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Monogram

Lower-cost, high-deductible plan with Rx coverage

  • Annual medical deductible (per covered person): $7,500
  • For family coverage, once two family members meet their individual deductibles, the family deductible will be met for all other family members
  • Illness/injury doctor's office visits, inpatient hospital, and outpatient hospital services are paid at 100% after deductible for most covered medical expenses, when you use an in-network provider
  • Preventive care services covered at 100%, when you use an in-network provider
  • Includes prescription coverage

Autograph Total Plus Rx/HSA

HSA-qualified plan with lower deductible options, plus Rx coverage

  • Individual coverage annual deductible options (combined medical/prescription): $1,500 | $2,500 | $3,500 | $5,000
  • Family coverage annual deductible options (combined medical/prescription): $3,000 | $5,000 | $7,000 | $10,000
  • For family coverage, all covered members' covered expenses apply to the family deductible; for example, if the covered expenses for one member are enough to meet the family deductible, the rest of the family doesn't need to meet an individual deductible
  • Illness/injury doctor's office visits, inpatient hospital, and outpatient hospital services are paid at 100% after deductible for most covered medical expenses, when you use an in-network provider
  • Preventive care services covered at 100%, when you use an in-network provider
  • Includes prescription coverage

Autograph Total HSA

HSA-qualified plan with higher deductible options

  • Individual coverage annual medical deductible options: $2,000 | $3,000 | $4,000 | $5,200
  • Family coverage annual medical deductible options: $4,000 | $6,000 | $8,000 | $10,400
  • For family coverage, all covered members' covered expenses apply to the family deductible; for example, if the covered expenses for one member are enough to meet the family deductible, the rest of the family doesn't need to meet an individual deductible
  • Illness/injury doctor's office visits, inpatient hospital, and outpatient hospital services are paid at 100% after deductible for most covered medical expenses, when you use and in-network provider
  • Preventive care services covered at 100%, when you use an in-network provider
  • Does not include prescription coverage

Note: The benefits listed above are for covered expenses for in-network providers only. Other out-of-pocket costs may apply, such as access fees or copayments. Services provided by out-of-network providers are processed at a lower level or may not be covered. Other deductibles may apply, including but not limited to prescription drug, mental health, and condition-specific deductibles. For details about out-of-network coverage, limitations, and exclusions, view the plans' Summary of Benefits.

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