<thead>
<tr class="footable-header">
                                <th scope="col" colspan="2" class="ninja_column_0 ninja_clmn_nm_ninja_column_1 ">Surest PPO</th><td class="ninja_temp_cell"></td></tr>
</thead>
<tbody>

        <tr data-row_id="95" class="ninja_table_row_0 nt_row_id_95">
            <td><b>HSA eligible</td><td><b>No</td>        </tr>
            <tr data-row_id="96" class="ninja_table_row_1 nt_row_id_96">
            <td><b>Company matching contribution to HSA</td><td>Lower deductible</td>        </tr>
            <tr data-row_id="97" class="ninja_table_row_2 nt_row_id_97">
            <td colspan="2"><center><strong>In-network care: your costs</td><td class="ninja_temp_cell"></td>        </tr>
            <tr data-row_id="98" class="ninja_table_row_3 nt_row_id_98">
            <td><strong>Preventive care</td><td>$0; plan pays 100%</td>        </tr>
            <tr data-row_id="99" class="ninja_table_row_4 nt_row_id_99">
            <td><b>Individual/family deductible</td><td><b>$0/$0</td>        </tr>
            <tr data-row_id="100" class="ninja_table_row_5 nt_row_id_100">
            <td><b>Individual/family out-ofpocket maximum (includes deductible)</td><td>$6,000/$12,000</td>        </tr>
            <tr data-row_id="101" class="ninja_table_row_6 nt_row_id_101">
            <td><b>Your coinsurance</td><td><b>N/A</td>        </tr>
            <tr data-row_id="102" class="ninja_table_row_7 nt_row_id_102">
            <td><b>Office visit (primary care/ specialist)</td><td>$40-$140 copay<sup>1</sup></td>        </tr>
            <tr data-row_id="103" class="ninja_table_row_8 nt_row_id_103">
            <td><b>Telemedicine visit</td><td><b>$0-$90 copay</td>        </tr>
            <tr data-row_id="104" class="ninja_table_row_9 nt_row_id_104">
            <td><b>Emergency room visit</td><td>$850 copay<sup>2</sup></td>        </tr>
            <tr data-row_id="105" class="ninja_table_row_10 nt_row_id_105">
            <td colspan="2"><center><b>Prescriptions: your costs</td><td class="ninja_temp_cell"></td>        </tr>
            <tr data-row_id="106" class="ninja_table_row_11 nt_row_id_106">
            <td><b>Retail: 30-day supply</b></br> Generic</br> Formulary</br> Non-formulary</br> Specialty</td><td>Tier 1-$10 copay<br> Tier 2-$90 copay<br> Tier 3-$160<br> Tier1-$440/Tier 2-$480/<br> Tier 3-$530</td>        </tr>
            <tr data-row_id="107" class="ninja_table_row_12 nt_row_id_107">
            <td><b>Mail order: 90-day supply</b><br> Generic<br> Formulary<br> Non-formulary<br> Specialty</td><td>Tier1-$25 copay<br> Tier 2-$225 copay<br> Tier 3-$400 copay<br> Not covered</td>        </tr>
            <tr data-row_id="108" class="ninja_table_row_13 nt_row_id_108">
            <td colspan="2"><b>Preventive maintenance drugs are covered at 100% on all three plans.</td><td class="ninja_temp_cell"></td>        </tr>
    </tbody><!--ninja_tobody_rendering_done-->
