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Patriot Health Health Insurance in OHIO – Health Plan Options

Patriot Health — First Dollar PPO 30

A comparison of the First Dollar PPO 30 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	Non-Specialist Office Visit: $30 copay (unlimited visits), Specialist Visit: $40 copay (unlimited visits)	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Deductible	Individual: $0, Family: $0	Individual: $5,000, Family: $10,000

Patriot Health — First Dollar PPO 40

A comparison of the First Dollar PPO 40 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — PPO 1500

A comparison of the PPO 1500 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	50%
Office Visit	Non-specialist Office Visit: $25 Copay (Ded. Waived). Specialist Visit: $35 Copay (Ded. Waived).	Non-Specialist Office Visit: 50%, Specialist Visit: 50%
Copay	Non-specialist Office Visit: $25 Copay (Ded. Waived). Specialist Visit: $35 Copay (Ded. Waived).	Non-Specialist Office Visit: 50%, Specialist Visit: 50%
Deductible	Individual: $1,500, Family: $3,000	Individual: $3,000, Family: $6,000

Patriot Health — PPO 2500

A comparison of the PPO 2500 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	50%
Office Visit	Non-specialist Office Visit: $30 Copay deductible waived, Specialist Visit: $40 Copay deductible waived	Non-Specialist Office Visit: 50%, Specialist Visit: 50%
Copay	Non-specialist Office Visit: $30 Copay deductible waived, Specialist Visit: $40 Copay deductible waived	Non-Specialist Office Visit: 50%, Specialist Visit: 50%
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

Patriot Health — PPO 5000

A comparison of the PPO 5000 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	50%
Office Visit	Non-specialist Office Visit: $40 Copay deductible waived, Specialist Visit: $50 Copay deductible waived	Non-Specialist Office Visit: 50%, Specialist Visit: 50%
Copay	Non-specialist Office Visit: $40 Copay deductible waived, Specialist Visit: $50 Copay deductible waived	Non-Specialist Office Visit: 50%, Specialist Visit: 50%
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Patriot Health — PPO Value 5000

A comparison of the PPO Value 5000 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — PPO High Deductible 3000 (HSA Compatible)

A comparison of the PPO High Deductible 3000 (HSA Compatible) offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	50% after deductible
Office Visit	Non-Specialist Office Visit: 100% after deductible, Specialist Visit: 100% after deductible	Non-Specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible
Copay	Non-Specialist Office Visit: 100% after deductible, Specialist Visit: 100% after deductible	Non-Specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Patriot Health — PPO High Deductible 5000 (HSA Compatible)

A comparison of the PPO High Deductible 5000 (HSA Compatible) offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	50% after deductible
Office Visit	Non-Specialist Office Visit: 100% after deductible, Specialist Visit: 100% after deductible	Non-Specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible
Copay	Non-Specialist Office Visit: 100% after deductible, Specialist Visit: 100% after deductible	Non-Specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Patriot Health — Preventive and Hospital Care 3000 (HSA Compatible)

A comparison of the Preventive and Hospital Care 3000 (HSA Compatible) offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — PPO Value 2500

A comparison of the PPO Value 2500 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — PPO Value 10000

A comparison of the PPO Value 10000 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — First Dollar PPO 30 with Dental

A comparison of the First Dollar PPO 30 with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — First Dollar PPO 40 with Dental

A comparison of the First Dollar PPO 40 with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — PPO 1500 with Dental

A comparison of the PPO 1500 with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	50%
Office Visit	Non-specialist Office Visit: $25 Copay (Ded. Waived). Specialist Visit: $35 Copay (Ded. Waived).	Non-Specialist Office Visit: 50%, Specialist Visit: 50%
Copay	Non-specialist Office Visit: $25 Copay (Ded. Waived). Specialist Visit: $35 Copay (Ded. Waived).	Non-Specialist Office Visit: 50%, Specialist Visit: 50%
Deductible	Individual: $1,500, Family: $3,000	Individual: $3,000, Family: $6,000

Patriot Health — PPO 2500 with Dental

A comparison of the PPO 2500 with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	50%
Office Visit	Non-specialist Office Visit: $30 Copay deductible waived, Specialist Visit: $40 Copay deductible waived	Non-Specialist Office Visit: 50%, Specialist Visit: 50%
Copay	Non-specialist Office Visit: $30 Copay deductible waived, Specialist Visit: $40 Copay deductible waived	Non-Specialist Office Visit: 50%, Specialist Visit: 50%
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

Patriot Health — PPO 5000 with Dental

A comparison of the PPO 5000 with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	50%
Office Visit	Non-specialist Office Visit: $40 Copay deductible waived, Specialist Visit: $50 Copay deductible waived	Non-Specialist Office Visit: 50%, Specialist Visit: 50%
Copay	Non-specialist Office Visit: $40 Copay deductible waived, Specialist Visit: $50 Copay deductible waived	Non-Specialist Office Visit: 50%, Specialist Visit: 50%
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Patriot Health — PPO Value 5000 with Dental

A comparison of the PPO Value 5000 with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — PPO High Deductible 3000 (HSA Compatible) with Dental

A comparison of the PPO High Deductible 3000 (HSA Compatible) with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	50% after deductible
Office Visit	Non-Specialist Office Visit: 100% after deductible, Specialist Visit: 100% after deductible	Non-Specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible
Copay	Non-Specialist Office Visit: 100% after deductible, Specialist Visit: 100% after deductible	Non-Specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Patriot Health — PPO High Deductible 5000 (HSA Compatible) with Dental

A comparison of the PPO High Deductible 5000 (HSA Compatible) with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	50% after deductible
Office Visit	Non-Specialist Office Visit: 100% after deductible, Specialist Visit: 100% after deductible	Non-Specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible
Copay	Non-Specialist Office Visit: 100% after deductible, Specialist Visit: 100% after deductible	Non-Specialist Office Visit: 50% after deductible, Specialist Visit: 50% after deductible
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Patriot Health — PPO Value 2500 with Dental

A comparison of the PPO Value 2500 with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — PPO Value 10000 with Dental

A comparison of the PPO Value 10000 with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — PPO 7500 with Unlimited Primary Care Visits plus Dental

A comparison of the PPO 7500 with Unlimited Primary Care Visits plus Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Copay Saver

A comparison of the Copay Saver offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	History and exam: $35 copay (maximum 2 visits per person per year)	History and exam: $35 copay (maximum 2 visits per person per year)
Copay	$35	$35
Deductible	$1,500 (Maximum 2 per family, per calendar year)	$1,500 (Maximum 2 per family, per calendar year)

Patriot Health — Copay Saver

A comparison of the Copay Saver offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	History and exam: $35 copay (maximum 2 visits per person per year)	History and exam: $35 copay (maximum 2 visits per person per year)
Copay	$35	$35
Deductible	$2,500 (Maximum 2 per family, per calendar year)	$2,500 (Maximum 2 per family, per calendar year)

Patriot Health — Copay Saver

A comparison of the Copay Saver offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	History and exam: $35 copay (maximum 2 visits per person per year)	History and exam: $35 copay (maximum 2 visits per person per year)
Copay	$35	$35
Deductible	$5,000 (Maximum 2 per family, per calendar year)	$5,000 (Maximum 2 per family, per calendar year)

Patriot Health — Copay Saver

A comparison of the Copay Saver offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	History and exam: $35 copay (maximum 2 visits per person per year)	History and exam: $35 copay (maximum 2 visits per person per year)
Copay	$35	$35
Deductible	$7,500	$7,500

Patriot Health — Copay Saver

A comparison of the Copay Saver offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	History and exam: $35 copay (maximum 2 visits per person per year)	History and exam: $35 copay (maximum 2 visits per person per year)
Copay	$35	$35
Deductible	$10,000	$10,000

Patriot Health — Single HSA 100

A comparison of the Single HSA 100 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	100% after deductible	100% after deductible
Copay	N/A	N/A
Deductible	$1,250	$1,250

Patriot Health — Single HSA 100

A comparison of the Single HSA 100 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	100% after deductible	100% after deductible
Copay	N/A	N/A
Deductible	$2,500	$2,500

Patriot Health — Single HSA 100

A comparison of the Single HSA 100 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	100% after deductible	100% after deductible
Copay	N/A	N/A
Deductible	$3,000	$3,000

Patriot Health — Single HSA 100

A comparison of the Single HSA 100 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	100% after deductible	100% after deductible
Copay	N/A	N/A
Deductible	$3,500	$3,500

Patriot Health — Single HSA 100

A comparison of the Single HSA 100 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	100% after deductible	100% after deductible
Copay	N/A	N/A
Deductible	$5,000	$5,000

Patriot Health — Plan 100

A comparison of the Plan 100 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	100% after deductible	100% after deductible
Copay	N/A	N/A
Deductible	$1,500 (maximum 2 per family, per calendar year)	$1,500 (maximum 2 per family, per calendar year)

Patriot Health — Plan 100

A comparison of the Plan 100 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	100% after deductible	100% after deductible
Copay	N/A	N/A
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Patriot Health — Plan 100

A comparison of the Plan 100 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	100% after deductible	100% after deductible
Copay	N/A	N/A
Deductible	$5,000 (maximum 2 per family, per calendar year)	$5,000 (maximum 2 per family, per calendar year)

Patriot Health — Plan 100

A comparison of the Plan 100 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	100% after deductible	100% after deductible
Copay	N/A	N/A
Deductible	$7,500	$7,500

Patriot Health — Plan 100

A comparison of the Plan 100 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	100% after deductible	100% after deductible
Copay	N/A	N/A
Deductible	$10,000	$10,000

Patriot Health — Plan 80

A comparison of the Plan 80 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	80% after deductible	80% after deductible
Copay	N/A	N/A
Deductible	$1,500 (maximum 2 per family, per calendar year)	$1,500 (maximum 2 per family, per calendar year)

Patriot Health — Plan 80

A comparison of the Plan 80 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	80% after deductible	80% after deductible
Copay	N/A	N/A
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Patriot Health — Plan 80

A comparison of the Plan 80 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	80% after deductible	80% after deductible
Copay	N/A	N/A
Deductible	$5,000 (maximum 2 per family, per calendar year)	$5,000 (maximum 2 per family, per calendar year)

Patriot Health — Plan 80

A comparison of the Plan 80 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	80% after deductible	80% after deductible
Copay	N/A	N/A
Deductible	$7,500	$7,500

Patriot Health — Plan 80

A comparison of the Plan 80 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	80% after deductible	80% after deductible
Copay	N/A	N/A
Deductible	$10,000	$10,000

Patriot Health — Saver 80

A comparison of the Saver 80 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Office Visit - History and Exam: Not covered	Office Visit - History and Exam: Not covered
Copay	N/A	N/A
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Patriot Health — Saver 80

A comparison of the Saver 80 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Office Visit - History and Exam: Not covered	Office Visit - History and Exam: Not covered
Copay	N/A	N/A
Deductible	$1,000 (maximum 2 per family, per calendar year)	$1,000 (maximum 2 per family, per calendar year)

Patriot Health — Saver 80

A comparison of the Saver 80 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Office Visit - History and Exam: Not covered	Office Visit - History and Exam: Not covered
Copay	N/A	N/A
Deductible	$1,500 (maximum 2 per family, per calendar year)	$1,500 (maximum 2 per family, per calendar year)

Patriot Health — Saver 80

A comparison of the Saver 80 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Office Visit - History and Exam: Not covered	Office Visit - History and Exam: Not covered
Copay	N/A	N/A
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Patriot Health — Saver 80

A comparison of the Saver 80 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Office Visit - History and Exam: Not covered	Office Visit - History and Exam: Not covered
Copay	N/A	N/A
Deductible	$5,000 (maximum 2 per family, per calendar year)	$5,000 (maximum 2 per family, per calendar year)

Patriot Health — Saver 80

A comparison of the Saver 80 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Office Visit - History and Exam: Not covered	Office Visit - History and Exam: Not covered
Copay	N/A	N/A
Deductible	$7,500 (maximum 2 per family, per calendar year)	$7,500 (maximum 2 per family, per calendar year)

Patriot Health — Saver 80

A comparison of the Saver 80 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Office Visit - History and Exam: Not covered	Office Visit - History and Exam: Not covered
Copay	N/A	N/A
Deductible	$10,000 (maximum 2 per family, per calendar year)	$10,000 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70%	70%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$1,000 (maximum 2 per family, per calendar year)	$1,000 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$1,000 (maximum 2 per family, per calendar year)	$1,000 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70%	70%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$1,000 (maximum 2 per family, per calendar year)	$1,000 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$1,500 (maximum 2 per family, per calendar year)	$1,500 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$1,500 (maximum 2 per family, per calendar year)	$1,500 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70%	70%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$1,500 (maximum 2 per family, per calendar year)	$1,500 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70%	70%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$3,500	$3,500

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$3,500	$3,500

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70%	70%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$3,500	$3,500

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$5,000 (maximum 2 per family, per calendar year)	$5,000 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$5,000 (maximum 2 per family, per calendar year)	$5,000 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70%	70%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$5,000 (maximum 2 per family, per calendar year)	$5,000 (maximum 2 per family, per calendar year)

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$7,500	$7,500

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$7,500	$7,500

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70%	70%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$7,500	$7,500

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$10,000	$10,000

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$10,000	$10,000

Patriot Health — Copay Select

A comparison of the Copay Select offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70%	70%
Office Visit	$35 copay -not subject to deductible ($25 copay available)	$35 copay -not subject to deductible ($25 copay available)
Copay	$35	$35
Deductible	$10,000	$10,000

Patriot Health — Blue Traditional Plan 2

A comparison of the Blue Traditional Plan 2 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$250 Individual, $500 Family	$250 Individual, $500 Family

Patriot Health — Blue Traditional Plan 1

A comparison of the Blue Traditional Plan 1 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Patriot Health — Blue Traditional Plan 2

A comparison of the Blue Traditional Plan 2 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Patriot Health — Blue Traditional Plan 1

A comparison of the Blue Traditional Plan 1 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$1,000 Individual, $2,000 Family	$1,000 Individual, $2,000 Family

Patriot Health — Blue Traditional Plan 2

A comparison of the Blue Traditional Plan 2 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$1,000 Individual, $2,000 Family	$1,000 Individual, $2,000 Family

Patriot Health — Blue Access Value

A comparison of the Blue Access Value offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70%	60%
Office Visit	Visits 1 and 2- member pays $30 copayment. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.	Visits 1 and 2- member pays coinsurance. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.
Copay	$30 for first 2 Office Visits.	N/A
Deductible	$2,000 Individual, $4,000 Family	$4,000 Individual, $8,000 Family

Patriot Health — Blue Traditional Plan 1

A comparison of the Blue Traditional Plan 1 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

Patriot Health — Blue Traditional Plan 2

A comparison of the Blue Traditional Plan 2 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

Patriot Health — Blue Traditional Plan 3

A comparison of the Blue Traditional Plan 3 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

Patriot Health — Blue Access Value

A comparison of the Blue Access Value offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70%	60%
Office Visit	Visits 1 and 2- member pays $30 copayment. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.	Visits 1 and 2- member pays coinsurance. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.
Copay	$30 for first 2 Office Visits.	N/A
Deductible	$3,000 Individual, $6,000 Family	$6,000 Individual, $12,000 Family

Patriot Health — Blue Access Value

A comparison of the Blue Access Value offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70%	60%
Office Visit	Visits 1 and 2- member pays $30 copayment. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.	Visits 1 and 2- member pays coinsurance. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.
Copay	$30 for first 2 Office Visits.	N/A
Deductible	$5,000 Individual, $10,000 Family	$10,000 Individual, $20,000 Family

Patriot Health — Blue Traditional Plan 1

A comparison of the Blue Traditional Plan 1 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 Family

Patriot Health — Blue Traditional Plan 3

A comparison of the Blue Traditional Plan 3 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 Family

Patriot Health — Blue Access Value

A comparison of the Blue Access Value offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70%	60%
Office Visit	Visits 1 and 2- member pays $30 copayment. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.	Visits 1 and 2- member pays coinsurance. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.
Copay	$30 for first 2 Office Visits.	N/A
Deductible	$10,000 Individual, $20,000 Family	$20,000 Individual, $40,000 Family

Patriot Health — Lumenos Health Incentive Account Plan 1

A comparison of the Lumenos Health Incentive Account Plan 1 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Lumenos Health Incentive Account Plan 2

A comparison of the Lumenos Health Incentive Account Plan 2 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Lumenos Health Incentive Account Plan 1

A comparison of the Lumenos Health Incentive Account Plan 1 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Lumenos Health Incentive Account Plan 2

A comparison of the Lumenos Health Incentive Account Plan 2 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Lumenos Health Incentive Account Plus Plan 1

A comparison of the Lumenos Health Incentive Account Plus Plan 1 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Lumenos Health Incentive Account Plus Plan 2

A comparison of the Lumenos Health Incentive Account Plus Plan 2 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Lumenos Health Incentive Account Plan 1

A comparison of the Lumenos Health Incentive Account Plan 1 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Lumenos Health Incentive Account Plus Plan 1

A comparison of the Lumenos Health Incentive Account Plus Plan 1 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Lumenos Health Incentive Account Plus Plan 1

A comparison of the Lumenos Health Incentive Account Plus Plan 1 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 80% Std Rx

A comparison of the Premier 80% Std Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 80% BuyUp Rx

A comparison of the Premier 80% BuyUp Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — SmartSense Premier Rx

A comparison of the SmartSense Premier Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — SmartSense Generic Rx

A comparison of the SmartSense Generic Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 80% Std Rx

A comparison of the Premier 80% Std Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 80% BuyUp Rx

A comparison of the Premier 80% BuyUp Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — SmartSense Premier Rx

A comparison of the SmartSense Premier Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — SmartSense Generic Rx

A comparison of the SmartSense Generic Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 80% Std Rx

A comparison of the Premier 80% Std Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 80% BuyUp Rx

A comparison of the Premier 80% BuyUp Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — SmartSense Premier Rx

A comparison of the SmartSense Premier Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — SmartSense Generic Rx

A comparison of the SmartSense Generic Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 80% Std Rx

A comparison of the Premier 80% Std Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 80% BuyUp Rx

A comparison of the Premier 80% BuyUp Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — SmartSense Premier Rx

A comparison of the SmartSense Premier Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — SmartSense Generic Rx

A comparison of the SmartSense Generic Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 100% Std Rx

A comparison of the Premier 100% Std Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 100% BuyUp Rx

A comparison of the Premier 100% BuyUp Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 80% Std Rx

A comparison of the Premier 80% Std Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 80% BuyUp Rx

A comparison of the Premier 80% BuyUp Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 100% Std Rx

A comparison of the Premier 100% Std Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 100% BuyUp Rx

A comparison of the Premier 100% BuyUp Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — SmartSense Premier Rx

A comparison of the SmartSense Premier Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — SmartSense Generic Rx

A comparison of the SmartSense Generic Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 100% Std Rx

A comparison of the Premier 100% Std Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 100% BuyUp Rx

A comparison of the Premier 100% BuyUp Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — SmartSense Premier Rx

A comparison of the SmartSense Premier Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — SmartSense Generic Rx

A comparison of the SmartSense Generic Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 100% Std Rx

A comparison of the Premier 100% Std Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Premier 100% BuyUp Rx

A comparison of the Premier 100% BuyUp Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Lumenos Health Savings Account Plan 3

A comparison of the Lumenos Health Savings Account Plan 3 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Lumenos Health Savings Account Plan 4

A comparison of the Lumenos Health Savings Account Plan 4 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Lumenos Health Savings Account Plan 3

A comparison of the Lumenos Health Savings Account Plan 3 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Lumenos Health Savings Account Plan 5

A comparison of the Lumenos Health Savings Account Plan 5 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Lumenos Health Savings Account Plan 3

A comparison of the Lumenos Health Savings Account Plan 3 offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Patriot Health — Blue Short Term

A comparison of the Blue Short Term offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$250 Individual, $500 Family	$250 Individual, $500 Family

Patriot Health — Blue Short Term

A comparison of the Blue Short Term offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Patriot Health — Blue Short Term

A comparison of the Blue Short Term offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$1,000 Individual, $2,000 Family	$1,000 Individual, $2,000 Family

Patriot Health — Blue Short Term

A comparison of the Blue Short Term offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

Patriot Health — Autograph Total Plus Rx/HSA

A comparison of the Autograph Total Plus Rx/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$1,500	$3,000

Patriot Health — Autograph Total Plus Rx/HSA and Dental

A comparison of the Autograph Total Plus Rx/HSA and Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$1,500	$3,000

Patriot Health — Autograph Total Plus Rx/HSA

A comparison of the Autograph Total Plus Rx/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$2,500	$5,000

Patriot Health — Autograph Total Plus Rx/HSA and Dental

A comparison of the Autograph Total Plus Rx/HSA and Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$2,500	$5,000

Patriot Health — Autograph Total Plus Rx/HSA

A comparison of the Autograph Total Plus Rx/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$3,500	$7,000

Patriot Health — Autograph Total Plus Rx/HSA and Dental

A comparison of the Autograph Total Plus Rx/HSA and Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$3,500	$7,000

Patriot Health — Autograph Total Plus Rx/HSA

A comparison of the Autograph Total Plus Rx/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$5,000	$10,000

Patriot Health — Autograph Total Plus Rx/HSA and Dental

A comparison of the Autograph Total Plus Rx/HSA and Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$5,000	$10,000

Patriot Health — Autograph Total Plus Rx/HSA

A comparison of the Autograph Total Plus Rx/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$3,000	$6,000

Patriot Health — Autograph Total Plus Rx/HSA and Dental

A comparison of the Autograph Total Plus Rx/HSA and Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$3,000	$6,000

Patriot Health — Autograph Total Plus Rx/HSA

A comparison of the Autograph Total Plus Rx/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$5,000	$10,000

Patriot Health — Autograph Total Plus Rx/HSA and Dental

A comparison of the Autograph Total Plus Rx/HSA and Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$5,000	$10,000

Patriot Health — Autograph Total Plus Rx/HSA

A comparison of the Autograph Total Plus Rx/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$7,000	$14,000

Patriot Health — Autograph Total Plus Rx/HSA and Dental

A comparison of the Autograph Total Plus Rx/HSA and Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$7,000	$14,000

Patriot Health — Autograph Total Plus Rx/HSA

A comparison of the Autograph Total Plus Rx/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$10,000	$20,000

Patriot Health — Autograph Total Plus Rx/HSA and Dental

A comparison of the Autograph Total Plus Rx/HSA and Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$10,000	$20,000

Patriot Health — Autograph Total/HSA

A comparison of the Autograph Total/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$2,000	$4,000

Patriot Health — Autograph Total/HSA with Dental

A comparison of the Autograph Total/HSA with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$2,000	$4,000

Patriot Health — Autograph Total/HSA

A comparison of the Autograph Total/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$3,000	$6,000

Patriot Health — Autograph Total/HSA with Dental

A comparison of the Autograph Total/HSA with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$3,000	$6,000

Patriot Health — Autograph Total/HSA

A comparison of the Autograph Total/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$4,000	$8,000

Patriot Health — Autograph Total/HSA with Dental

A comparison of the Autograph Total/HSA with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$4,000	$8,000

Patriot Health — Autograph Total/HSA

A comparison of the Autograph Total/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$5,200	$10,400

Patriot Health — Autograph Total/HSA with Dental

A comparison of the Autograph Total/HSA with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$5,200	$10,400

Patriot Health — Autograph Total/HSA

A comparison of the Autograph Total/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$4,000	$8,000

Patriot Health — Autograph Total/HSA with Dental

A comparison of the Autograph Total/HSA with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$4,000	$8,000

Patriot Health — Autograph Total/HSA

A comparison of the Autograph Total/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$6,000	$12,000

Patriot Health — Autograph Total/HSA with Dental

A comparison of the Autograph Total/HSA with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$6,000	$12,000

Patriot Health — Autograph Total/HSA

A comparison of the Autograph Total/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$8,000	$16,000

Patriot Health — Autograph Total/HSA with Dental

A comparison of the Autograph Total/HSA with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$8,000	$16,000

Patriot Health — Autograph Total/HSA

A comparison of the Autograph Total/HSA offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$10,400	$20,800

Patriot Health — Autograph Total/HSA with Dental

A comparison of the Autograph Total/HSA with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$10,400	$20,800

Patriot Health — Monogram

A comparison of the Monogram offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	75%
Office Visit	100% after deductible	75% after deductible
Copay	N/A	N/A
Deductible	$7,500 (Two family members must meet their deductible).	$15,000 (Two family members must meet their deductible).

Patriot Health — Monogram with Dental

A comparison of the Monogram with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	75%
Office Visit	100% after deductible	75% after deductible
Copay	N/A	N/A
Deductible	$7,500 (Two family members must meet their deductible).	$15,000 (Two family members must meet their deductible).

Patriot Health — Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible)

A comparison of the Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$1,000 (Two members must meet their deductible).	$2,000 (Two members must meet their deductible).

Patriot Health — Portrait Share 80 Plus Rx Unlimited

A comparison of the Portrait Share 80 Plus Rx Unlimited offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$1,000 (Two members must meet their deductible).	$2,000 (Two members must meet their deductible).

Patriot Health — Portrait Share 80 Plus Rx Unlimited and Dental

A comparison of the Portrait Share 80 Plus Rx Unlimited and Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$1,000 (Two members must meet their deductible).	$2,000 (Two members must meet their deductible).

Patriot Health — Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) with Dental

A comparison of the Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$1,000 (Two members must meet their deductible).	$2,000 (Two members must meet their deductible).

Patriot Health — Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible)

A comparison of the Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$2,500 (Two members must meet their deductible).	$5,000 (Two members must meet their deductible).

Patriot Health — Portrait Share 80 Plus Rx Unlimited

A comparison of the Portrait Share 80 Plus Rx Unlimited offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$2,500 (Two members must meet their deductible).	$5,000 (Two members must meet their deductible).

Patriot Health — Portrait Share 80 Plus Rx Unlimited and Dental

A comparison of the Portrait Share 80 Plus Rx Unlimited and Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$2,500 (Two members must meet their deductible).	$5,000 (Two members must meet their deductible).

Patriot Health — Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) with Dental

A comparison of the Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$2,500 (Two members must meet their deductible).	$5,000 (Two members must meet their deductible).

Patriot Health — Autograph Share 80 Plus Rx

A comparison of the Autograph Share 80 Plus Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	see brochure	see brochure

Patriot Health — Autograph Share 80 Plus Rx (with $500 Deductible Rx)

A comparison of the Autograph Share 80 Plus Rx (with $500 Deductible Rx) offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	see brochure	see brochure

Patriot Health — Autograph Share 80 Plus Rx with Dental

A comparison of the Autograph Share 80 Plus Rx with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	see brochure	see brochure

Patriot Health — Autograph Share 80 Plus Rx

A comparison of the Autograph Share 80 Plus Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	$5,000	$10,000

Patriot Health — Autograph Share 80 Plus Rx (with $500 Deductible Rx)

A comparison of the Autograph Share 80 Plus Rx (with $500 Deductible Rx) offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	$5,000	$10,000

Patriot Health — Autograph Share 80 Plus Rx with Dental

A comparison of the Autograph Share 80 Plus Rx with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	$5,000	$10,000

Patriot Health — Autograph Share 80 Plus Rx

A comparison of the Autograph Share 80 Plus Rx offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	$6,000	$12,000

Patriot Health — Autograph Share 80 Plus Rx (with $500 Deductible Rx)

A comparison of the Autograph Share 80 Plus Rx (with $500 Deductible Rx) offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	$6,000	$12,000

Patriot Health — Autograph Share 80 Plus Rx with Dental

A comparison of the Autograph Share 80 Plus Rx with Dental offered by Patriot Health is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	$6,000	$12,000