Metal Tier
Gold
Silver
Silver
Bronze
Bronze (HSA)
Plan Name MODA – Be Serene MODA – Be Agile MODA – Be Reliable MODA – Be Certain MODA – Be Active (HSA)
Network First Choice Health First Choice Health First Choice Health First Choice Health First Choice Health
Type PPO PPO PPO PPO PPO
Copay $15 $20 $25/visit for first 4 visits, 25% subsequent visits $30/visit for first 4 visits, 35% subsequent visits 20%
Deductible per Person $650 $1,250 $2,750 $5,250 $5,250
Coinsurance 85%  / 15% 70% / 30% 75% / 25% 65% / 35% 80% / 20%
Maximum Out of Pocket (includes deductible) $4,000 $6,350 $6,600 $6,600 $6,450
Value $2 $2 $2 $2 $2
Generic 50% 50% 50% 50% 50%
Brand 50% 50% 50% 50% 50%
Additional Info A great option with greatest benefits at the core of the plan. A plan with high benefits at a greater value without a limit on office visits with copay only. A plan with high benefits at a greater value with limited office visits with copay only. A great option with value at the core of the plan. A great value for those who don’t need the benefits of the higher plans. HSA plans require the deductible be met prior to benefits being paid.
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