The following will increase:

Copayments for pharmacy benefits – except for Tier 1 (generic) drugs, which will stay the same

Copayment for emergency room visits: $150 (previously $125)

See the plan documents effective July 1, 2025, for the new copayment amounts.

The following will increase:

Calendar-year deductible (in-network/out-of-network):

• Individual: $750 (previously $500)

• Family: $1,500 (previously $1,000)

Out-of-pocket maximum (in-network):

• Individual: $3,500 (previously $2,500)

• Family: $6,000 (previously $5,000)

Out-of-pocket maximum (out-of-network):

• Individual: $4,500 (previously $3,500)

• Family: $8,000 (previously $7,000)

Copayments for pharmacy benefits – except for Tier 1 (generic) drugs, which will stay the same

Copayment for emergency room visits: $150 (previously $125)

See the plan documents effective July 1, 2025, for the new copayment amounts.

You will need to pay the full cost for visits to virtual providers until you meet the plan’s calendar-year deductible, which includes both the medical and pharmacy deductibles.

See the plan documents effective July 1, 2025, for information on the calendar-year deductible