<thead>
<tr class="footable-header">
                                                                        <th scope="col"  class="ninja_column_0 ninja_clmn_nm_ninja_column_1 "></th><th scope="col"  class="ninja_column_1 ninja_clmn_nm_uhcppocore ">UnitedHealthcare PPO Core</th><th scope="col"  class="ninja_column_2 ninja_clmn_nm_uhc32hdhpwoptionalhsa ">UnitedHealthcare $3,300 HDHP w/Optional HSA</th><th scope="col"  class="ninja_column_3 ninja_clmn_nm_surestppo ">Surest PPO</th></tr>
</thead>
<tbody>

        <tr data-row_id="218" class="ninja_table_row_0 nt_row_id_218">
            <td><b>HSA Eligible</td><td><b>No</td><td><b>Yes</td><td><b>No</td>        </tr>
            <tr data-row_id="219" class="ninja_table_row_1 nt_row_id_219">
            <td><b>Company Matching Contribution to HSA</td><td>N/A</td><td>• $300 (teammate only)<br> • $425 (teammate + spouse/domestic partner/child(ren))<br> • $600 (teammate + family)<br> • See <b><span style="color: #68ace5;"><a href=“https://benefitsmyway.mybenefitport.com/health-savings-account/”>HSA page</b></a></span> for details<br> You must contribute to your HSA in order to receive the company match</td><td>N/A</td>        </tr>
            <tr data-row_id="220" class="ninja_table_row_2 nt_row_id_220">
            <td><strong>In-network Care: Your Costs</td><td></td><td></td><td></td>        </tr>
            <tr data-row_id="221" class="ninja_table_row_3 nt_row_id_221">
            <td><strong>Preventive Care</td><td>$0; plan pays 100%</td><td>$0; plan pays 100%</td><td>$0; plan pays 100%</td>        </tr>
            <tr data-row_id="222" class="ninja_table_row_4 nt_row_id_222">
            <td><b>Individual/Family Deductible</td><td><b>$2,000/$4,000</td><td><b>$3,300/$6,600</td><td><b>$0/$0</td>        </tr>
            <tr data-row_id="223" class="ninja_table_row_5 nt_row_id_223">
            <td><b>Individual/Family Out-of-Pocket Maximum (Includes deductible)</td><td>$6,000/$12,000</td><td>$6,550/$13,100</td><td>$6,000/$12,000</td>        </tr>
            <tr data-row_id="224" class="ninja_table_row_6 nt_row_id_224">
            <td><b>Your Coinsurance</td><td><b>20% after deductible</td><td><b>30% after deductible</td><td><b>N/A</td>        </tr>
            <tr data-row_id="225" class="ninja_table_row_7 nt_row_id_225">
            <td><b>Office Visit (Primary Care/ Specialist)</td><td>$30 copay/$60 copay</td><td>30% after deductible</td><td>$40-$140 copay<sup>1</sup></td>        </tr>
            <tr data-row_id="226" class="ninja_table_row_8 nt_row_id_226">
            <td><b>Telemedicine Visit</td><td><b>$30</td><td><b>30% after deductible</td><td><b>$0-$160 copay</td>        </tr>
            <tr data-row_id="227" class="ninja_table_row_9 nt_row_id_227">
            <td><b>Emergency Room Visit</td><td>20% after deductible</td><td>30% after deductible</td><td>$850 copay<sup>2</sup></td>        </tr>
            <tr data-row_id="228" class="ninja_table_row_10 nt_row_id_228">
            <td><b>Prescriptions: Your Costs</td><td></td><td></td><td></td>        </tr>
            <tr data-row_id="229" class="ninja_table_row_11 nt_row_id_229">
            <td><b>Retail: 30-day Supply</b></br> Generic</br> Formulary</br> Non-formulary</br> Specialty</td><td>Deductible does not apply:<br> Tier 1—$15<br> Tier 2—$60<br> Tier 3—$75<br> Tier 4—50%<br> Coinsurance up to $125 max*</td><td>30% after deductible*</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="230" class="ninja_table_row_12 nt_row_id_230">
            <td><b>Mail order: 90-day Supply</b><br> Generic<br> Formulary<br> Non-formulary<br> Specialty</td><td>Deductible does not apply:<br> Tier 1—$38<br> Tier 2—$125<br> Tier 3—$188<br> Tier 4—N/A</td><td>Tier 1—30% after deductible<br> Tier 2—30% after deductible<br> Tier 3—30% after deductible<br> Tier 4—N/A</td><td>Tier 1—$25 copay<br> Tier 2—$225 copay<br> Tier 3—$400 copay<br> Not covered</td>        </tr>
            <tr data-row_id="231" class="ninja_table_row_13 nt_row_id_231">
            <td colspan="4"><b>Preventive maintenance drugs are covered at 100% on all three plans.</td><td class="ninja_temp_cell" data-colspan="#colspan#"></td><td class="ninja_temp_cell" data-colspan="#colspan#"></td><td class="ninja_temp_cell" data-colspan="#colspan#"></td>        </tr>
    </tbody><!--ninja_tobody_rendering_done-->
