Common use of Advantage Benefit Chart for Services Incurred During Plan Years 2020 and 2021 Clause in Contracts

Advantage Benefit Chart for Services Incurred During Plan Years 2020 and 2021. 2020 and 2021Benefit Provision Benefit Level 1 The member pays: Benefit Level 2 The member pays: Benefit Level 3 The member pays: Benefit Level 4 The member pays: Deductible for all services except drugs and preventive care (S/F) $250/$500 $400/$800 $750/$1,500 $1,500/$3,000 Office visit copay/urgent care (copay waived for preventive services) For 2020