BestChoice PPO
| Health Plan # | Ded In/Out Comb | Office Copay | Urgent Care Copay | ER Copay | Coins % In/Out | Coins Stoploss In/Out | Pharmacy |
|---|---|---|---|---|---|---|---|
| RS18 | $2000 | $20 | $45 | $100 | 80% / 60% | $3000/$6000 | $15/40/55 |
| RS19 | $2000 | $25 | $50 | $100 | 75% / 50% | $3000/$6000 | $15/40/55 |
| RS20 | $2000 | $30 | $55 | $100 | 75% / 50% | $4000/$8000 | $20/40/60 |
| RS21 | $2000 | Ded & Coins | Ded & Coins | $100 | 100% / 70% | $0/$8000 | 80% / 50%/ 50% after cal yr ded |
| RS22 | $2500 | $25 | $50 | $100 | 80% / 60% | $3000/$6000 | $10/40/60 |
| RS23 | $2500 | $25 | $50 | $100 | 70% / 50% | $3000/$6000 | $20/40/60 |
| RS24 | $2500 | $30 | $55 | $100 | 70% / 50% | $4000/$8000 | $20/40/60 |
| RS25 | $3000 | $30 | $55 | $100 | 100% / 70% | $0/$10000 | $10/40/60 |
| RS26 | $3000 | $40 | $65 | $100 | 70% / 50% | $5000/$10000 | $20/40/60 |
| RS27 | $3000 | Ded & Coins | Ded & Coins | $100 | 80% / 60% | $4000/$8000 | $20/40/60 |
| RS28 | $4000 | $40 | $65 | $100 | 70% / 50% | $5000/$10000 | $20/40/60 |
| RS29 | $4000 | $40 | $65 | $100 | 50% / 50% | $7500/$15000 | $20/40/60 |
| RS30 | $5000 | $30 | $55 | $100 | 100% / 70% | $0/$10000 | $10/40/60 |
| RS31 | $5000 | $40 | $65 | $100 | 80% / 60% | $3500/$7000 | $20/40/60 |
| RS32 | $5000 | $40 | $65 | $100 | 70% / 50% | $5000/$10000 | $20/40/60 |
