<thead>
<tr class="footable-header">
                                                                        <th scope="col"  class="ninja_column_0 ninja_clmn_nm_benefit "> </th><th scope="col"  class="ninja_column_1 ninja_clmn_nm_carrier ">Kaiser HDHP with<br>Optional HSA—CA</th><th scope="col"  class="ninja_column_2 ninja_clmn_nm_kaiser_hdhp_with_optional_hsa_northwest ">Kaiser HDHP with<br>Optional HSA—CO</th><th scope="col"  class="ninja_column_3 ninja_clmn_nm_kaiser_hdhp_with_optional_hsa_ga ">Kaiser HDHP with<br>Optional HSA—GA</th></tr>
</thead>
<tbody>

        <tr data-row_id="179" class="ninja_table_row_0 nt_row_id_179">
            <td> </td><td><center><b>In-Network</td><td><center><b>In-Network </td><td><center><b>In-Network  </td>        </tr>
            <tr data-row_id="189" class="ninja_table_row_1 nt_row_id_189">
            <td><b>Annual Deductible</b><br>Single<br>Family<br>Embedded or Aggregate</td><td><br>$3,300<br>$6,600<br>Embedded</td><td><br>$3,300<br>$6,600<br>Embedded </td><td><br>$3,300<br>$6,600<br>Embedded  </td>        </tr>
            <tr data-row_id="190" class="ninja_table_row_2 nt_row_id_190">
            <td><b>Annual Out-of-Pocket Max</b><br>Single<br>Family<br>Embedded or Aggregate</td><td><br>$6,000<br>$12,000<br>Yes</td><td><br>$6,000<br>$12,000<br>Yes </td><td><br>$6,000<br>$12,000<br>Yes  </td>        </tr>
            <tr data-row_id="180" class="ninja_table_row_3 nt_row_id_180">
            <td><b>Office Visit</td><td>30% after deductible</td><td>30% after deductible </td><td>30% after deductible  </td>        </tr>
            <tr data-row_id="181" class="ninja_table_row_4 nt_row_id_181">
            <td><b>Preventive Services</td><td>No charge</td><td>No charge </td><td>No charge  </td>        </tr>
            <tr data-row_id="191" class="ninja_table_row_5 nt_row_id_191">
            <td><b>Chiropractic Care (May require medical necessity)</td><td>30% after deductible (up to 20 visits per year)</td><td>30% after deductible (up to 20 visits per year) </td><td>30% after deductible (up to 20 visits per year)  </td>        </tr>
            <tr data-row_id="192" class="ninja_table_row_6 nt_row_id_192">
            <td><b>Lab & X-Ray</td><td>30% after deductible</td><td>30% after deductible </td><td>30% after deductible  </td>        </tr>
            <tr data-row_id="193" class="ninja_table_row_7 nt_row_id_193">
            <td><b>Inpatient Hospitalization</td><td>30% after deductible </td><td>30% after deductible  </td><td>30% after deductible   </td>        </tr>
            <tr data-row_id="182" class="ninja_table_row_8 nt_row_id_182">
            <td><b>Outpatient Surgery</td><td>30% after deductible  </td><td>30% after deductible   </td><td>30% after deductible        </td>        </tr>
            <tr data-row_id="183" class="ninja_table_row_9 nt_row_id_183">
            <td><b>Urgent Care</td><td>30% after deductible   </td><td>30% after deductible    </td><td>30% after deductible    </td>        </tr>
            <tr data-row_id="184" class="ninja_table_row_10 nt_row_id_184">
            <td><b>Emergency Room</td><td>30% after deductible    </td><td>30% after deductible     </td><td>30% after deductible     </td>        </tr>
            <tr data-row_id="185" class="ninja_table_row_11 nt_row_id_185">
            <td><b><center>Prescription Drugs</td><td><b><center>Generic/Brand</td><td><b><center>Generic/Brand </td><td><b><center>Generic/Brand  </td>        </tr>
            <tr data-row_id="186" class="ninja_table_row_12 nt_row_id_186">
            <td><b>Deductible (Single/Family)</td><td>Combined w/medical</td><td>Combined w/medical </td><td>Combined w/medical  </td>        </tr>
            <tr data-row_id="187" class="ninja_table_row_13 nt_row_id_187">
            <td><b>Retail (30-day supply)</td><td>$15/$35 (after deductible)</td><td>$15/$35 (after deductible) </td><td>$15/$35 (after deductible)  </td>        </tr>
            <tr data-row_id="188" class="ninja_table_row_14 nt_row_id_188">
            <td><b>Mail Order (90-day supply)</td><td>$30/$70 (after deductible)</td><td>$30/$70 (after deductible) </td><td>$30/$70 (after deductible)  </td>        </tr>
    </tbody><!--ninja_tobody_rendering_done-->
