Calendar year deductible	$7,000 per individual / $14,000 per family
Calendar year pharmacy deductible	N/A
Calendar year out-of-pocket maximum	$7,000 per individual / $14,000 per family

Preventive Care	$0
Well Baby Care	$0
Prenatal Office Visits	$0
Pediatric Dental Benefits: Preventive	$0
Pediatric Vision Benefits: Exams	$0

24/7 Nurse Hotline	No additional cost
Shield Concierge	Not available
Health and Wellness Discounts (gym, weight loss programs, and more)	No additional cost

Retail Prescription Drugs	Before deductible:
	Tiers 1-4 = Full cost
	After deductible:
	Tiers 1-4: $0

Office Visit - Primary Care (internal medicine, family practice, OB/GYN, pediatrics)	Before deductible:
	Full cost
	After deductible:
	$0
Office Visit - Specialist Care	Before deductible:
	Full cost
	After deductible:
	$0
Teladoc	0% after ded
Retail clinics	Cost depends on the  service performed. Cost is the same as if the service was performed elsewhere.
Acupuncture (from an American Specialty Health Plans network acupuncturist)	Before deductible:
	Full cost
	After deductible:
	$0
Chiropractic (from an American Specialty Health Plans network chiropractor)	Not covered

Laboratory Tests	Before deductible:
	Full cost
	After deductible:
	$0
X-rays	Before deductible:
	Full cost
	After deductible:
	$0
Imaging (CT / PET scan, MRI) from an outpatient radiology center	Before deductible:
	Full cost
	After deductible:
	$0

Urgent care	Before deductible:
	Full cost
	After deductible:
	$0
Emergency Room Services	Before deductible:
	Full cost
	After deductible:
	$0
Ambulance	Before deductible:
	Full cost
	After deductible:
	$0

Maternity - Prenatal Office Visits	$0
Maternity - Other professional services	Before deductible:
	Full cost
	After deductible:
	$0
Maternity - hospital stay	After deductible:
	$0
	Before deductible:
	Full cost

Outpatient Surgery Services	Before deductible:
	Full cost
	After deductible:
	$0
Hospital Stays	Before deductible:
	Full cost
	After deductible:
	$0

Pediatric Dental Benefits: Preventive	$0
Pediatric Dental Benefits: Restorative Procedures	20%
Pediatric Dental Benefits: Medically Necessary Orthodontics	50%
Pediatric Vision Benefits: Exams	$0
Pediatric Vision Benefits: Eye Glasses	1 pair per year