$0 copay per day for days 9-90 
Your plan covers an unlimited number of days for an inpatient stay. 
Outpatient hospital coverage •Outpatient surgery at Outpatient Hospital:  $150 copay 
•Outpatient surgery at Ambulatory Surgical Center:   $100 copay 
Doctor visits •Primary care provider:  $0 copay 
•Specialist:  $25 copay Your primary care provider (PCP) will work with you to coordinate the care you need with specialists or certain other