1. Rates for the coming plan year, Employee Only
HMO PPO* CDHP*
Biweekly
Premium
$252.42 $102.24 $46.60
Annual Deductible None None $2000/$4000
Annual Out-of-
Pocket Maximum
$4000 $6850 $6600/$12000
Medical Account No No HRA
Office Visit $20 $30/$50 20%/50%
Specialist $35 $50/$75 20%/50%
Emergency Care $125 $200 20%
Urgent Care $30 $30/$100 20%/50%
2. Prescriptions –
Generic
$10 $20/$50 $10/50%
Prescriptions –
Brand Name
$35 $40/$100 $50/50%
*Prices listed are In-Network/Out-of-Network
Knights Healthcare