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.
Contact Information
Kaiser HMO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,000/$2,000
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$20 copay
Urgent Care
$20 copay
Emergency Room
20% after deductible
Retail Rx (Up 30-day Supply)
Generic
$10
Brand Name
$30
Specialty
20% up to $250 per prescription
Mail Order Rx (Up 90-day Supply)
Generic
$20
Brand Name
$60
Specialty
20% up to $250 per prescription
Shows what you pay for in-network services only. You always pay the deductible and copay ($). You pay coinsurance (%) after you meet the deductible.
Plan Cost - Bi-weekly
Employee Only: $40.97
Employee and Spouse: $126.21
Employee and Child(ren): $99.97
Employee and Family: $191.21
Anthem PPO 1000
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,000/$3,000
Out-of-Pocket Max (Individual/Family)
$3,500/$7,500
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$40 copay
Urgent Care
$50 copay
Emergency Room
$250 per visit (waived if admitted)
Retail Rx (Up 30-day Supply)
Generic
$15
Brand Name
$30
Specialty
Varies based on tier
Mail Order Rx (Up 90-day Supply)
Generic
$30
Brand Name
$60
Specialty
2x retail (Varies based on tier)
Shows what you pay for in-network services only. You always pay the deductible and copay ($). You pay coinsurance (%) after you meet the deductible.
Plan Cost - Bi-weekly
Employee Only: $56.36
Employee and Spouse: $188.37
Employee and Child(ren): $131.35
Employee and Family: $239.30
Anthem HSA 1650
Benefit Highlights
In-Network
Deductible (Individual/Individual within a Family/Family)
$1,650/$3,300/$3,500
Out-of-Pocket Max (Individual/Individual within a Family/Family)
$4,000/$4,000/$5,000
Preventive Care
$0
Primary Care Visit
20% after deductible
Specialist Visit
20% after deductible
Urgent Care
20% after deductible
Emergency Room
20% after deductible
Retail Rx (Up 30-day Supply)
Generic
$15 after deductible
Brand Name
$30 after deductible
Specialty
Cost varies depending on drug tier
Mail Order Rx (Up 90-day Supply)
Generic
$30 after deductible
Brand Name
$60 after deductible
Specialty
Cost varies depending on drug tier
Shows what you pay for in-network services only. You always pay the deductible and copay ($). You pay coinsurance (%) after you meet the deductible.
Plan Cost - Bi-weekly
Employee Only: $41.74
Employee and Spouse: $104.93
Employee and Child(ren): $84.49
Employee and Family: $193.02
Anthem HRA 3500
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,500/$7,000
Out-of-Pocket Max (Individual/Family)
$4,500/$9,000
Preventive Care
$0
Primary Care Visit
20% after deductible
Specialist Visit
20% after deductible
Urgent Care
20% after deductible
Emergency Room
20% after deductible
Retail Rx (Up 30-day Supply)
Generic
$15 after deductible
Brand Name
$30 after deductible
Specialty
Cost varies depending on drug tier
Mail Order Rx (Up 90-day Supply)
Generic
$30 after deductible
Brand Name
$60 after deductible
Specialty
Cost varies depending on drug tier
Shows what you pay for in-network services only. You always pay the deductible and copay ($). You pay coinsurance (%) after you meet the deductible.
Plan Cost - Bi-weekly
Employee Only: $18.46
Employee and Spouse: $57.10
Employee and Child(ren): $44.20
Employee and Family: $106.68