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<br />NCACC Health Design Summary Recommended Plan {Option II} <br />In-Network HMO <br />• DoctorlSpec. Copays $15/$30 <br />• Wellness/Preventive Doctor visits copay waived <br />• Rx Copays $51$95/$30, 3 month mail order$~3/$261$60 <br />• ER Copay $950, Urgenf Care Copay $30 <br />• Annual Deductible of $250 for Hospital, Surgery, Testing etc. (9001 coinsurance after <br />deductible is met) <br />In and Out-Network PPO <br />• Doctor/Spec. Copays $951$30 <br />• WellnesslPreventive Doctor visits copay waived <br />• Rx Copays $51$951$30, 3 month mail order$931$26/$60 <br />• ER Copay $950, Urgent Care Copay $30 <br />• Annual Deductible of $250 for Hospital, Surgery, Testing etc. (90% coinsurance after <br />deductible is met) <br />