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Pennsylvania 2027 Summit Plan
2027 Plan Highlights
Summit (PPO)
Monthly Plan Premium
$25
Maximum Annual Out-of-Pocket
Healthcare Expenses
$5,500
Hospital and Medical Benefits
Inpatient Hospital (Physical)
$325 per stay
Primary Care Provider Visit
$0 copay
Specialist Visit
$20 copay
Emergency Room/Urgent Care
$100/$30 copay
Outpatient Surgery
$200 copay
Outpatient Lab Work
$20 copay
X-rays
$15 copay
Prescription Drug Benefits
Part D Prescription Drug Coverage
$0 deductible
$0 copay (Tier 1)
at preferred pharmacies
Additional Benefits
Dental Benefit
$5000 annual allowance
Over-the-Counter Allowance
$380 annual allowance ($95/qtr)
Flexible Spending Card
$490 prepaid debit card
Vision
$350 annual allowance
Hearing
$0 copay for exam;
$399, $599, $899 per aid
Transportation
$0 copay for up to 36 trips
Fitness Membership
$0 (Expansive Nationwide Network)
