What Is HealthyPath
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| For Illustrative Purposes Only |  |
|
|---|---|---|
| Benefit | Tier 1 Local HealthyPath Network |
Tier 2 Open Network |
| Annual Deductible | $0 | $5,000/ $10,000 |
| Out of Pocket Maximum | $4,500/ $9,000 | $9,000/ $18,000 |
| Primary Care | $0 | $50 Copay |
| Routine OB Gyn Office Visit | $0 | $50 Copay |
| Specialist Visit | $0 | $75 Copay |
| Mental Health Outpatient Visit | $0 | $50 Copay |
| Urgent Care Clinic Visit | $0 | $75 Copay |
| Outpatient Surgery | $250 Copay | Deductible, then 30% |
| Inpatient Surgery | $500 Copay | Deductible, then 30% |
| Emergency Transportation | 0% | Deductible, then 30% |
| Scheduled Medical Transportation | 30% | Deductible, then 30% |
| Labs & Imaging | $0 | Deductible, then 30% |
