<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 Optional HSA— Mid‑Atlantic States/WA</th><th scope="col"  class="ninja_column_2 ninja_clmn_nm_kaiser_hdhp_with_optional_hsa_northwest ">Kaiser HDHP with Optional HSA—Northwest</th></tr>
</thead>
<tbody>

        <tr data-row_id="164" class="ninja_table_row_0 nt_row_id_164">
            <td> </td><td><center><b>In-Network</td><td><center><b>In-Network </td>        </tr>
            <tr data-row_id="174" class="ninja_table_row_1 nt_row_id_174">
            <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>        </tr>
            <tr data-row_id="175" class="ninja_table_row_2 nt_row_id_175">
            <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>        </tr>
            <tr data-row_id="165" class="ninja_table_row_3 nt_row_id_165">
            <td><b>Office Visit</td><td>30% after deductible</td><td>30% after deductible*</td>        </tr>
            <tr data-row_id="166" class="ninja_table_row_4 nt_row_id_166">
            <td><b>Preventive Services</td><td>No charge</td><td>No charge </td>        </tr>
            <tr data-row_id="176" class="ninja_table_row_5 nt_row_id_176">
            <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>        </tr>
            <tr data-row_id="177" class="ninja_table_row_6 nt_row_id_177">
            <td><b>Lab & X-Ray</td><td>30% after deductible</td><td>30% after deductible </td>        </tr>
            <tr data-row_id="178" class="ninja_table_row_7 nt_row_id_178">
            <td><b>Inpatient Hospitalization</td><td>30% after deductible </td><td>30% after deductible  </td>        </tr>
            <tr data-row_id="167" class="ninja_table_row_8 nt_row_id_167">
            <td><b>Outpatient Surgery</td><td>30% after deductible  </td><td>30% after deductible   </td>        </tr>
            <tr data-row_id="168" class="ninja_table_row_9 nt_row_id_168">
            <td><b>Urgent Care</td><td>30% after deductible   </td><td>30% after deductible    </td>        </tr>
            <tr data-row_id="169" class="ninja_table_row_10 nt_row_id_169">
            <td><b>Emergency Room</td><td>30% after deductible    </td><td>30% after deductible     </td>        </tr>
            <tr data-row_id="170" class="ninja_table_row_11 nt_row_id_170">
            <td><b><center>Prescription Drugs</td><td><b><center>Generic/Brand</td><td><b><center>Generic/Brand </td>        </tr>
            <tr data-row_id="171" class="ninja_table_row_12 nt_row_id_171">
            <td><b>Deductible (Single/Family)</td><td>Combined w/medical</td><td>Combined w/medical </td>        </tr>
            <tr data-row_id="172" class="ninja_table_row_13 nt_row_id_172">
            <td><b>Retail (30-day supply)</td><td>$15/$35 (after deductible)</td><td>$15/$35 (after deductible) </td>        </tr>
            <tr data-row_id="173" class="ninja_table_row_14 nt_row_id_173">
            <td><b>Mail Order (90-day supply)</td><td>$30/$70 (after deductible)</td><td>$30/$70 (after deductible) </td>        </tr>
    </tbody><!--ninja_tobody_rendering_done-->
