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 HDHP with HSA
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,700/$3,400
Out-of-Pocket Max (Individual/Family)
$3,400/$6,800
Preventive Care
$0
Primary Care Visit
10% after deductible
Specialist Visit
10% after deductible
Urgent Care
10% after deductible
Emergency Room
$100 + 10% coinsurance
Retail Rx (Up to 30-Day Supply)
Generic
$10 after deductible
Preferred Brand
$25 after deductible
Non-Preferred Brand
$40 after deductible
Specialty
30% after deductible up to $200
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 after deductible
Preferred Brand
$63 after deductible
Non-Preferred Brand
$100 after deductible
Specialty
30% after deductible up to $200
Out-of-Network
Deductible (Individual/Family)
$1,700/$3,400
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
40% after deductible
Primary Care Visit
40% after deductible
Specialist Visit
40% after deductible
Urgent Care
40% after deductible
Emergency Room
$100 + 10% coinsurance
Retail Rx (Up to 30-Day Supply)
Generic
25% after deductible up to $250
Preferred Brand
25% after deductible up to $250
Non-Preferred Brand
25% after deductible up to $250
Specialty
25% 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
Plan Cost
Employee Only: $0.00
Employee and Spouse: $55.00
Employee and Child(ren): $40.00
Employee and Family: $90.00
Anthem PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$250/$500
Out-of-Pocket Max (Individual/Family)
$2,250/$4,500
Preventive Care
$0
Primary Care Visit
$15 copay
Specialist Visit
$15 copay
Urgent Care
$15 copay
Emergency Room
$100 + 10% coinsurance
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$25
Non-Preferred Brand
$40
Specialty
30% up to $200
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$63
Non-Preferred Brand
$100
Specialty
30% up to $200
Out-of-Network
Deductible (Individual/Family)
$250/$500
Out-of-Pocket Max (Individual/Family)
$10,250/$20,500
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
$100 + 10% coinsurance
Retail Rx (Up to 30-Day Supply)
Generic
25% up to $250
Preferred Brand
25% up to $250
Non-Preferred Brand
25% up to $250
Specialty
25% 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
Plan Cost
Employee Only: $110.00
Employee and Spouse: $485.00
Employee and Child(ren): $360.00
Employee and Family: $765.00
Kaiser HDHP with HSA (CA Only)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$1,700/$3,400
Out-of-Pocket Max (Individual/Family)
$3,400/$6,800
Preventive Care
$0
Primary Care Visit
10% after deductible
Specialist Visit
10% after deductible
Urgent Care
10% after deductible
Emergency Room
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 after deductible
Preferred Brand
$30 after deductible
Non-Preferred Brand
$30 after deductible
Specialty
20% after deductible up to $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 after deductible
Preferred Brand
$60 after deductible
Non-Preferred Brand
$60 after deductible
Specialty
Not covered
Plan Cost
Employee Only: $0.00
Employee and Spouse: $40.00
Employee and Child(ren): $35.00
Employee and Family: $65.00
Kaiser HMO (CA Only)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
None
Out-of-Pocket Max (Individual/Family)
$1,500/$3,000
Preventive Care
$0
Primary Care Visit
$25
Specialist Visit
$35
Urgent Care
$25
Emergency Room
$125
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$25
Non-Preferred Brand
$25
Specialty
$25
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$50
Non-Preferred Brand
$50
Specialty
Not covered
Plan Cost
Employee Only: $70.00
Employee and Spouse: $340.00
Employee and Child(ren): $295.00
Employee and Family: $525.00
HMAA PPO (HI Only)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$100/$300
Out-of-Pocket Max (Individual/Family)
$2,500/$7,500
Primary Care Visit
10%
Specialist Visit
10%
Out-of-Network
Deductible (Individual/Family)
$100/$300
Out-of-Pocket Max (Individual/Family)
$2,500/$7,500
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Plan Cost
Employee Only: $65.00
Employee + 1 : $230.00
Employee + 2+ : $265.00
Triple S (Puerto Rico Only)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
None
Out-of-Pocket Max (Individual/Family)
$6,350/$12,700
Primary Care Visit
$10
Specialist Visit
$12
Retail Rx (Up to 30-Day Supply)
Generic
$5
Preferred Brand
$15
Non-Preferred Brand
$3
Plan Cost
Employee Only: $25.00
Employee + 1 : $100.00
Employee + 2+ : $125.00