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.
Kaiser HMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$250/$500
Out-of-Pocket Max (Individual/Family)
$2,500/$5,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$30 copay
Urgent Care
$20 copay
Emergency Room
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$30 copay
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$60 copay (prior authorization required)
Per Pay Period Plan Cost
Employee Only: $53.37
Employee and Spouse/DP: $176.10
Employee and Child(ren): $144.08
Employee and Family: $248.13
Kaiser HDHP
Benefit Highlights
In-Network Only
Deductible (Individual/Family Individual/Family)
$2,000/#3,400/$4,000
Out-of-Pocket Max (Individual/Family)
$3,600 Self only enrollment,
$3,600 for any one member within a Family
enrollment, $7,200 for an entire Family.
Preventive Care
$0
Primary Care Visit
$30 copay after deductible
Specialist Visit
$50 copay after deductible
Urgent Care
$30 copay after deductible
Emergency Room
$200 copay after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$30 copay (prior authorization required)
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$60 copay (prior authorization required)
Per Pay Period Plan Cost
Employee Only: $42.72
Employee and Spouse/DP: $134.26
Employee and Child(ren): $109.85
Employee and Family: $189.18
Cigna OAP
Benefit Highlights
In-Network
Deductible (Individual/Family)
$200/$600
Out-of-Pocket Max (Individual/Family)
$2,700/$5,400
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$25 copay
Urgent Care
$20 copay
Emergency Room
$150 copay + 10% (copay waived if admitted)
Retail Rx (Up to 30-Day/90-Day Supply)
Generic
$10 copay/$30 copay
Preferred Brand
$30 copay/$90 copay
Non-Preferred Brand
$50 copay/$150 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$100 copay
Out-of-Network
Deductible (Individual/Family)
$200/$600
Out-of-Pocket Max (Individual/Family)
$5,200/$10,400
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
$150 copay + 10% (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
You pay 50%
Preferred Brand
You pay 50%
Non-Preferred Brand
You pay 50%
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Per Pay Period Plan Cost
Employee Only: $59.71
Employee and Spouse/DP: $196.18
Employee and Child(ren): $145.01
Employee and Family: $247.36
Cigna HDHP
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,700 / $3,400
Out-of-Pocket Max (Individual/Family)
$3,500/$7,000
Preventive Care
$0
Primary Care Visit
10% after deductible
Specialist Visit
10% after deductible
Urgent Care
10% after deductible
Emergency Room
$150 copay + 10% after deductible
Retail Rx (Up to 30-Day/90-Day Supply)
Generic
$10 copay after deductible/$30 copay after deductible
Preferred Brand
$25 copay after deductible/$75 copay after deductible
Non-Preferred Brand
$40 copay after deductible/$120 copay after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay after deductible
Preferred Brand
$50 copay after deductible
Non-Preferred Brand
$80 copay after deductible
Specialty
Not covered
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
$150 copay + 10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
You pay 50% after deductible
Preferred Brand
You pay 50% after deductible
Non-Preferred Brand
You pay 50% after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Per Pay Period Plan Cost
Employee Only: $48.85
Employee and Spouse/DP: $160.49
Employee and Child(ren): $118.63
Employee and Family: $202.36