BestChoice PPO
| Health Plan # | Ded In/Out Comb | Office Copay | Urgent Care Copay | ER Copay | Coins % In/Out | Coins Stoploss In/Out | Pharmacy |
|---|---|---|---|---|---|---|---|
| RS01 | $250 | $15 | $40 | $100 | 90% / 70% | $1000/$2000 | $15/30/45 |
| RS02 | $500 | $15 | $40 | $100 | 90% / 70% | $2000/$4000 | $15/30/45 |
| RS03 | $500 | $15 | $40 | $100 | 80% / 60% | $2000/$4000 | $15/30/45 |
| RS04 | $500 | $20 | $45 | $100 | 80% / 60% | $2500/$5000 | $20/35/50 |
| RS05 | $750 | $20 | $45 | $100 | 80% / 60% | $3000/$6000 | $15/30/45 |
| RS06 | $1000 | $20 | $45 | $100 | 100% / 70% | $0/$8000 | $15/30/45 |
| RS07 | $1000 | $20 | $45 | $100 | 80% / 60% | $2500/$5000 | $15/30/45 |
| RS08 | $1000 | $25 | $50 | $100 | 90% / 70% | $3000/$6000 | $15/30/45 |
| RS09 | $1000 | $25 | $50 | $100 | 80% / 60% | $3000/$6000 | $20/35/50 |
| RS10 | $1000 | $25 | $50 | $100 | 75% / 50% | $4000/$8000 | $20/40/60 |
| RS11 | $1000 | $30 | $55 | $100 | 80% / 60% | $4000/$8000 | $20/35/50 |
| RS12 | $1000 | Ded & Coins | Ded & Coins | $100 | 80% / 60% | $3000/$6000 | $20/35/50 |
| RS14 | $1500 | $20 | $45 | $100 | 80% / 60% | $3000/$6000 | $15/30/45 |
| RS15 | $1500 | $25 | $50 | $100 | 75% / 50% | $3000/$6000 | $15/40/55 |
| RS16 | $1500 | $30 | $55 | $100 | 80% / 60% | $3000/$6000 | $20/35/50 |
| RS17 | $1500 | $30 | $55 | $100 | 75% / 50% | $4000/$8000 | $20/40/60 |
