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 Senior Advantage HMO Plan + Medicare Part D Prescription
Benefit Highlights
In-Network Only
Deductible
None
Out-of-Pocket Max
$1,000 per individual
Preventive Care
$0
Primary Care Visit
$10
Specialist Visit
$10
Urgent Care
$10
Emergency Room
$25
Medicare Part D Rx (Up to 100-Day Supply)
Initial Coverage Stage (up to $2,000 in 2025)
$10
Catastrophic Coverage Stage (over $2,000 in 2025)
$0
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
Kaiser Traditional HMO Plan
Benefit Highlights
In-Network Only
Deductible
None
Out-of-Pocket Max (Individual/Family)
$1,500/$3,000
Preventive Care
$0
Primary Care Visit
$10
Specialist Visit
$10
Urgent Care
$10
Emergency Room
$25
Retail Rx (Up to 100-Day Supply)
Tier 1 — Generic
$10
Tier 2 — Brand
$10
Tier 4 — Specialty (up to 30-Day Supply)
$10
Mail-Order Rx (Up to 100-Day Supply)
Tier 1 — Generic
$10
Tier 2 — Brand
$10
Tier 4 — Specialty (up to 30-Day Supply)
$10
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
Kaiser Deductible HMO Plan
Benefit Highlights
In-Network Only
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
$XX
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
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
$XX
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
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
Kaiser HSA-Qualified HDHP HMO Plan
Benefit Highlights
In-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
$XX
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
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
$XX
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
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
Anthem Fee-for-Service PPO (CA) (Retirees Age 65 or Over)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
Not applicable
Preventive Care
20% (dependent children through age 18)
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Retail Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Tier 3 — Typically Non-Preferred Brand / Specialty Drugs
Not covered
Mail-Order Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Tier 3 — Typically Non-Preferred Brand / Specialty Drugs
Not covered
Out-of-Network
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
Not applicable
Preventive Care
20% (dependent children through age 18)
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Retail Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Tier 3 — Typically Non-Preferred Brand / Specialty Drugs
Not covered
Mail-Order Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Tier 3 — Typically Non-Preferred Brand / Specialty Drugs
Not covered
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
Anthem Fee-for-Service PPO + Prescription (CA) (Retirees Age 65 or Over)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
Not applicable
Preventive Care
20% (dependent children through age 18)
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Retail Rx (Up to 100-Day Supply)
Tier 1 — Generic
$10
Tier 2 — Typically Preferred Brand
$15
Tier 3 — Typically Non-Preferred Brand / Specialty Drugs
$15
Mail-Order Rx (Up to 100-Day Supply)
Tier 1 — Generic
$10
Tier 2 — Typically Preferred Brand
$15
Tier 3 — Typically Non-Preferred Brand / Specialty Drugs
$15
Out-of-Network
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
Not applicable
Preventive Care
20% (dependent children through age 18)
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Retail Rx (Up to 100-Day Supply)
Tier 1 — Generic
$10 + 50%
Tier 2 — Typically Preferred Brand
$15 + 50%
Tier 3 — Typically Non-Preferred Brand / Specialty Drugs
$15 + 50%
Mail-Order Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Tier 3 — Typically Non-Preferred Brand / Specialty Drugs
Not covered
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
Anthem Custom Premier PPO
Benefit Highlights
In-Network Only
Deductible
$0 per individual
Out-of-Pocket Max
$1,600 per individual
Preventive Care
$0 (birth up to age 1)
20% (ages 1+)
20% (adult)
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Retail Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Tier 3 — Typically Non-Preferred Brand
Not covered
Tier 4 — Typically Specialty (Brand and Generic)
Not covered
Mail-Order Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Tier 3 — Typically Non-Preferred Brand
Not covered
Tier 4 — Typically Specialty (Brand and Generic)
Not covered
Out-of-Network
Deductible
$0 per individual
Out-of-Pocket Max
$1,600 per individual
Preventive Care
$0 (birth up to age 1)
20% (age 1 to age 7)
Not covered (ages 7+)
20% (adult)
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Retail Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Tier 3 — Typically Non-Preferred Brand
Not covered
Tier 4 — Typically Specialty (Brand and Generic)
Not covered
Mail-Order Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Tier 3 — Typically Non-Preferred Brand
Not covered
Tier 4 — Typically Specialty (Brand and Generic)
Not covered
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
Anthem Custom Premier PPO + Prescription
Benefit Highlights
In-Network Only
Deductible
$0 per individual
Out-of-Pocket Max
$1,600 per individual
Preventive Care
$0 (birth up to age 1)
20% (ages 1+)
20% (adult)
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Retail Rx (Up to 30-Day Supply)
Tier 1 — Typically Generic
$10
Tier 2 — Typically Preferred Brand
$15
Mail-Order Rx (Up to 90-Day Supply)
Tier 1 — Typically Generic
$10
Tier 2 — Typically Preferred Brand
$15
Out-of-Network
Deductible
$0 per individual
Out-of-Pocket Max
$1,600 per individual
Preventive Care
$0 (birth up to age 1)
20% (age 1 to age 7)
Not covered (ages 7+)
20% (adult)
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Retail Rx (Up to 30-Day Supply)
Tier 1 — Typically Generic
$10 + 50% up to $250 per prescription
Tier 2 — Typically Preferred Brand
$15 + 50% up to $250 per prescription
Mail-Order Rx (Up to 90-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
Anthem Custom BC Premier PPO
Benefit Highlights
In-Network
Deductible
$0 per individual
Out-of-Pocket Max
$1,600 per individual
Preventive Care
$0 (birth up to age 1)
20% (ages 1+)
20% (adult)
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Retail Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Tier 3 — Typically Non-Preferred Brand
Not covered
Tier 4 — Typically Specialty (Brand and Generic)
Not covered
Mail-Order Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Tier 3 — Typically Non-Preferred Brand
Not covered
Tier 4 — Typically Specialty (Brand and Generic)
Not covered
Out-of-Network
Deductible
$0 per individual
Out-of-Pocket Max
$1,600 per individual
Preventive Care
$0 (birth up to age 1)
20% (age 1 to age 7)
Not covered (ages 7+)
20% (adult)
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Retail Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Tier 3 — Typically Non-Preferred Brand
Not covered
Tier 4 — Typically Specialty (Brand and Generic)
Not covered
Mail-Order Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Tier 3 — Typically Non-Preferred Brand
Not covered
Tier 4 — Typically Specialty (Brand and Generic)
Not covered
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
Anthem Custom BC Premier PPO + Prescription
Benefit Highlights
In-Network
Deductible
$0 per individual
Out-of-Pocket Max
$1,600 per individual
Preventive Care
$0 (birth up to age 1)
20% (ages 1+)
20% (adult)
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Retail Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
$10
Tier 2 — Typically Preferred Brand
$15
Mail-Order Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
$10
Tier 2 — Typically Preferred Brand
$15
Out-of-Network
Deductible
$0 per individual
Out-of-Pocket Max
$1,600 per individual
Preventive Care
$0 (birth up to age 1)
20% (age 1 to age 7)
Not covered (ages 7+)
20% (adult)
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Retail Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
$10 + 50% up to $250 per prescription
Tier 2 — Typically Preferred Brand
$15 + 50% up to $250 per prescription
Mail-Order Rx (Up to 100-Day Supply)
Tier 1 — Typically Generic
Not covered
Tier 2 — Typically Preferred Brand
Not covered
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX