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 (CA)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$1,000/$2,000
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
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 maximum
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$60 copay
Bi-Weekly Plan Cost
Non-Exempt
Employee Only: $110.00
Employee and Spouse/DP: $280.00
Employee and Child(ren): $250.00
Employee and Family: $437.00
Exempt
Employee Only: $161.00
Employee and Spouse/DP: $392.00
Employee and Child(ren): $348.00
Employee and Family: $569.00
Cigna EPO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$500/$1,000
Out-of-Pocket Max (Individual/Family)
$2,500/$5,000
Preventive Care
$0
Primary Care Visit
$25 copay
Specialist Visit
$40 copay
Urgent Care
$75 copay
Emergency Room
$200 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$25 copay
Non-Preferred Brand
$50 copay
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$25 copay
Preferred Brand
$62 copay
Non-Preferred Brand
$125 copay
Specialty
Not covered
Bi-Weekly Plan Cost
Non-Exempt
Employee Only: $110.00
Employee and Spouse/DP: $280.00
Employee and Child(ren): $250.00
Employee and Family: $437.00
Exempt
Employee Only: $161.00
Employee and Spouse/DP: $392.00
Employee and Child(ren): $348.00
Employee and Family: $569.00
Cigna PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$750/$1,500
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
$25 copay
Specialist Visit
$40 copay
Urgent Care
$75 copay
Emergency Room
$200 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay after deductible
Preferred Brand
$25 copay after deductible
Non-Preferred Brand
$50 copay after deductible
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$25 copay after deductible
Preferred Brand
$62 copay after deductible
Non-Preferred Brand
$125 copay after deductible
Specialty
Not covered
Out-of-Network
Deductible (Individual/Family)
$1,500/$3,000
Out-of-Pocket Max (Individual/Family)
$4,500/$9,000
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
$200 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
20%
Preferred Brand
20%
Non-Preferred Brand
20%
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Bi-Weekly Plan Cost
Non-Exempt
Employee Only: $144.00
Employee and Spouse/DP: $351.00
Employee and Child(ren): $311.00
Employee and Family: $529.00
Exempt
Employee Only: $185.00
Employee and Spouse/DP: $441.00
Employee and Child(ren): $390.00
Employee and Family: $674.00
Cigna HDHP
Benefit Highlights
In-Network
Self Only: $2,000
Family: $3,400 per member,
up to $4,000 per family
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
$0
Primary Care Visit
10% after deductible
Specialist Visit
10% after deductible
Urgent Care
10% after deductible
Emergency Room
10% after deductible (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay after deductible
Preferred Brand
$25 copay after deductible
Non-Preferred Brand
$50 copay after deductible
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$25 copay after deductible
Preferred Brand
$62 copay after deductible
Non-Preferred Brand
$125 copay after deductible
Specialty
Not covered
Out-of-Network
Self Only: $2,000
Family: $3,400 per member,
up to $4,000 per family
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
10% after deductible (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
20% after deductible
Preferred Brand
20% after deductible
Non-Preferred Brand
20% after deductible
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Bi-Weekly Plan Cost
Non-Exempt
Employee Only: $75.00
Employee and Spouse/DP: $210.00
Employee and Child(ren): $190.00
Employee and Family: $331.00
Exempt
Employee Only: $111.00
Employee and Spouse/DP: $286.00
Employee and Child(ren): $259.00
Employee and Family: $424.00