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

        <tr data-row_id="91" class="ninja_table_row_0 nt_row_id_91">
            <td></td><td><b>In-Network</td><td><b>In-Network</td>        </tr>
            <tr data-row_id="90" class="ninja_table_row_1 nt_row_id_90">
            <td><b>Annual Deductible</b><br> Single<br> Family<br> Embedded or Aggregate</td><td>$3,200<br> $6,400<br> Embedded</td><td>$3,200<br> $6,400<br> Embedded</td>        </tr>
            <tr data-row_id="89" class="ninja_table_row_2 nt_row_id_89">
            <td><b>Annual Out-of-Pocket Max</b><br> Single<br> Family<br> Embedded</td><td>$6,000<br> $12,000<br> Yes</td><td>$6,000<br> $12,000<br> Yes</td>        </tr>
            <tr data-row_id="92" class="ninja_table_row_3 nt_row_id_92">
            <td><strong>Office Visit</td><td>30% after deductible</td><td>30% after deductible*</td>        </tr>
            <tr data-row_id="93" class="ninja_table_row_4 nt_row_id_93">
            <td><b>Preventive Services</td><td>No Charge</td><td>No Charge</td>        </tr>
            <tr data-row_id="94" class="ninja_table_row_5 nt_row_id_94">
            <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="95" class="ninja_table_row_6 nt_row_id_95">
            <td><b>Lab & X-Ray</td><td>30% after deductible</td><td>30% after deductible</td>        </tr>
            <tr data-row_id="96" class="ninja_table_row_7 nt_row_id_96">
            <td><b>Inpatient Hospitalization</td><td>30% after deductible</td><td>30% after deductible</td>        </tr>
            <tr data-row_id="97" class="ninja_table_row_8 nt_row_id_97">
            <td><b>Outpatient Surgery</td><td>30% after deductible</td><td>30% after deductible</td>        </tr>
            <tr data-row_id="98" class="ninja_table_row_9 nt_row_id_98">
            <td><b>Urgent Care</td><td>30% after deductible</td><td>30% after deductible</td>        </tr>
            <tr data-row_id="99" class="ninja_table_row_10 nt_row_id_99">
            <td><b>Emergency Room</td><td>30% after deductible</td><td>30% after deductible</td>        </tr>
            <tr data-row_id="100" class="ninja_table_row_11 nt_row_id_100">
            <td><b>Prescription Drugs</td><td><b>Generic/Brand</td><td><b>Generic/Brand</td>        </tr>
            <tr data-row_id="101" class="ninja_table_row_12 nt_row_id_101">
            <td><b>Deductible (Single/Family)</td><td>Combined w/medical</td><td>Combined w/medical</td>        </tr>
            <tr data-row_id="102" class="ninja_table_row_13 nt_row_id_102">
            <td><b>Retail (30 day supply)</td><td>$15/$35<br>(after deductible)</td><td>$15/$35<br>(after deductible)</td>        </tr>
            <tr data-row_id="103" class="ninja_table_row_14 nt_row_id_103">
            <td><b>Mail Order (90 day supply)</td><td>$30/$70<br>(after deductible)</td><td>$30/$70<br>(after deductible)</td>        </tr>
    </tbody><!--ninja_tobody_rendering_done-->
