Page 6 - Washington Nationals 2023 Benefits Guide -10.26.22_Neat
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80/60 PPO PLAN
80/60 PPO Plan
Plan Provision In-Network Out-of-Network
Annual Deductible
Individual $300 $600
Family $600 $1,200
Out-of-Pocket Maximum (Excludes Deductible)
Individual $1,500 $3,000
Family $3,000 $6,000
Lifetime Maximum Unlimited
Preventive Care 100% Not covered
Primary Physician Office Visit $15 Copay 60%*
Specialist Office Visit $15 Copay 60%*
X-Ray and Lab 80%* 60%*
Inpatient Hospital Services 80%* 60%*
Outpatient Hospital Services 80%* 60%*
Urgent Care $15 copay 60%*
Emergency Room Care $100 Copay
Type of Coverage Employee Monthly Cost 80/60 PPO
Individual $218
Employee+ Child(ren) $515
Employee + Spouse $575
Family $650
Click here for more detailed information on this available benefit option.
2023 Washington Nationals Benefit Guide Page 6
