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https://aptia365.com/horacemann 10 Copyright 2024 Aptia Insurance Services Group, LLC. All rights reserved.Review Your Medical Plan OptionsHMO PlanNetwork: QuartzBenefits are per insured person and after deductible.HMO MediumIn-Network Out-Of-NetworkAnnual DeductibleIndividual $500 Not coveredFamily $1,000 Not coveredOut-of-Pocket MaximumIndividual $500 Not coveredFamily $1,000 Not coveredMedical Benefits CoveragePlan Coinsurance 100% Not coveredPreventive Care 100% Not coveredPrimary/Specialist Visit $30 copay* Not coveredUrgent Care $30 copay* Not coveredInpatient Hospital 100% Not coveredOutpatient Hospital 100% Not coveredEmergency Room $125 copay* 125 copay*Retail Prescriptions(30-day supply)Tier 1 $10 copay* Not coveredTier 2 $25 copay* Not coveredTier 3 $50 copay* Not coveredTier 4 $200 copay* Not coveredTier 5 $5 copay* Not coveredMail-order Prescriptions(90-day supply)Tier 1 Not covered Not coveredTier 2 Not covered Not coveredTier 3 Not covered Not coveredTier 4 Not covered Not coveredTier 5 Not covered Not covered*Deductible does not apply.Medical and Prescription Drug Coverage