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MEDICAL COVERAGE PLAN A
Plan A: HDHP with HSA
Plan Provision
In-Network Out-of-Network
If you enroll in our Medical Plan A, the Rangers will contribute $250
Company Contribution to HSA annually into your Health Savings Account (H.S.A.); over 26 pay
periods.
Annual Deductible
1
Individual $1,500 Combined with In-Network
Family $3,000 Combined with In-Network
Out-of-Pocket Maximum (Includes Deductible)
Individual $1,600 $3,600
Family $3,200 $6,000
Lifetime Maximum Unlimited
Preventive Care 100% 60% after Deductible
Primary Physician Office Visit 80% after Deductible 60% after Deductible
Specialist Office Visit 80% after Deductible 60% after Deductible
X-Ray and Lab 80% after Deductible 60% after Deductible
Inpatient Hospital Services 80% after Deductible 60% after Deductible
Outpatient Hospital Services 80% after Deductible 60% after Deductible
Urgent Care 80% after Deductible 60% after Deductible
Emergency Room Care 80% after Deductible
Retail Prescriptions 80% after Deductible
1 If you enroll any dependents, the full family deductible must be met before the plan begins to pay.
Plan A: Employee Cost
Tier
Monthly Bi-Weekly
Individual $100.05 $46.18
Employee+ Child(ren) $196.38 $90.64
Employee + Spouse $203.64 $93.99
Family $276.30 $127.52
The above is a summary of this benefit option.
Click here for more detailed information on this available benefit option.
2023 Rangers Baseball LLC (the Texas Rangers) Benefit Guide Page 8
