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 HMO Trio – CA Only
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$2,000/$4,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$20 copay
Urgent Care
$20 copay
Emergency Room
$150 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
$30 copay
Non-Preferred Brand
$50 copay
Specialty
20% up to $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$100 copay
Specialty
Not Covered
Monthly Plan Cost
Employee Only: $57.94
Employee and Spouse: $544.71
Employee and Child(ren): $382.43
Employee and Family: $909.79
Blue Shield EPO – Non-CA Only
Benefit Highlights
Deductible (Individual/Family)
$500/$1,500
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$25 copay
Urgent Care
$20 copay
Emergency Room
$150 copay + 20% coinsurance (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$25 copay
Non-Preferred Brand
$40 copay
Specialty
30% to $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$50 copay
Non-Preferred Brand
$80 copay
Specialty
30% up to $500
Monthly Plan Cost
Employee Only: $207.44
Employee and Spouse: $1,037.28
Employee and Child(ren): $760.60
Employee and Family: $1,659.68
Blue Shield Full HDHP PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,250/$4,500
Out-of-Pocket Max (Individual/Family)
$3,500/$7,000
Preventive Care
$0
Primary Care Visit
20%*
Specialist Visit
20%*
Urgent Care
20%*
Emergency Room
$150 copay + 20% after deductible
(copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$25 copay
Non-Preferred Brand
$40 copay
Specialty
30% to $250*
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay*
Preferred Brand
$50 copay*
Non-Preferred Brand
$80 copay*
Specialty
30% up to $500*
*After Deductible
Out-of-Network
Deductible (Individual/Family)
$2,250/$4,500
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
Not covered
Primary Care Visit
50%*
Specialist Visit
50%*
Urgent Care
50%*
Emergency Room
$150 copay + 20%*
(copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay + 25%*
Preferred Brand
$25 copay + 25%*
Non-Preferred Brand
$40 copay + 25%*
Specialty
30% up to $250 + 25% of purchase price*
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
*After Deductible
Monthly Plan Cost
Employee Only: $67.32
Employee and Spouse: $632.87
Employee and Child(ren): $444.32
Employee and Family: $1,057.05
Kaiser Deductible HMO – CA Only
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$250/$500
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$30 copay
Urgent Care
$20 copay
Emergency Room
10% coinsurance after deductible
Retail Rx
(Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Specialty
20% up to $250
Mail-Order Rx
(Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Specialty
20% up to $500
Monthly Plan Cost
Employee Only: $48.78
Employee and Spouse: $458.53
Employee and Child(ren): $321.94
Employee and Family: $765.84