{ "document_id": 13522, "page": 10, "width_pt": 792, "height_pt": 612, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "engine": "paddleocr_vl", "source_run_id": 13633, "item_count": 140, "counts_by_type": { "footer": 1, "footnote": 4, "heading": 1, "table": 1, "table_cell": 133 }, "build_ms": 63, "items": [ { "id": "p10.1", "order": 1, "type": "heading", "bbox": { "l": 34.8, "t": 577.68, "r": 173.04, "b": 554.64 }, "text": "Benefits Grid", "attrs": { "block_label": "paragraph_title" }, "level": 3 }, { "id": "p10.2", "order": 2, "type": "table", "bbox": { "l": 35.28, "t": 559.2, "r": 757.92, "b": 85.92 }, "text": "", "attrs": { "block_label": "table", "n_rows": 18, "n_cols": 9, "integrity": { "cells_checked": 133, "cells_flagged": 1, "flags": [ { "row": 6, "col": 0, "coverage": 0.53, "text": "Therapy Services (per visit: physical, occupational, speech…" } ] } }, "children": [ { "id": "p10.2.1", "order": 3, "type": "table_cell", "bbox": { "l": 68.0194, "t": 537.8417, "r": 129.226, "b": 520.9437 }, "text": "Plan Options", "attrs": { "row": 0, "col": 0, "rowspan": 2, "colspan": 1, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p10.2.2", "order": 4, "type": "table_cell", "bbox": { "l": 210.5981, "t": 543.914, "r": 265.9471, "b": 531.844 }, "text": "LivingWell CDHP", "attrs": { "row": 0, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p10.2.3", "order": 5, "type": "table_cell", "bbox": { "l": 364.1482, "t": 543.914, "r": 414.7972, "b": 531.844 }, "text": "LivingWell PPO", "attrs": { "row": 0, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p10.2.4", "order": 6, "type": "table_cell", "bbox": { "l": 494.9334, "t": 543.914, "r": 571.2914, "b": 531.844 }, "text": "LivingWell Basic CDHP", "attrs": { "row": 0, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p10.2.5", "order": 7, "type": "table_cell", "bbox": { "l": 652.1356, "t": 543.914, "r": 707.7246, "b": 531.844 }, "text": "LivingWell HDHP", "attrs": { "row": 0, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true, "column_header": true, "header_source": "pdf" } }, { "id": "p10.2.6", "order": 8, "type": "table_cell", "bbox": { "l": 179.7701, "t": 523.6067, "r": 214.8152, "b": 512.7437 }, "text": "In-Network", "attrs": { "row": 1, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.7", "order": 9, "type": "table_cell", "bbox": { "l": 251.6713, "t": 523.6067, "r": 300.5935, "b": 512.7437 }, "text": "Out-of-Network", "attrs": { "row": 1, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.8", "order": 10, "type": "table_cell", "bbox": { "l": 333.8513, "t": 523.6067, "r": 368.8964, "b": 512.7437 }, "text": "In-Network", "attrs": { "row": 1, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.9", "order": 11, "type": "table_cell", "bbox": { "l": 399.2726, "t": 523.6067, "r": 448.1948, "b": 512.7437 }, "text": "Out-of-Network", "attrs": { "row": 1, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.10", "order": 12, "type": "table_cell", "bbox": { "l": 480.9901, "t": 523.6067, "r": 516.0352, "b": 512.7437 }, "text": "In-Network", "attrs": { "row": 1, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.11", "order": 13, "type": "table_cell", "bbox": { "l": 545.3313, "t": 523.6067, "r": 594.2535, "b": 512.7437 }, "text": "Out-of-Network", "attrs": { "row": 1, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.12", "order": 14, "type": "table_cell", "bbox": { "l": 624.6389, "t": 523.6067, "r": 659.684, "b": 512.7437 }, "text": "In-Network", "attrs": { "row": 1, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.13", "order": 15, "type": "table_cell", "bbox": { "l": 693.2375, "t": 523.6067, "r": 742.1597, "b": 512.7437 }, "text": "Out-of-Network", "attrs": { "row": 1, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.14", "order": 16, "type": "table_cell", "bbox": { "l": 41.8125, "t": 506.22839999999997, "r": 132.5613, "b": 481.18039999999996 }, "text": "Diagnostic tests in doctor's office\nSurgery in Office Setting", "attrs": { "row": 2, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.15", "order": 17, "type": "table_cell", "bbox": { "l": 170.1133, "t": 505.9964, "r": 224.4717, "b": 481.4204 }, "text": "Deductible, then 20%\nDeductible, then 20%", "attrs": { "row": 2, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.16", "order": 18, "type": "table_cell", "bbox": { "l": 248.9533, "t": 505.9964, "r": 303.3117, "b": 481.4204 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 2, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.17", "order": 19, "type": "table_cell", "bbox": { "l": 324.1945, "t": 505.9964, "r": 378.5529, "b": 481.4204 }, "text": "Office Visit Co-pay\nDeductible, then 25%", "attrs": { "row": 2, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.18", "order": 20, "type": "table_cell", "bbox": { "l": 396.5546, "t": 505.9964, "r": 450.913, "b": 481.4204 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 2, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.19", "order": 21, "type": "table_cell", "bbox": { "l": 471.3333, "t": 505.9964, "r": 525.6917, "b": 481.4204 }, "text": "Deductible, then 30%\nDeductible, then 30%", "attrs": { "row": 2, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.20", "order": 22, "type": "table_cell", "bbox": { "l": 542.6133, "t": 505.9964, "r": 596.9717, "b": 481.4204 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 2, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.21", "order": 23, "type": "table_cell", "bbox": { "l": 614.9821, "t": 505.9964, "r": 669.3405, "b": 481.4204 }, "text": "Deductible, then 30%\nDeductible, then 30%", "attrs": { "row": 2, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.22", "order": 24, "type": "table_cell", "bbox": { "l": 690.5195, "t": 505.9964, "r": 744.8779, "b": 481.4204 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 2, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.23", "order": 25, "type": "table_cell", "bbox": { "l": 41.8125, "t": 475.6684, "r": 129.6021, "b": 458.4604 }, "text": "Behavioral Health and Substance Abuse Use", "attrs": { "row": 3, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.24", "order": 26, "type": "table_cell", "bbox": { "l": 170.1133, "t": 471.4364, "r": 224.4717, "b": 462.7004 }, "text": "Deductible, then 20%", "attrs": { "row": 3, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.25", "order": 27, "type": "table_cell", "bbox": { "l": 248.9533, "t": 471.4364, "r": 303.3117, "b": 462.7004 }, "text": "Deductible, then 50%", "attrs": { "row": 3, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.26", "order": 28, "type": "table_cell", "bbox": { "l": 324.1945, "t": 471.4364, "r": 378.5529, "b": 462.7004 }, "text": "Deductible, then 25%", "attrs": { "row": 3, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.27", "order": 29, "type": "table_cell", "bbox": { "l": 396.5546, "t": 471.4364, "r": 450.913, "b": 462.7004 }, "text": "Deductible, then 50%", "attrs": { "row": 3, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.28", "order": 30, "type": "table_cell", "bbox": { "l": 471.3333, "t": 471.4364, "r": 525.6917, "b": 462.7004 }, "text": "Deductible, then 30%", "attrs": { "row": 3, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.29", "order": 31, "type": "table_cell", "bbox": { "l": 542.6133, "t": 471.4364, "r": 596.9717, "b": 462.7004 }, "text": "Deductible, then 50%", "attrs": { "row": 3, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.30", "order": 32, "type": "table_cell", "bbox": { "l": 614.9821, "t": 471.4364, "r": 669.3405, "b": 462.7004 }, "text": "Deductible, then 30%", "attrs": { "row": 3, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.31", "order": 33, "type": "table_cell", "bbox": { "l": 690.5195, "t": 471.4364, "r": 744.8779, "b": 462.7004 }, "text": "Deductible, then 50%", "attrs": { "row": 3, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.32", "order": 34, "type": "table_cell", "bbox": { "l": 41.8125, "t": 452.9484, "r": 137.7941, "b": 412.06039999999996 }, "text": "Autism Services\nAllergy Injection without Office Visit\nAllergy Serum", "attrs": { "row": 4, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.33", "order": 35, "type": "table_cell", "bbox": { "l": 170.1133, "t": 452.7164, "r": 224.4717, "b": 412.30039999999997 }, "text": "Deductible, then 20%\nDeductible, then 20%\nDeductible, then 20%", "attrs": { "row": 4, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.34", "order": 36, "type": "table_cell", "bbox": { "l": 248.9533, "t": 452.7164, "r": 303.3117, "b": 412.30039999999997 }, "text": "Deductible, then 50%\nDeductible, then 50%\nDeductible, then 50%", "attrs": { "row": 4, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.35", "order": 37, "type": "table_cell", "bbox": { "l": 324.1945, "t": 452.7164, "r": 378.5529, "b": 412.30039999999997 }, "text": "Deductible, then 25%\n$15 Co-pay\n$15 Co-pay", "attrs": { "row": 4, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.36", "order": 38, "type": "table_cell", "bbox": { "l": 396.5546, "t": 452.7164, "r": 450.913, "b": 412.30039999999997 }, "text": "Deductible, then 50%\nDeductible, then 50%\nDeductible, then 50%", "attrs": { "row": 4, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.37", "order": 39, "type": "table_cell", "bbox": { "l": 471.3333, "t": 452.7164, "r": 525.6917, "b": 412.30039999999997 }, "text": "Deductible, then 30%\nDeductible, then 30%\nDeductible, then 30%", "attrs": { "row": 4, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.38", "order": 40, "type": "table_cell", "bbox": { "l": 542.6133, "t": 452.7164, "r": 596.9717, "b": 412.30039999999997 }, "text": "Deductible, then 50%\nDeductible, then 50%\nDeductible, then 50%", "attrs": { "row": 4, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.39", "order": 41, "type": "table_cell", "bbox": { "l": 614.9821, "t": 452.7164, "r": 669.3405, "b": 412.30039999999997 }, "text": "Deductible, then 30%\nDeductible, then 30%\nDeductible, then 30%", "attrs": { "row": 4, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.40", "order": 42, "type": "table_cell", "bbox": { "l": 690.5195, "t": 452.7164, "r": 744.8779, "b": 412.30039999999997 }, "text": "Deductible, then 50%\nDeductible, then 50%\nDeductible, then 50%", "attrs": { "row": 4, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.41", "order": 43, "type": "table_cell", "bbox": { "l": 41.8125, "t": 405.14840000000004, "r": 150.5773, "b": 379.9404 }, "text": "Chiropractic Care (manipulation therapy) (maximum of 26 visits per year, no more than one visit a day)", "attrs": { "row": 5, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.42", "order": 44, "type": "table_cell", "bbox": { "l": 170.1133, "t": 396.9164, "r": 224.4717, "b": 388.18039999999996 }, "text": "Deductible, then 20%", "attrs": { "row": 5, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.43", "order": 45, "type": "table_cell", "bbox": { "l": 248.9533, "t": 396.9164, "r": 303.3117, "b": 388.18039999999996 }, "text": "Deductible, then 50%", "attrs": { "row": 5, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.44", "order": 46, "type": "table_cell", "bbox": { "l": 337.1101, "t": 396.9164, "r": 365.6373, "b": 388.18039999999996 }, "text": "$25 Co-pay", "attrs": { "row": 5, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.45", "order": 47, "type": "table_cell", "bbox": { "l": 396.5546, "t": 396.9164, "r": 450.913, "b": 388.18039999999996 }, "text": "Deductible, then 50%", "attrs": { "row": 5, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.46", "order": 48, "type": "table_cell", "bbox": { "l": 471.3333, "t": 396.9164, "r": 525.6917, "b": 388.18039999999996 }, "text": "Deductible, then 30%", "attrs": { "row": 5, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.47", "order": 49, "type": "table_cell", "bbox": { "l": 542.6133, "t": 396.9164, "r": 596.9717, "b": 388.18039999999996 }, "text": "Deductible, then 50%", "attrs": { "row": 5, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.48", "order": 50, "type": "table_cell", "bbox": { "l": 614.9821, "t": 396.9164, "r": 669.3405, "b": 388.18039999999996 }, "text": "Deductible, then 30%", "attrs": { "row": 5, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.49", "order": 51, "type": "table_cell", "bbox": { "l": 690.5195, "t": 396.9164, "r": 744.8779, "b": 388.18039999999996 }, "text": "Deductible, then 50%", "attrs": { "row": 5, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.50", "order": 52, "type": "table_cell", "bbox": { "l": 41.8125, "t": 372.7484, "r": 139.0253, "b": 355.5404 }, "text": "Therapy Services (per visit: physical, occupational, speech - maximum combined limit of 90 visits per year)", "attrs": { "row": 6, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.51", "order": 53, "type": "table_cell", "bbox": { "l": 170.1133, "t": 364.5164, "r": 224.4717, "b": 355.7804 }, "text": "Deductible, then 20%", "attrs": { "row": 6, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.52", "order": 54, "type": "table_cell", "bbox": { "l": 248.9533, "t": 364.5164, "r": 303.3117, "b": 355.7804 }, "text": "Deductible, then 50%", "attrs": { "row": 6, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.53", "order": 55, "type": "table_cell", "bbox": { "l": 324.1945, "t": 364.5164, "r": 378.5529, "b": 355.7804 }, "text": "Deductible, then 25%", "attrs": { "row": 6, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.54", "order": 56, "type": "table_cell", "bbox": { "l": 396.5546, "t": 364.5164, "r": 450.913, "b": 355.7804 }, "text": "Deductible, then 50%", "attrs": { "row": 6, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.55", "order": 57, "type": "table_cell", "bbox": { "l": 471.3333, "t": 364.5164, "r": 525.6917, "b": 355.7804 }, "text": "Deductible, then 30%", "attrs": { "row": 6, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.56", "order": 58, "type": "table_cell", "bbox": { "l": 542.6133, "t": 364.5164, "r": 596.9717, "b": 355.7804 }, "text": "Deductible, then 50%", "attrs": { "row": 6, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.57", "order": 59, "type": "table_cell", "bbox": { "l": 614.9821, "t": 364.5164, "r": 669.3405, "b": 355.7804 }, "text": "Deductible, then 30%", "attrs": { "row": 6, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.58", "order": 60, "type": "table_cell", "bbox": { "l": 690.5195, "t": 364.5164, "r": 744.8779, "b": 355.7804 }, "text": "Deductible, then 50%", "attrs": { "row": 6, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.59", "order": 61, "type": "table_cell", "bbox": { "l": 41.8125, "t": 340.9847, "r": 98.2189, "b": 331.3287 }, "text": "Emergency Services", "attrs": { "row": 7, "col": 0, "rowspan": 1, "colspan": 9, "bbox_refit": true } }, { "id": "p10.2.60", "order": 62, "type": "table_cell", "bbox": { "l": 41.8125, "t": 324.909, "r": 93.4277, "b": 315.701 }, "text": "Urgent Care Center", "attrs": { "row": 8, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.61", "order": 63, "type": "table_cell", "bbox": { "l": 211.0933, "t": 324.677, "r": 265.4517, "b": 315.941 }, "text": "Deductible, then 20%", "attrs": { "row": 8, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.62", "order": 64, "type": "table_cell", "bbox": { "l": 375.2088, "t": 324.677, "r": 403.736, "b": 315.941 }, "text": "$50 Co-pay", "attrs": { "row": 8, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.63", "order": 65, "type": "table_cell", "bbox": { "l": 505.9333, "t": 324.677, "r": 560.2917, "b": 315.941 }, "text": "Deductible, then 30%", "attrs": { "row": 8, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.64", "order": 66, "type": "table_cell", "bbox": { "l": 652.7508, "t": 324.677, "r": 707.1092, "b": 315.941 }, "text": "Deductible, then 30%", "attrs": { "row": 8, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.65", "order": 67, "type": "table_cell", "bbox": { "l": 41.8125, "t": 310.189, "r": 142.9389, "b": 292.981 }, "text": "Emergency Room (emergency medical treatment only)", "attrs": { "row": 9, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.66", "order": 68, "type": "table_cell", "bbox": { "l": 211.0933, "t": 305.957, "r": 265.4517, "b": 297.221 }, "text": "Deductible, then 20%", "attrs": { "row": 9, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.67", "order": 69, "type": "table_cell", "bbox": { "l": 337.89, "t": 309.957, "r": 441.0556, "b": 293.221 }, "text": "$150 Co-pay, then Deductible, then 25%. Co-pay waived if admitted.", "attrs": { "row": 9, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.68", "order": 70, "type": "table_cell", "bbox": { "l": 505.9333, "t": 305.957, "r": 560.2917, "b": 297.221 }, "text": "Deductible, then 30%", "attrs": { "row": 9, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.69", "order": 71, "type": "table_cell", "bbox": { "l": 652.7508, "t": 305.957, "r": 707.1092, "b": 297.221 }, "text": "Deductible, then 30%", "attrs": { "row": 9, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.70", "order": 72, "type": "table_cell", "bbox": { "l": 41.8125, "t": 287.469, "r": 114.2909, "b": 278.261 }, "text": "Emergency Room Physician", "attrs": { "row": 10, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.71", "order": 73, "type": "table_cell", "bbox": { "l": 211.0933, "t": 287.237, "r": 265.4517, "b": 278.501 }, "text": "Deductible, then 20%", "attrs": { "row": 10, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.72", "order": 74, "type": "table_cell", "bbox": { "l": 362.2933, "t": 287.237, "r": 416.6517, "b": 278.501 }, "text": "Deductible, then 25%", "attrs": { "row": 10, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.73", "order": 75, "type": "table_cell", "bbox": { "l": 505.9333, "t": 287.237, "r": 560.2917, "b": 278.501 }, "text": "Deductible, then 30%", "attrs": { "row": 10, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.74", "order": 76, "type": "table_cell", "bbox": { "l": 652.7508, "t": 287.237, "r": 707.1092, "b": 278.501 }, "text": "Deductible, then 30%", "attrs": { "row": 10, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.75", "order": 77, "type": "table_cell", "bbox": { "l": 41.8125, "t": 271.629, "r": 82.9709, "b": 246.42899999999997 }, "text": "Ambulance\nOther Services", "attrs": { "row": 11, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.76", "order": 78, "type": "table_cell", "bbox": { "l": 170.1133, "t": 239.71699999999998, "r": 224.4717, "b": 230.981 }, "text": "Deductible, then 20%", "attrs": { "row": 11, "col": 1, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.77", "order": 79, "type": "table_cell", "bbox": { "l": 362.2933, "t": 271.397, "r": 416.6517, "b": 262.661 }, "text": "Deductible, then 25%", "attrs": { "row": 11, "col": 2, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.78", "order": 80, "type": "table_cell", "bbox": { "l": 505.9333, "t": 271.397, "r": 560.2917, "b": 262.661 }, "text": "Deductible, then 30%", "attrs": { "row": 11, "col": 3, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.79", "order": 81, "type": "table_cell", "bbox": { "l": 652.7508, "t": 271.397, "r": 707.1092, "b": 262.661 }, "text": "Deductible, then 30%", "attrs": { "row": 11, "col": 4, "rowspan": 1, "colspan": 2, "bbox_refit": true } }, { "id": "p10.2.80", "order": 82, "type": "table_cell", "bbox": { "l": 41.8125, "t": 239.949, "r": 144.1133, "b": 214.901 }, "text": "Inpatient Hospital (Semi-private room)\nOutpatient Hospital/Surgery", "attrs": { "row": 12, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.81", "order": 83, "type": "table_cell", "bbox": { "l": 170.1133, "t": 223.877, "r": 224.4717, "b": 199.301 }, "text": "Deductible, then 20%\nDeductible, then 20%", "attrs": { "row": 12, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.82", "order": 84, "type": "table_cell", "bbox": { "l": 248.9533, "t": 223.877, "r": 303.3117, "b": 199.301 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 12, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.83", "order": 85, "type": "table_cell", "bbox": { "l": 324.1945, "t": 223.877, "r": 378.5529, "b": 199.301 }, "text": "Deductible, then 25%\nDeductible, then 25%", "attrs": { "row": 12, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.84", "order": 86, "type": "table_cell", "bbox": { "l": 396.5546, "t": 223.877, "r": 450.913, "b": 199.301 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 12, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.85", "order": 87, "type": "table_cell", "bbox": { "l": 471.3333, "t": 223.877, "r": 525.6917, "b": 199.301 }, "text": "Deductible, then 30%\nDeductible, then 30%", "attrs": { "row": 12, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.86", "order": 88, "type": "table_cell", "bbox": { "l": 542.6133, "t": 223.877, "r": 596.9717, "b": 199.301 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 12, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.87", "order": 89, "type": "table_cell", "bbox": { "l": 614.9821, "t": 223.877, "r": 669.3405, "b": 199.301 }, "text": "Deductible, then 30%\nDeductible, then 30%", "attrs": { "row": 12, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.88", "order": 90, "type": "table_cell", "bbox": { "l": 690.5195, "t": 223.877, "r": 744.8779, "b": 199.301 }, "text": "Deductible, then 50%\nDeductible, then 50%", "attrs": { "row": 12, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true, "merged_continuation": true } }, { "id": "p10.2.89", "order": 91, "type": "table_cell", "bbox": { "l": 41.8125, "t": 208.269, "r": 145.4093, "b": 199.06099999999998 }, "text": "Outpatient/Ambulatory Surgery Center", "attrs": { "row": 13, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.90", "order": 92, "type": "table_cell", "bbox": { "l": 170.1133, "t": 181.11700000000002, "r": 224.4717, "b": 172.38099999999997 }, "text": "Deductible, then 20%", "attrs": { "row": 13, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.91", "order": 93, "type": "table_cell", "bbox": { "l": 248.9533, "t": 181.11700000000002, "r": 303.3117, "b": 172.38099999999997 }, "text": "Deductible, then 50%", "attrs": { "row": 13, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.92", "order": 94, "type": "table_cell", "bbox": { "l": 324.1945, "t": 169.11700000000002, "r": 378.5529, "b": 160.38099999999997 }, "text": "Deductible, then 25%", "attrs": { "row": 13, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.93", "order": 95, "type": "table_cell", "bbox": { "l": 396.5546, "t": 181.11700000000002, "r": 450.913, "b": 172.38099999999997 }, "text": "Deductible, then 50%", "attrs": { "row": 13, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.94", "order": 96, "type": "table_cell", "bbox": { "l": 471.3333, "t": 181.11700000000002, "r": 525.6917, "b": 172.38099999999997 }, "text": "Deductible, then 30%", "attrs": { "row": 13, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.95", "order": 97, "type": "table_cell", "bbox": { "l": 542.6133, "t": 181.11700000000002, "r": 596.9717, "b": 172.38099999999997 }, "text": "Deductible, then 50%", "attrs": { "row": 13, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.96", "order": 98, "type": "table_cell", "bbox": { "l": 614.9821, "t": 181.11700000000002, "r": 669.3405, "b": 172.38099999999997 }, "text": "Deductible, then 30%", "attrs": { "row": 13, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.97", "order": 99, "type": "table_cell", "bbox": { "l": 690.5195, "t": 181.11700000000002, "r": 744.8779, "b": 172.38099999999997 }, "text": "Deductible, then 50%", "attrs": { "row": 13, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.98", "order": 100, "type": "table_cell", "bbox": { "l": 41.8125, "t": 181.349, "r": 82.4189, "b": 172.14100000000002 }, "text": "Maternity Care", "attrs": { "row": 14, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.99", "order": 101, "type": "table_cell", "bbox": { "l": 170.1133, "t": 154.197, "r": 224.4717, "b": 145.461 }, "text": "Deductible, then 20%", "attrs": { "row": 14, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.100", "order": 102, "type": "table_cell", "bbox": { "l": 248.9533, "t": 138.35700000000003, "r": 303.3117, "b": 129.62099999999998 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.101", "order": 103, "type": "table_cell", "bbox": { "l": 322.2664, "t": 193.11700000000002, "r": 380.4816, "b": 145.461 }, "text": "$25 Co-pay (office visit pregnancy diagnosed) Delivery Charge: Deductible, then 25%", "attrs": { "row": 14, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.102", "order": 104, "type": "table_cell", "bbox": { "l": 396.5546, "t": 138.35700000000003, "r": 450.913, "b": 129.62099999999998 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.103", "order": 105, "type": "table_cell", "bbox": { "l": 471.3333, "t": 154.197, "r": 525.6917, "b": 145.461 }, "text": "Deductible, then 30%", "attrs": { "row": 14, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.104", "order": 106, "type": "table_cell", "bbox": { "l": 542.6133, "t": 138.35700000000003, "r": 596.9717, "b": 129.62099999999998 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.105", "order": 107, "type": "table_cell", "bbox": { "l": 614.9821, "t": 154.197, "r": 669.3405, "b": 145.461 }, "text": "Deductible, then 30%", "attrs": { "row": 14, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.106", "order": 108, "type": "table_cell", "bbox": { "l": 690.5195, "t": 138.35700000000003, "r": 744.8779, "b": 129.62099999999998 }, "text": "Deductible, then 50%", "attrs": { "row": 14, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.107", "order": 109, "type": "table_cell", "bbox": { "l": 41.8125, "t": 154.42899999999997, "r": 149.7693, "b": 145.221 }, "text": "Durable Medical Equipment and Supplies", "attrs": { "row": 15, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.108", "order": 110, "type": "table_cell", "bbox": { "l": 170.1133, "t": 138.35700000000003, "r": 224.4717, "b": 129.62099999999998 }, "text": "Deductible, then 20%", "attrs": { "row": 15, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.109", "order": 111, "type": "table_cell", "bbox": { "l": 248.9533, "t": 154.197, "r": 303.3117, "b": 145.461 }, "text": "Deductible, then 20%", "attrs": { "row": 15, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.110", "order": 112, "type": "table_cell", "bbox": { "l": 324.1945, "t": 138.35700000000003, "r": 378.5529, "b": 129.62099999999998 }, "text": "Deductible, then 25%", "attrs": { "row": 15, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.111", "order": 113, "type": "table_cell", "bbox": { "l": 396.5546, "t": 154.197, "r": 450.913, "b": 145.461 }, "text": "Deductible, then 25%", "attrs": { "row": 15, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.112", "order": 114, "type": "table_cell", "bbox": { "l": 471.3333, "t": 138.35700000000003, "r": 525.6917, "b": 129.62099999999998 }, "text": "Deductible, then 30%", "attrs": { "row": 15, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.113", "order": 115, "type": "table_cell", "bbox": { "l": 542.6133, "t": 154.197, "r": 596.9717, "b": 145.461 }, "text": "Deductible, then 30%", "attrs": { "row": 15, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.114", "order": 116, "type": "table_cell", "bbox": { "l": 614.9821, "t": 138.35700000000003, "r": 669.3405, "b": 129.62099999999998 }, "text": "Deductible, then 30%", "attrs": { "row": 15, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.115", "order": 117, "type": "table_cell", "bbox": { "l": 690.5195, "t": 154.197, "r": 744.8779, "b": 145.461 }, "text": "Deductible, then 30%", "attrs": { "row": 15, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.116", "order": 118, "type": "table_cell", "bbox": { "l": 41.8125, "t": 138.589, "r": 89.8189, "b": 129.38099999999997 }, "text": "Home Health Care", "attrs": { "row": 16, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.117", "order": 119, "type": "table_cell", "bbox": { "l": 170.1133, "t": 119.43689999999998, "r": 224.4717, "b": 110.70089999999999 }, "text": "Deductible, then 20%", "attrs": { "row": 16, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.118", "order": 120, "type": "table_cell", "bbox": { "l": 248.9533, "t": 119.43689999999998, "r": 303.3117, "b": 110.70089999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 16, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.119", "order": 121, "type": "table_cell", "bbox": { "l": 324.1945, "t": 119.43689999999998, "r": 378.5529, "b": 110.70089999999999 }, "text": "Deductible, then 25%", "attrs": { "row": 16, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.120", "order": 122, "type": "table_cell", "bbox": { "l": 396.5546, "t": 119.43689999999998, "r": 450.913, "b": 110.70089999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 16, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.121", "order": 123, "type": "table_cell", "bbox": { "l": 471.3333, "t": 119.43689999999998, "r": 525.6917, "b": 110.70089999999999 }, "text": "Deductible, then 30%", "attrs": { "row": 16, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.122", "order": 124, "type": "table_cell", "bbox": { "l": 542.6133, "t": 119.43689999999998, "r": 596.9717, "b": 110.70089999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 16, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.123", "order": 125, "type": "table_cell", "bbox": { "l": 614.9821, "t": 119.43689999999998, "r": 669.3405, "b": 110.70089999999999 }, "text": "Deductible, then 30%", "attrs": { "row": 16, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.124", "order": 126, "type": "table_cell", "bbox": { "l": 690.5195, "t": 119.43689999999998, "r": 744.8779, "b": 110.70089999999999 }, "text": "Deductible, then 50%", "attrs": { "row": 16, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.125", "order": 127, "type": "table_cell", "bbox": { "l": 41.8125, "t": 123.66890000000001, "r": 152.3693, "b": 106.46089999999998 }, "text": "X-ray, Lab, and Diagnostics including MRI, CT, and PET scans", "attrs": { "row": 17, "col": 0, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.126", "order": 128, "type": "table_cell", "bbox": { "l": 211.0933, "t": 271.397, "r": 265.4517, "b": 262.661 }, "text": "Deductible, then 20%", "attrs": { "row": 17, "col": 1, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.127", "order": 129, "type": "table_cell", "bbox": { "l": 248.9533, "t": 239.71699999999998, "r": 303.3117, "b": 230.981 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 2, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.128", "order": 130, "type": "table_cell", "bbox": { "l": 324.1945, "t": 239.71699999999998, "r": 378.5529, "b": 230.981 }, "text": "Deductible, then 25%", "attrs": { "row": 17, "col": 3, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.129", "order": 131, "type": "table_cell", "bbox": { "l": 396.5546, "t": 239.71699999999998, "r": 450.913, "b": 230.981 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 4, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.130", "order": 132, "type": "table_cell", "bbox": { "l": 471.3333, "t": 239.71699999999998, "r": 525.6917, "b": 230.981 }, "text": "Deductible, then 30%", "attrs": { "row": 17, "col": 5, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.131", "order": 133, "type": "table_cell", "bbox": { "l": 542.6133, "t": 239.71699999999998, "r": 596.9717, "b": 230.981 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 6, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.132", "order": 134, "type": "table_cell", "bbox": { "l": 614.9821, "t": 239.71699999999998, "r": 669.3405, "b": 230.981 }, "text": "Deductible, then 30%", "attrs": { "row": 17, "col": 7, "rowspan": 1, "colspan": 1, "bbox_refit": true } }, { "id": "p10.2.133", "order": 135, "type": "table_cell", "bbox": { "l": 690.5195, "t": 239.71699999999998, "r": 744.8779, "b": 230.981 }, "text": "Deductible, then 50%", "attrs": { "row": 17, "col": 8, "rowspan": 1, "colspan": 1, "bbox_refit": true } } ] }, { "id": "p10.3", "order": 136, "type": "footnote", "bbox": { "l": 32.16, "t": 100.56, "r": 756.48, "b": 82.32 }, "text": "Notes: The boxed areas of the grid are components of each plan most often used by members when choosing a plan option, but are not all inclusive. You can refer to the Summary of Benefits and Coverage (SBC) for more information. KEHP has made every attempt to ensure the accuracy of the benefits outlined in this Benefits Grid. If an error has occurred, the benefits outlined in the 2025 Summary Plan Descriptions (SPDs) and Medical Benefit Booklets will determine how benefits are paid. Benefits are subject to the terms, conditions, limitations, and exclusions set forth in the SPDs.", "attrs": { "block_label": "vision_footnote" } }, { "id": "p10.4", "order": 137, "type": "footnote", "bbox": { "l": 30.48, "t": 82.56, "r": 525.6, "b": 72.72 }, "text": "• Co-pays do not accumulate toward the deductible, but they do accumulate toward the applicable maximum out-of-pocket. Once your maximum out-of-pocket is met, you do not have to pay any more co-pays.", "attrs": { "block_label": "vision_footnote" } }, { "id": "p10.5", "order": 138, "type": "footnote", "bbox": { "l": 32.88, "t": 72.72, "r": 738.48, "b": 54.24 }, "text": "- Certain drugs to treat diabetes, COPD, asthma, and hypertension are subject to reduced co-pays and co-insurance with no Deductibles. A 90-day supply of maintenance drugs may be subject to lower co-pays and co-insurance. Select preventive/maintenance drugs bypass the deductible on the CDHPs. Claims are processed based on provider billing type, which may include separate charges from a lab performing services outside of the doctor's office visit.", "attrs": { "block_label": "vision_footnote" } }, { "id": "p10.6", "order": 139, "type": "footnote", "bbox": { "l": 31.92, "t": 52.32, "r": 752.16, "b": 35.04 }, "text": "*The HDHP has a non-embedded deductible which means all family members share a deductible and out-of-pocket (OOP) maximum, regardless of the number of family members. The entire deductible must be met before any one family member receives benefits. The entire OOP must be met before the family has satisfied the OOP maximum.", "attrs": { "block_label": "vision_footnote" } }, { "id": "p10.7", "order": 140, "type": "footer", "bbox": { "l": 34.8, "t": 29.76, "r": 47.28, "b": 20.64 }, "text": "10", "attrs": { "block_label": "number" } } ], "excluded_furniture": { "first": [], "last": [] } }