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Apr 01, 2022 · worksheet that spells out all options available, and the specific costs involved. Your employees also have ... Out-of-Pocket Max Ind/Fam $2,500 / $5,000 9 $2,500 / $5,000 $2,500 / $5,000 3 Lifetime Maximum Unlimited Unlimited Unlimited Dr. Office Visits (PCP) $20 Copay $30 Copay $30 Copay

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