In-Network Deductible
(Individual/Family)
$3,300/$6,600
In-Network Out-of-Pocket Maximum
(Individual/Family)
$5,500/$11,000
Office Visits (PCP/Specialist)
20% after deductible
Diagnostic Testing
20% after deductible
Urgent Care:
20% after deductible
Prescription Drugs: 30 day supply (retail)
20% after deductible
Premera HDHP 3300 Medical Plan Benefit Summary
Summary of Benefits & Coverage (SBC)