HMO BENEFIT PLANS WITHOUT DEDUCTIBLES
BPL#	BPL W/VISION	MEDICAL DEDUCTIBLE	PHYSICIAN OFFICE VISIT	IN & OUT PATIENT HOSPITALIZATION	EMBERGENCY ROOM	URGENT CARE	OUT-OF-POCKET MAXIMUM
41000 / JHW00100	41020 / JHW01300	N/A	$10	NONE	$50	$25	$1000/$2000
41001 / JHW00200	41021 / JHW01400	N/A	$10	10%	$60	$30	$1000/$2000
41002 / JHW00300	41022 / JHW01500	N/A	$15	10%	$60	$30	$1000/$2000
41003 / JHW00400	41023 / JHW01600	N/A	$20	20%	$60	$30	$1500/$3000
41004 / JHW00500	41024 / JHW01700	N/A	$20	20%	$100	$50	$2500/$5000
41006 / JHW00600	41026 / JHW01800	N/A	$20	30%	$100	$50	$3000/$6000

HMO BENEFIT PLANS WITH MEDICAL DEDUCTIBLES
BPL#	BPL W/VISION	MEDICAL DEDUCTIBLE	PHYSICIAN OFFICE VISIT	IN & OUT PATIENT HOSPITALIZATION	EMBERGENCY ROOM	URGENT CARE	OUT-OF-POCKET MAXIMUM
41011 / JHW00700	41031 / JHW01900	$100/$200	$10	10%	$60	$30	$1000/$2000
41012 / JHW00800	41032 / JHW02000	$250/$500	$15	10%	$60	$30	$1000/$2000
41013 / JHW00900	41033 / JHW02100	$500/$1000	$20	20%	$60	$30	$1500/$3000
41014 / JHW01000	41034 / JHW02200	$750/$1500	$20	20%	$100	$50	$2500/$5000
41015 / JHW01100	41035 / JHW02300	$1000/$2000	$20	20%	$100	$50	$2500/$5000
41016 / JHW01200	41036 / JHW02400	$1500/$3000	$25	30%	$100	$50	$3000/$6000