Plan Features MMI EPO 1000 2022 MMI EPO 2500 202 1 MMI EPO 500 202 2 IN NETWORK Calendar Year Deductibles (Indiv / Family) Preventive Care Primary Care Visit Specialist Visit Diagnostic Exam X - Rays Complex Images Outpatient Procedure Inpatient Visit Emergency Room Urgent Care Pharmacy / RX (30 Day Supply) Pharmacy / RX (90 Day Supply) Calendar Year Out - of - Pocket Max (Indiv / Family) OUT OF NETWORK Calendar Year Deductibles (Indiv / Family) Preventive Care Primary Care Visit Specialist Visit Diagnostic Exam X - Rays Complex Images Outpatient Procedure Inpatient Visit Emergency Room Urgent Care Pharmacy / RX (30 Day Supply) Pharmacy / RX (90 Day Supply) Calendar Year Out - of - Pocket Max (Indiv / Family) MONTHLY PRICING Employee $0.00 $0.00 $0.00 Employee + Spouse $0.00 $0.00 $0.00 Employee + Child(ren) $0.00 $0.00 $0.00 Employee + Family $0.00 $0.00 $0.00 9 9 MEDICAL PLAN I S U M M A R Y O F C O V E R A G E BENEFITS GUIDE MEDICAL PLAN