Medical
Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Anthem Blue Cross HDHP
Benefit Highlights
In-Network
Deductible (Individual/Individual within a Family/Family)
$2,000/$3,400/$5,000
Out-of-Pocket Max (Individual/Individual within a Family/Family)
$4,250/$4,250/$8,500
Preventive Care
No charge
Primary Care Visit
10% coinsurance after deductible
Specialist Visit
10% coinsurance after deductible
Urgent Care
10% coinsurance after deductible
Emergency Room
10% coinsurance after deductible
Retail Rx (Up to 30-Day Supply)
Generic
Tier 1a: $5 copay after deductible; Tier 1b: $15 copay after deductible
Preferred Brand
$40 copay after deductible
Non-Preferred Brand
$60 copay after deductible
Specialty
30% coinsurance after deductible, up to $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
Tier 1a: $10 copay after deductible; Tier 1b: $30 copay after deductible
Preferred Brand
$100 copay after deductible
Non-Preferred Brand
$150 copay after deductible
Specialty
30% coinsurance after deductible, up to $250
Out-of-Network
Deductible (Individual/Individual within a Family/Family)
$6,000/$6,000/$12,000
Out-of-Pocket Max (Individual/Individual within a Family/Family)
$12,750/$12,750/$25,500
Preventive Care
30% coinsurance after deductible
Primary Care Visit
30% coinsurance after deductible
Specialist Visit
30% coinsurance after deductible
Urgent Care
30% coinsurance after deductible
Emergency Room
10% coinsurance after deductible
Retail Rx (Up to 30-Day Supply)
Generic
30% coinsurance after deductible, up to $250
Preferred Brand
30% coinsurance after deductible, up to $250
Non-Preferred Brand
30% coinsurance after deductible, up to $250
Specialty
30% coinsurance after deductible, up to $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Bi-Weekly Plan Cost
Employee Only: $31.93
Employee and Spouse/DP: $101.78
Employee and Child(ren): $83.27
Employee and Family: $157.38
Anthem Blue Cross PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$250/$750
Out-of-Pocket Max (Individual/Family)
$2,500/$5,000
Preventive Care
No charge
Primary Care Visit
$20 copay
Specialist Visit
$40 copay
Urgent Care
$20 copay
Emergency Room
$150 copay plus 10% after deductible (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
Tier 1a: $5 copay; Tier 1b: $15 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
30% coinsurance up to $250, deductible waived
Mail-Order Rx (Up to 100-Day Supply)
Generic
Tier 1a: $10 copay; Tier 1b: $30 copay
Preferred Brand
$75 copay
Non-Preferred Brand
$125 copay
Specialty
30% coinsurance up to $250, deductible waived
Out-of-Network
Deductible (Individual/Family)
$750/$2,250
Out-of-Pocket Max (Individual/Family)
$7,500/$15,000
Preventive Care
30% coinsurance after deductible
Primary Care Visit
30% coinsurance after deductible
Specialist Visit
30% coinsurance after deductible
Urgent Care
30% coinsurance after deductible
Emergency Room
$150 copay plus 10% after deductible (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
50% coinsurance up to $250, deductible waived
Preferred Brand
50% coinsurance up to $250, deductible waived
Non-Preferred Brand
50% coinsurance up to $250, deductible waived
Specialty
50% coinsurance up to $250, deductible waived
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Bi-Weekly Plan Cost
Employee Only: $45.13
Employee and Spouse/DP: $141.65
Employee and Child(ren): $115.90
Employee and Family: $218.36
Anthem Blue Cross HMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$2,000/$4,000
Preventive Care
No charge
Primary Care Visit
$20 copay
Specialist Visit
$40 copay
Urgent Care
$20 copay
Emergency Room
$200 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
Tier 1a: $5 copay; Tier 1b: $20 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$60 copay
Specialty
30% coinsurance up to $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
Tier 1a: $10 copay; Tier 1b: $30 copay
Preferred Brand
$75 copay
Non-Preferred Brand
$50 copay
Specialty
30% coinsurance up to $250
Bi-Weekly Plan Cost
Employee Only: $35.13
Employee and Spouse/DP: $103.99
Employee and Child(ren): $86.23
Employee and Family: $154.46
Kaiser HMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$o/$0
Out-of-Pocket Max (Individual/Family)
$1,500/$3,000
Preventive Care
No charge
Primary Care Visit
$20 copay
Specialist Visit
$20 copay
Urgent Care
$20 copay
Emergency Room
$200 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
Not covered
Specialty
20% coinsurance up to $250
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
Not covered
Specialty
Not covered
Bi-Weekly Plan Cost
Employee Only: $58.06
Employee and Spouse/DP: $132.14
Employee and Child(ren): $120.12
Employee and Family: $180.19