Simply Blue HRA 1000 — Deductible $1,000 single, $2,000 family (in-network), $2,000 single, $4,000 family (out-of-network); co-pay 20 percent in-network, 40 percent out-of-network; $30 office visit co-pay; $150 emergency room; 12 chiropractic visits
Simply Blue HRA 1500 — Deductible $1,500 single, $3,000 family (in-network), $3,000 single, $6,000 family (out-of-network); co-pay 20 percent in-network, 40 percent out-of-network; $30 office visit co-pay; $150 emergency room; 12 chiropractic visits
Simply Blue HRA 2500 — Deductible $2,500 single, $5,000 family (in-network), $5,000 single, $10,000 family (out-of-network); co-pay 20 percent in-network, 40 percent out-of-network; $30 office visit co-pay; $150 emergency room; 12 chiropractic visits
Simple Blue HRA 4000 — Deductible $4,000 single, $8,000 family for both (in- and out-of-network), co-pay 20 percent in-network, 40 percent out-of-network; $30 office visit co-pay; $150 emergency room; 12 chiropractic visits