Comparison Chart - RF | Human Resources

Description	RF Traditional PPO (Empire BlueCross Blue Shield)	RF Deductible PPO
Co-Pay	$20.00	$30
In-Network Deductible	None	$500 Individual / $1,250 Family
In-Network Co-Insurance	None	90/10 coinsurance
Out of Network Deductible	Yes ($1000 Individual/ $2500 Family deductible)	Yes ($1500 Individual/ $3750 Family deductible)
Out of Network Co-Insurance	80/20 coinsurance	40/60 coinsurance
Preventive Care	$0 (up to $300 gym reimbursement)	$0 (up to $300 gym reimbursement)
Hospital	$100	Deductible and Coinsurance
ER Visit	$50	$50
Lab or X-rays	$20	Deductible and Coinsurance
Prescriptions	$10/$25/$45	$10/$25/$45

COVERAGE TYPE		RF Traditional PPO (Empire BlueCross Blue Shield)	RF Deductible PPO
In Network	Individual Coverage	$4,224	$1,500
In Network	Family Coverage	$10,560	$3,750
Out of Network	Individual Coverage	$4,000	$5,500
Out of Network	Family Coverage	$10,000	$13,750