | |
| Coinsurance | |
| HSA Eligible | |
| Primary Care Physician Office Visit | |
| Specialist Office Visit | |
| VirtualCare PCP visit (Delivered via the Capital Blue Cross Virtual Care platform) | |
| Emergency Room | |
| Urgent Care | |
| Diagnostic lab services | |
| Out Patient Diagnostic Test | |
| Out Patient High Tech Imaging | |
| Out Patient Surgery Service | |
| In Patient Hospital Admission | |
| Retail Rx | |
| Home Delivery RX | |
| Formulary | |
| Disclaimer |
| Benefits | |
|---|---|
| Deductible | |
| Out of Pocket Maximum | |
| Routine Dental Checkup | |
| Diagnostic and preventative services | |
| Basic services | |
| Major services | |
| Orthodontia services |
| Benefits |
|---|