OAP Base $1,500 HDHP Local Plus OAP Buy-Up $500 Deductible (Single/Family) $1,500 / $3,000 $6,000 / $12,000 $500 / $1,000 Out-of-Pocket Max (Single/Family) $5,500 / $11,000 $6,750 / $13,500 $3,500 / $7,000 Physician/Specialist Visits $30 / $60 copay $30 / $60 after deductible $25 / $50 copay Coinsurance 20% 0% 20% Preventive Care 100% Covered 100% Covered 100% Covered Hospital/Out-Patient 20% after deductible 0% after deductible 20% after deductible Emergency Room $350 copay 0% after deductible $350 copay Urgent Care Centers $85 copay 0% after deductible $85 copay The OAP Base $1,500 plan is in-network coverage only Medical Options – In-Network