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https://aptia365.com/atlanticunionbank 9 Copyright 2024 Aptia Insurance Services Group, LLC. All rights reserved.Review Your Medical Plan OptionsAnthemNetwork: PPOMedical Plan SummaryThe following benefits are included in your plan options. Unless otherwise noted, benefits are per insured person and after deductible.Co-Pay Plan ($1,000/$2,000) HSA Enhanced ($2,000/$4,000) HSA Basic ($4,000/$8,000)Health Savings AccountHSA Eligible No Yes YesAUB HSA Match* N/A Up to $500 IndividualUp to $1,000 FamilyUp to $500 IndividualUp to $1,000 FamilyIn-Network Out-ofNetwork In-Network Out-ofNetwork In-Network Out-ofNetworkAnnual DeductibleIndividual $1,000 $2,000 $2,000 $4,000 $4,000 $8,000Family $2,000 $4,000 $4,000 $8,000 $8,000 $16,000Out-of-Pocket MaximumIndividual $4,000 $8,000 $4,000 $8,000 $6,350 $12,700Family $8,000 $16,000 $8,000 $16,000 $9,450 $25,400Medical Benefits CoveragePlan Coinsurance 20% 40% 10% 30% 30% 50%Preventive Care 0% 40% 0% 30% 0% 50%Primary/Specialist Visit$25/$45 copay**40% 10% 30% 30% 50%Inpatient Hospital 20% 40% 10% 30% 30% 50%Outpatient Hospital20% 40% 10% 30% 30% 50%Urgent Care 20% 40% 10% 30% 30% 50%Emergency Room $150 copay $150 copay 10% 10% 30% 30%*HSA Match Program: Teammates enrolled in a qualified HSA medical plan will receive a company match to your AUB Health Savings Account dollar for dollar up to $500 for the Teammate Only tier or $1,000 for all other coverage tiers (helping you cover dependent cost).**Co-pays begin on effective date for the Co-Pay Plan ($1,000/$2,000) (prior to meeting annual deductible).Medical Plan Coverage