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 + HSA
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,400/$6,800
Out-of-Pocket Max (Individual/Family)
$5,600/$11,200
Primary Care Visit
$0*
Specialist Visit
$0*
Urgent Care
$0*
Emergency Room
$0*
Retail Rx (Up to 30-Day Supply)
Generic/Lower Cost Generic
$15 copay*/$5 copay*
Preferred Brand
$40 copay*
Non-Preferred Brand
$60 copay*
Specialty
30%* (not to exceed $250)
Mail-Order Rx (Up to 90-Day Supply)
Generic/Lower Cost Generic
$30 copay*/$10 copay*
Preferred Brand
$100 copay*
Non-Preferred Brand
$150 copay*
Specialty
30%* (not to exceed $250)
*After deductible
Out-of-Network
Deductible (Individual/Family)
$10,200 / $20,400
Out-of-Pocket Max (Individual/Family)
$16,800/$33,600
Primary Care Visit
30%*
Specialist Visit
30%*
Urgent Care
30%*
Emergency Room
$0*
Retail Rx (Up to 30-Day Supply)
Generic
30% (not to exceed $250)
Preferred Brand
30% (not to exceed $250)
Non-Preferred Brand
30% (not to exceed $250)
Specialty
30% (not to exceed $250)
Mail-Order Rx (Up to 90-Day Supply)
Generic/Lower Cost Generic
Not covered/Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Semi-Monthly Plan Cost
Employee Only: $0.00
Employee and Spouse/DP: $183
Employee and Child(ren): $120
Employee and Family: $325.50
Anthem PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$750/$2,250
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Primary Care Visit
$30 copay
Specialist Visit
$50 copay
Urgent Care
$20 copay
Emergency Room
$150 copay + 20%* (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic/Lower Cost Generic
$20 copay/$5 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
30% (not to exceed $250)
Mail-Order Rx (Up to 90-Day Supply)
Generic/Lower Cost Generic
$40 copay/$10 copay
Preferred Brand
$75 copay
Non-Preferred Brand
$125 copay
Specialty
30% (not to exceed $250)
*After deductible
Out-of-Network
Deductible (Individual/Family)
$2,250/$6,750
Out-of-Pocket Max (Individual/Family)
$15,000/$30,000
Primary Care Visit
40%*
Specialist Visit
40%*
Urgent Care
40%*
Emergency Room
$150 copay + 20%* (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
50% (not to exceed $250)
Preferred Brand
50% (not to exceed $250)
Non-Preferred Brand
50% (not to exceed $250)
Specialty
50% (not to exceed $250)
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
Specialty
Not Covered
Semi-Monthly Plan Cost
Employee Only: $47.50
Employee and Spouse/DP: $329
Employee and Child(ren): $235
Employee and Family: $540.50
Kaiser HMO (CA only)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Primary Care Visit
$30 copay
Specialist Visit
$40 copay
Urgent Care
$30 copay
Emergency Room
$250 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$15 copay
Preferred Brand
$35 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay
Preferred Brand
$70 copay
Semi-Monthly Plan Cost
Employee Only: $47.50
Employee and Spouse/DP: $318.50
Employee and Child(ren): $307
Employee and Family: $422