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.
Aetna Managed Choice POS (HDHP/HSA)
Benefit Highlights
In-Network
Deductible (Individual/Member/Family)
$3,300/$3,300/$6,600
Out-of-Pocket Max (Individual/Member/Family)
$6,000/$6,000/$12,000
Preventive Care
$0
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
$10 (after deductible)
Preferred Brand
$30 (after deductible)
Non-Preferred Brand
$50 (after deductible)
Specialty
30% Coinsurance, not to exceed $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 (after deductible)
Preferred Brand
$60 (after deductible)
Non-Preferred Brand
$100 (after deductible)
Out-of-Network
Deductible (Individual/Member/Family)
$3,300/$3,300/$6,600
Out-of-Pocket Max (Individual/Member/Family)
$8,000/$8,000/$16,000
Preventive Care
40% (after deductible)
Primary Care Visit
40% (after deductible)
Specialist Visit
40% (after deductible)
Urgent Care
40% (after deductible)
Emergency Room
20% (after deductible)
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Monthly Plan Cost
Tier A ( up to $49/hr)
Employee Only: $86
Employee + Spouse/DP: $625
Employee + Child(ren): $480
Employee + Family: $990
Tier B ($49/hr to $98/hr)
Employee Only: $142
Employee + Spouse/DP: $775
Employee + Child(ren): $565
Employee + Family: $1,117
Tier C ($98/hr and up)
Employee Only: $249
Employee + Spouse/DP: $900
Employee + Child(ren): $770
Employee + Family: $1,270
Partners
Employee Only: $1,381.74
Employee + Spouse/DP: $3,372.82
Employee + Child(ren): $2,466.40
Employee + Family: $4,291.67
Aetna HMO – CA Only
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$2,500/$5,000
Preventive Care
$0
Primary Care Visit
$20
Specialist Visit
$30
Urgent Care
$35
Emergency Room
$150 copay, waived if admitted
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$30
Non-Preferred Brand
$50
Specialty
30% Coinsurance, not to exceed $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$60
Non-Preferred Brand
$100
Monthly Plan Cost
Tier A ( up to $49/hr)
Employee Only: $195
Employee + Spouse/DP: $827
Employee + Child(ren): $674
Employee + Family: $1,197
Tier B ($49/hr to $98/hr)
Employee Only: $303
Employee + Spouse/DP: $1,014
Employee + Child(ren): $826
Employee + Family: $1,425
Tier C ($98/hr and up)
Employee Only: $450
Employee + Spouse/DP: $1,187
Employee + Child(ren): $1,105
Employee + Family: $1,693
Partners
Employee Only: $1,702.42
Employee + Spouse/DP: $4,085.82
Employee + Child(ren): $2,979.26
Employee + Family: $5,192.39
Kaiser Deductible HMO (HDHP with HSA) – CA Only
Benefit Highlights
In-Network Only
Deductible (Individual/Member/Family)
$2,500/$3,400/$5,000
Out-of-Pocket Max (Individual/Member/Family)
$4,500/$4,500/$9,000
Preventive Care
$0 (deductible waived)
Primary Care Visit
$30 (after deductible)
Specialist Visit
$50 (after deductible)
Urgent Care
$30 (after deductible)
Emergency Room
$200 (after deductible)
Retail Rx (Up to 30-Day Supply)
Generic
$10 (after deductible)
Preferred Brand
$30 (after deductible)
Non-Preferred Brand
$30 (after deductible)
Specialty
20% Coinsurance, not to exceed $250
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 (after deductible)
Preferred Brand
$60 (after deductible)
Non-Preferred Brand
$60 (after deductible)
Specialty
Not covered
Monthly Plan Cost
Tier A ( up to $49/hr)
Employee Only: $86
Employee + Spouse/DP: $422
Employee + Child(ren): $380
Employee + Family: $644
Tier B ($49/hr to $98/hr)
Employee Only: $142
Employee + Spouse/DP: $562
Employee + Child(ren): $450
Employee + Family: $842
Tier C ($98/hr and up)
Employee Only: $249
Employee + Spouse/DP: $766
Employee + Child(ren): $670
Employee + Family: $1,126
Partners
Employee Only: $817.35
Employee + Spouse/DP: $1,798.17
Employee + Child(ren): $1,634.70
Employee + Family: $2,574.65
Kaiser HMO – 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
Specialist Visit
$30
Urgent Care
$20
Emergency Room
$50
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$30
Non-Preferred Brand
$30
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$60
Non-Preferred Brand
$60
Monthly Plan Cost
Tier A ( up to $49/hr)
Employee Only: $195
Employee + Spouse/DP: $827
Employee + Child(ren): $674
Employee + Family: $1,197
Tier B ($49/hr to $98/hr)
Employee Only: $303
Employee + Spouse/DP: $1,014
Employee + Child(ren): $826
Employee + Family: $1,425
Tier C ($98/hr and up)
Employee Only: $450
Employee + Spouse/DP: $1,187
Employee + Child(ren): $1,105
Employee + Family: $1,693
Partners
Employee Only: $1,122.21
Employee + Spouse/DP: $2,468.86
Employee + Child(ren): $2,244.42
Employee + Family: $3,534.96