DOCTOR OFFICE VISITS 
Primary care provider (PCP) $10 copay 30% of the cost 
Specialists $40 copay 30% of the cost 
PREVENTIVE CARE 
N/A Our plan covers many preventive  
services at no cost when you see  
an in-network provider including: 
•Abdominal aortic aneurysm  
screening 
•Alcohol misuse counseling $0 copay or  30% of the cost ,  
depending on the service and