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 PPO (Non-CA)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1000/$2000
Out-of-Pocket Max (Individual/Family)
$4000/$8000
Preventive Care
$0
Primary Care Visit
$20
Specialist Visit
$40
Urgent Care
$XX
Emergency Room
$200
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$30
Non-Preferred Brand
50% (Min. $50, Max. $100)
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$70
Non-Preferred Brand
$125
Specialty
Not covered
Out-of-Network
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$200
Retail Rx (Up to 30-Day Supply)
Generic
$XX
Preferred Brand
$XX
Non-Preferred Brand
$XX
Specialty
$XX
Mail-Order Rx (Up to 90-Day Supply)
Generic
$XX
Preferred Brand
$XX
Non-Preferred Brand
$XX
Specialty
$XX
Bi-Weekly Plan Cost
Employee Only: $83.40
Employee and Spouse: $235.74
Employee and Child(ren): $232.90
Employee and Family: $262.12
Surcharges
Spousal Surcharge: $50.00
Employee Tobacco Surcharge: $18.46
Spouse Tobacco Surcharge: $18.46
Employee Biometric Screening Surcharge: $18.46
Spouse Biometric Screening Surcharge: $18.46
Anthem HDHP (Non-CA)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,300/$6,600
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
$0
Primary Care Visit
$0*
Specialist Visit
$0*
Urgent Care
$XX
Emergency Room
$0*
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$30
Non-Preferred Brand
$50
Specialty
25% (Max. 150)
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10
Preferred Brand
$75
Non-Preferred Brand
$150
Specialty
25% (Max. $150)
* After deductible
Out-of-Network
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$0*
Retail Rx (Up to 30-Day Supply)
Generic
$XX
Preferred Brand
$XX
Non-Preferred Brand
$XX
Specialty
$XX
Mail-Order Rx (Up to 90-Day Supply)
Generic
$XX
Preferred Brand
$XX
Non-Preferred Brand
$XX
Specialty
$XX
Bi-Weekly Plan Cost
Employee Only: $34.81
Employee and Spouse: $108.83
Employee and Child(ren): $109.98
Employee and Family: $117.42
Surcharges
Spousal Surcharge: $50.00
Employee Tobacco Surcharge: $18.46
Spouse Tobacco Surcharge: $18.46
Employee Biometric Screening Surcharge: $18.46
Spouse Biometric Screening Surcharge: $18.46
Kaiser PPO (CA)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$750/$1,500
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
$0
Primary Care Visit
$25
Specialist Visit
$25
Urgent Care
$XX
Emergency Room
20%*
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$30
Non-Preferred Brand
20% (Max. $250)
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$70
Non-Preferred Brand
$125
Specialty
Not covered
Out-of-Network
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
20%*
Retail Rx (Up to 30-Day Supply)
Generic
$XX
Preferred Brand
$XX
Non-Preferred Brand
$XX
Specialty
$XX
Mail-Order Rx (Up to 90-Day Supply)
Generic
$XX
Preferred Brand
$XX
Non-Preferred Brand
$XX
Specialty
$XX
Bi-Weekly Plan Cost
Employee Only: $83.40
Employee and Spouse: $235.74
Employee and Child(ren): $232.90
Employee and Family: $262.12
Surcharges
Spousal Surcharge: $50.00
Employee Tobacco Surcharge: $18.46
Spouse Tobacco Surcharge: $18.46
Employee Biometric Screening Surcharge: $18.46
Spouse Biometric Screening Surcharge: $18.46