IN - NETWORK Preventive Family Doctor, Specialist, Urgent Care Rx - Pharmacy Emergency Room Visit Hospital (In or Out) Deductible Employee Coinsurance Out of Pocket Maximum SWIA HSA Contributions Out of Network Deductible Medical Plan $4,000 HDHP 100% Covered Deductible Deductible Deductible Deductible $4,000 per Individual $8,000 per Family 0% $4,000 per Individual $8,000 per Family +$1,000 Contribution!!! $6,000 per Individual $12,000 per Family M E D I C A L