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HSA Plan

Network

Preventive:
100% coverage
Diagnostic:
20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 750 Plan

Network

Preventive:
100% coverage
Diagnostic:
20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

PPO 1250 Plan

Network

Preventive:
100% coverage
Diagnostic:
20% coinsurance after deductible

Non-Network

40% coinsurance after deductible

One mammogram per year. Additional mammograms are covered if recommended by physician. See Cancer Screenings.


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