General Benefits
| In-Network Benefits | Out-Of-Network Benefits |
| Foundation Hospital Care pays 80 percent and policyholders pay 20 percent of covered expenses after they meet their calendar year deductible. | Foundation Hospital Care pays 60 percent and policyholders pay 40 percent of covered expenses after they meet their calendar year deductible. |
| Emergency Room visit is subject to a $200 copayment amount and calendar year deductible, then pays 80 percent and policyholders pay 20 percent. | Emergency Room visit is subject to a $200 copayment amount and calendar year deductible, then pays 80 percent and policyholders pay 20 percent. |
