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.
Blue Shield PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,500
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
$20 copay; deductible does not apply
Specialist Visit
$25 copay; deductible does not apply
Urgent Care
$20 copay; deductible does not apply
Emergency Room
$150 copay plus 20%; deductible does not apply (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Tier 1
$15
Tier 2
$30
Tier 3
$45
Tier 4
30% up to $250 prescription
Mail-Order Rx (Up to 90-Day Supply)
Tier 1
$30
Tier 2
$60
Tier 3
$90
Tier 4
30% up to $500 prescription
Out-of-Network
Deductible (Individual/Family)
$1,500/$4,500
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
Not covered
Primary Care Visit
You pay 40% after deductible
Specialist Visit
You pay 40% after deductible
Urgent Care
You pay 40% after deductible
Emergency Room
$150 copay plus 20%; deductible does not apply (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Tier 1
25% plus $15 prescription
Tier 2
25% plus $30 prescription
Tier 3
25% plus $45 prescription
Tier 4
30% up to $250 prescription plus 25% of purchase price
Mail-Order Rx (Up to 90-Day Supply)
Tier 1
Not covered
Tier 2
Not covered
Tier 3
Not covered
Tier 4
Not covered
Plan Cost
Employee Only: $0.00
Employee and Spouse/DP: $437.79
Employee and Child(ren): $291.87
Employee and Family: $766.16
Blue Shield PPO Savings (HDHP) + HSA
Benefit Highlights
In-Network
Deductible (Individual/Individual Within a Family/Family)
$1,800/$3,400/$3,600
Out-of-Pocket Max (Individual/ Family)
$4,500/$9,000
Preventive Care
$0
Primary Care Visit
You pay 20% after deductible
Specialist Visit
You pay 20% after deductible
Urgent Care
You pay 20% after deductible
Emergency Room
$150 per visit plus 20% after deductible
Retail Rx (Up to 30-Day Supply)
Tier 1
$10
Tier 2
$25
Tier 3
$40
Tier 4
30% up to $250 prescription
Mail-Order Rx (Up to 90-Day Supply)
Tier 1
$20
Tier 2
$50
Tier 3
$80
Tier 4
30% up to $500 prescription
Out-of-Network
Deductible (Individual/Individual Within a Family/Family)
$1,800/$3,400/$3,600
Out-of-Pocket Max (Individual/Family)
$8,000/$16,000
Preventive Care
Not covered
Primary Care Visit
You pay 40% after deductible
Specialist Visit
You pay 40% after deductible
Urgent Care
You pay 40% after deductible
Emergency Room
$150 per visit plus 20% after deductible
Retail Rx (Up to 30-Day Supply)
Tier 1
25% plus $10 prescription
Tier 2
25% plus $25 prescription
Tier 3
25% plus $40 prescription
Tier 4
30% up to $250/prescription plus 25% of purchase price
Mail-Order Rx (Up to 90-Day Supply)
Tier 1
Not covered
Tier 2
Not covered
Tier 3
Not covered
Tier 4
Not covered
Plan Cost
Employee Only: $0.00
Employee and Spouse/DP: $338.92
Employee and Child(ren): $225.94
Employee and Family: $593.12
Blue Shield EPO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0
Out-of-Pocket Max (Individual/Family)
$1,500/$3,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$25 copay
Urgent Care
$20 copay
Emergency Room
$100 copay (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Tier 1
$15
Tier 2
$30
Tier 3
$45
Tier 4
30% up to $250 prescription
Mail-Order Rx (Up to 90-Day Supply)
Tier 1
$30
Tier 2
$60
Tier 3
$90
Tier 4
30% up to $500 prescription
Out-of-Network
Deductible (Individual/Family)
N/A
Out-of-Pocket Max (Individual/Family)
N/A
Preventive Care
N/A
Primary Care Visit
N/A
Specialist Visit
N/A
Urgent Care
N/A
Emergency Room
$100 copay (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Tier 1
25% plus $15/prescription
Tier 2
25% plus $30/prescription
Tier 3
25% plus $45/prescription
Tier 4
30% up to $250/prescription plus 25% of purchase price
Mail-Order Rx (Up to 90-Day Supply)
Tier 1
$30
Tier 2
$60
Tier 3
$90
Tier 4
30% up to $500 prescription
Plan Cost
Employee Only: $0.00
Employee and Spouse/DP: $460.37
Employee and Child(ren): $306.92
Employee and Family: $805.65
Kaiser DHMO (CA only)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$500/$1,000
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
$30 copay
Specialist Visit
$40 copay
Urgent Care
$30 copay
Emergency Room
You pay 20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic (Tier 1)
$10 copay
Most Brand Drugs (Tier 2)
$30 copay
Specialty
20% up to $250
Mail-Order Rx (Up to 100-Day Supply)
Generic (Tier 1)
$20 copay
Most Brand drugs (Tier 2)
$60 copay
Specialty
Not covered
Plan Cost
Employee Only: $0.00
Employee and Spouse/DP: $267.89
Employee and Child(ren): $223.25
Employee and Family: $446.49
Kaiser HSA (CA only)
Benefit Highlights
In-Network Only
Deductible (Individual/Individual Within a Family/Family)
$2,000/$3,400/$4,000
Out-of-Pocket Max (Individual/Family)
$3,600/$7,200
Preventive Care
$0
Primary Care Visit
$30 after deductible
Specialist Visit
$50 after deductible
Urgent Care
$30 after deductible
Emergency Room
$200 after deductible (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic (Tier 1)
$10 copay after deductible
Most Brand drugs (Tier 2)
$30 copay after deductible
Specialty
20% up to $250 after deductible
Mail-Order Rx (Up to 100-Day Supply)
Generic (Tier 1)
$20 copay after deductible
Most Brand drugs (Tier 2)
$60 copay after deductible
Specialty
Not covered
Plan Cost
Employee Only: $0.00
Employee and Spouse/DP: $220.59
Employee and Child(ren): $183.84
Employee and Family: $367.65