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* For HSA Core, no one in your family pays more than the individual deductible/OOP maximum before the plan pays 100% of their covered expenses. For HSA Value, there’s no individual cap on the deductible, but no one pays more than the individual OOP maximum.
** What you pay after the deductible is met.
*** The most you pay before the plan pays 100% of eligible expenses. Medical and Prescription Drug expenses are combined.
† If you use the ER for a non-emergency, you will be charged an additional $500 that will NOT count toward your deductible or OOP maximum.