EPO / HSAEPOHDHPHSA-EligibleDental Included
2000 EP w HSA & Dental
$2,000 individual deductible · HSA-eligible · embedded dental
Includes embedded dental — preventive, basic & major
Schedule of benefits
What members pay on 2000 EP w HSA & Dental.
Deductibles & Limits
- Deductible — Individual
- $2,000
- Deductible — Family
- $4,000
- OOP Max — Individual
- $8,500
- OOP Max — Family
- $17,000
Care & Visits
- Preventive Care
- $0 — No Deductible
- Telemedicine
- $0 — Unlimited
- PCP / Specialist Visit
- $50 (after deductible)
- Urgent Care
- $50 (after deductible)
- Emergency Room
- $1,000 (after deductible)
- Labs
- $25 (after deductible)
- X-Rays
- $50 (after deductible)
- Advanced Imaging
- $200 (after deductible)
Hospital & Surgery
- Inpatient Hospital
- $2,500/admission (after ded.)
- Outpatient Surgery
- $2,500/surgery (after ded.)
Pharmacy
- Preventive Rx / Generics
- $0 Copay
- Preferred Brand / Specialty
- Limited Formulary / PAP
Extras
- Dental — Annual Deductible
- $50
- Dental — Preventive
- 100%
- Dental — Basic
- 80%
- Dental — Major
- 50%
FCHP network only
All plans underwritten by Benefit Re Insurance, Inc. (NAIC #17459). FCHP and PHCS national networks — over 800,000 providers. Plans effective July 1, 2026. Premiums quoted on request.
Quote 2000 EP w HSA & Dental for your group.
Premiums quoted on request — brokers can pre-qualify a group in 60 seconds with the Savings Estimator.