| • | Minimum deductible: $1,000 individual; $2,000 family |
| • | Out-of-pocket maximum (includes deductible): $5,000 individual; $10,000 family |
| • | No services paid for prior to meeting deductible (except for preventive care) |
| • | No deductible required for preventive care |
| • | For family coverage: family deductible must be met before any reimbursement can be made |
| • | No prescription drug co-payments |
| • | Higher limits allowed for non-participating provider services |