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                                <th scope="col" colspan="2" class="ninja_column_0 ninja_clmn_nm_ninja_column_1 ">UPMC HDHP EPO with Optional HSA</th><td class="ninja_temp_cell"></td></tr>
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        <tr data-row_id="125" class="ninja_table_row_0 nt_row_id_125">
            <td><b>Annual Deductible</b><br>Single<br>Family<br>Embedded or Aggregate</td><td><br>$4,000<br>$8,000<br>Embedded</td>        </tr>
            <tr data-row_id="126" class="ninja_table_row_1 nt_row_id_126">
            <td><b>Annual Out-of-Pocket Max</b><br>Single<br>Family<br>Embedded or Aggregate</td><td><br>$6,550<br>$13,100<br>Yes</td>        </tr>
            <tr data-row_id="129" class="ninja_table_row_2 nt_row_id_129">
            <td><b>Lifetime Max</td><td>Unlimited</td>        </tr>
            <tr data-row_id="130" class="ninja_table_row_3 nt_row_id_130">
            <td><b>Office Visit</td><td>30% after deductible</td>        </tr>
            <tr data-row_id="131" class="ninja_table_row_4 nt_row_id_131">
            <td><b>Preventive Services</td><td>No charge</td>        </tr>
            <tr data-row_id="132" class="ninja_table_row_5 nt_row_id_132">
            <td><b>Chiropractic Care (May require medical necessity)</td><td>30% after deductible (up to 25 visits combined with acupuncture)</td>        </tr>
            <tr data-row_id="133" class="ninja_table_row_6 nt_row_id_133">
            <td><b>Lab & X-Ray</td><td>30% after deductible</td>        </tr>
            <tr data-row_id="136" class="ninja_table_row_7 nt_row_id_136">
            <td><b>Inpatient Hospitalization</td><td>30% after deductible </td>        </tr>
            <tr data-row_id="137" class="ninja_table_row_8 nt_row_id_137">
            <td><b>Outpatient Surgery</td><td>30% after deductible   </td>        </tr>
            <tr data-row_id="138" class="ninja_table_row_9 nt_row_id_138">
            <td><b>Urgent Care</td><td>30% after deductible    </td>        </tr>
            <tr data-row_id="140" class="ninja_table_row_10 nt_row_id_140">
            <td><b>Emergency Room</td><td>30% after deductible     </td>        </tr>
            <tr data-row_id="141" class="ninja_table_row_11 nt_row_id_141">
            <td><center><b>Prescription Drugs</td><td><center><b>Generic/Brand</td>        </tr>
            <tr data-row_id="142" class="ninja_table_row_12 nt_row_id_142">
            <td><b>Deductible (Single/Family)</td><td>Combined w/medical</td>        </tr>
            <tr data-row_id="143" class="ninja_table_row_13 nt_row_id_143">
            <td><b>Retail (30 day supply)</td><td>30%/30% (after deductible)</td>        </tr>
            <tr data-row_id="144" class="ninja_table_row_14 nt_row_id_144">
            <td><b>Mail Order (90 day supply)</td><td>30%/30% (after deductible) </td>        </tr>
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