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) 3500
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,500/$7,000
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
No Charge
Primary Care Visit
20% after deductible
Specialist Visit
20% after deductible
Urgent Care
20% after deductible
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$5-$15 Copay after medical deductible
Preferred Brand
$40 Copay after medical deductible
Non-Preferred Brand
$60 Copay after medical deductible
Specialty
30% up to $250/RX after medical deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10-$30 Copay after medical deductible
Preferred Brand
$80 Copay after medical deductible
Non-Preferred Brand
$120 Copay after medical deductible
Specialty
Not Covered
Out-of-Network
Deductible (Individual/Family)
$10,500/$21,000
Out-of-Pocket Max (Individual/Family)
$18,000/$36,000
Preventive Care
50% after deductible
Primary Care Visit
50% after deductible
Specialist Visit
50% after deductible
Urgent Care
50% after deductible
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
50% to $250 after medical deductible
Preferred Brand
50% to $250 after medical deductible
Non-Preferred Brand
50% to $250 after medical deductible
Specialty
50% to $250 after medical deductible
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: $136.08
Employee + Spouse/DP: $299.38
Employee + Children: $244.95
Employee + Family: $421.86
Anthem EPO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$1,000/$3,000
Out-of-Pocket Max (Individual/Family)
$5,500/$11,000
Preventive Care
No Charge
Primary Care Visit
$20 copay
Specialist Visit
$40 copay
Urgent Care
$20 copay
Emergency Room
$150 copay then 20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$5-$20 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$60 copay
Specialty
30% up to $250/RX
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10-$40 copay
Preferred Brand
$80 copay
Non-Preferred Brand
$120 copay
Specialty
Not covered
Plan Cost
Employee Only: $160.95
Employee + Spouse/DP: $354.09
Employee + Children: $289.71
Employee + Family: $498.94
Anthem PPO Solutions
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,500/$3,000
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
No Charge
Primary Care Visit
$20 copay
Specialist Visit
$40 copay
Urgent Care
$20 copay
Emergency Room
$150 copay then 20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$5-$20 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$60 copay
Specialty
30% up to $250/RX
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10-$40 copay
Preferred Brand
$80 copay
Non-Preferred Brand
$120 copay
Specialty
Not covered
Out-of-Network
Deductible (Individual/Family)
$4,500/$9,000
Out-of-Pocket Max (Individual/Family)
$15,000/$30,000
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 then 20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
50% to $250/RX
Preferred Brand
50% to $250/RX
Non-Preferred Brand
50% to $250/RX
Specialty
50% to $250/RX
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: $160.95
Employee + Spouse/DP: $354.09
Employee + Children: $289.71
Employee + Family: $498.94
Anthem PPO Classic
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,500
Out-of-Pocket Max (Individual/Family)
$3,500/$7,000
Preventive Care
No Charge
Primary Care Visit
$20 copay
Specialist Visit
$40 copay
Urgent Care
$20 copay
Emergency Room
$150 copay then 10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$5-$15 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
30% up to $250/RX
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10-$30 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$100 copay
Specialty
Not covered
Out-of-Network
Deductible (Individual/Family)
$1,500/$4,500
Out-of-Pocket Max (Individual/Family)
$10,500/$21,000
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 then 10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
50% to $250/RX
Preferred Brand
50% to $250/RX
Non-Preferred Brand
50% to $250/RX
Specialty
50% to $250/RX
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: $202.28
Employee + Spouse/DP: $445.01
Employee + Children: $364.10
Employee + Family: $940.59
Kaiser HDHP (HSA) CA Only
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$2,500/$3,400/$5,000
Out-of-Pocket Max (Individual/Family)
$4,600/$9,200
Preventive Care
No Charge
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 after medical deductible
Preferred Brand
$30 copay after medical deductible
Non-Preferred Brand
$30 copay after medical deductible
Specialty
20% up to $250/RX after medical deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay after medical deductible
Preferred Brand
$60 copay after medical deductible
Non-Preferred Brand
$60 copay after medical deductible
Specialty
Not covered
Plan Cost
Employee Only: $125.42
Employee + Spouse/DP: $275.92
Employee + Children: $250.86
Employee + Family: $401.34
Kaiser HMO CA Only
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$750/$1,500
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
No Charge
Primary Care Visit
$30 copay
Specialist Visit
$40 copay
Urgent Care
$30 copay
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$30 copay
Specialty
20% up to $250/RX
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$60 copay
Specialty
Not covered
Plan Cost
Employee Only: $184.22
Employee + Spouse/DP: $405.28
Employee + Children: $368.44
Employee + Family: $884.25