EPO HP-Network Plan / EPO Network Plan

If you wish to enroll in the EPO Plan and you live in a high-performance network location, you can choose the EPO HP-Network Plan. Otherwise you can choose the EPO Network Plan.

Access the 2026 EPO Network/EPO HP-Network Medical Plan Everyday Guide

2026 EPO Plan
Where Available	Nationwide except HI, EPO HP-Network in select locations nationwide Find BCI providers in your area.
Annual Deductible - Associate - Family	Embedded $1,750 $5,250
Annual Out-of-Pocket Max - Associate - Family	Embedded $5,500 $16,500
	IN-NETWORK - YOU PAY
Preventive Care	$0²
Teladoc Telemedicine Visit - Medical - Mental Health	$20 per visit $20 per visit
Office Visit - PCP - Specialist	$20 copay³ $40 copay3
Urgent Care	$40 copay3
Emergency Room	$200 copay + 30%²
Diagnostic Testing	PCP office: $20 copay³ Specialist office: $40 copay³
Outpatient X-Ray and Lab	PCP office: $20 copay3 Specialist office: $40 copay3
Hospitalization - Inpatient Semi-Private Room - Inpatient Physician	30%² 30%²
Outpatient Treatment (Physical, Occupational & Speech Therapy)	$40 copay³
Mental Health/Substance Abuse - Inpatient - Outpatient	30%² $20 copay³ (Outpatient psychotherapy)
Pharmacy Retail	30-day supply
- Annual Deductible Applies - Pharmacy Out-of-Pocket Max	No Combined with medical
- Preventive Drugs on Essential Drug List - Generic - Brand Preferred - Brand Non-Preferred	$0 copay $10 copay 25% (min $35, max $105) 35% (min $70, max $140)
Pharmacy Retail/Mail Order	90-day supply
- Preventive Drugs on Essential Drug List - Generic - Brand Preferred - Brand Non-Preferred	$0 copay $30 copay 25% (min $105, max $315) 35% (min $210, max $420)

1) Coinsurance you pay after you meet the annual deductible unless otherwise noted.
2) Annual deductible waived.

EPO Network Plan and EPO HP-Network Plan