Benefits Package for Celero Inc Medical Plan Details Company Contribution Your company contributes separately to employees' and dependents' premiums. Employee : Your company covers up to 63% of the premium of the base plan. Employee pays the difference in premium if they select a more expensive plan. Dependents : Your company covers up to 63% of the premium of the base plan. Employee pays the difference in premium if they select a more expensive plan. BASE PLAN EPO Oxford NJ Gold Metro EPO 2000/6850/30 Plan Details Deductible Max Out-of-Pocket Co-Insurance Doctor Visits Preventative Care Primary physician office visit Specialist office visit Urgent care Facilities Emergency room Inpatient facility cost Surgery Drug Costs Drug Deductible Generic drugs Preferred brand drugs  View Details (PDF) $2000 $6850 30% $0 $30 $60 $60 $100 $500 30% $0 $15 $35 After deductible is met. 1 of 6 Disclaimer : The above quotes are for illustrative purposes only and are subject to underwriting approval. All coverages are subject to the terms, conditions, and exclusions of the actual policy issued. With Gusto Insurance Services , LLC 525 20th St San Francisco, CA 94107 (800) 936-0383 Agency license NPN 17609789 

GustoBenefitsSummary (1).pdf

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