| Benefits |
NYLA Premier EPO $30 |
NYLA Plus EPO $30 |
NYLA Comprehensive EPO $40 |
| Annual Deductible |
$750/individual; $1,500/family |
$1,500/individual; $3,000/family |
$3,000/individual; $6,000/family |
| Coinsurance |
MVP Covers 80% After Deductible |
MVP Covers 80% After Deductible |
MVP Covers 80% After Deductible |
| Annual Out of Pocket |
$2,500/individual; $5,000/family |
$5,000/individual; $10,000/family |
$10,000/individual; $20,000/family |
Therapy Services (Office Setting) |
$30 Copay |
$30 Copay |
$40 Copay |
| Prescription Drug |
$10/25/40 to $2,500 Annual Max, then 50% Coverage |
$10/25/40 to $2,500 Annual Max, then 50% Coverage |
$10/50%/50% |