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.
Active
Anthem Prudent Buyer PPO
Benefit Highlights
In-Network
Deductible (Per Individual)
$0
Out-of-Pocket Max (Per Individual)
$889
Preventive Care
$25 + 20%
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: Preferred Brand
$15
Mail-Order Rx (Up to 100-Day Supply)
Tier 1: Generic
$10
Tier 2: Preferred Brand
$15
Out-of-Network
Deductible (Per Individual)
$0
Out-of-Pocket Max (Per Individual)
$1,500
Preventive Care
30%
Primary Care Visit
30%
Specialist Visit
30%
Urgent Care
30%
Emergency Room
20%
Retail Rx (Up to 100-Day Supply)
Tier 1: Generic
$10 + 50% up to $250
Tier 2: Preferred Brand
$15 + 50% up to $250
Mail-Order Rx (Up to 100-Day Supply)
Tier 1: Generic
Not covered
Tier 2: Preferred Brand
Not covered
Plan Cost
Active employees contribute $80/month for all plans and tiers.
Kaiser Traditional HMO
Benefit Highlights
In-Network Only
Deductible
None
Out-of-Pocket Max (Individual/Individual within a Family/Family)
$1,500/$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 3: Specialty
$10
Mail-Order Rx (Up to 100-Day Supply)
Tier 1: Generic
$10
Tier 2: Brand
$10
Tier 3: Specialty
$10 (up to 30-day supply)
Plan Cost
Active employees contribute $80/month for all plans and tiers.
UHC Signature Value HMO
Benefit Highlights
In-Network Only
Deductible
None
Out-of-Pocket Max (Individual/Family)
$2,000/$6,000
Preventive Care
$10
Primary Care Visit
$10
Specialist Visit
$10
Urgent Care
$10
Emergency Room
$50
Plan Cost
Active employees contribute $80/month for all plans and tiers.
UHC Harmony HMO
Benefit Highlights
In-Network
Deductible
None
Out-of-Pocket Max (Individual/Family)
$2,000/$6,000
Preventive Care
$10
Primary Care Visit
$10
Specialist Visit
$10
Urgent Care
$10
Emergency Room
$50
Plan Cost
Active employees contribute $80/month for all plans and tiers.
Early Retiree
Anthem Fee for Service Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max
N/A
Preventive Care
20%
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
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
Out-of-Network
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max
N/A
Preventive Care
20%
Primary Care Visit
20%
Specialist Visit
20%
Urgent Care
20%
Emergency Room
20%
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
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
Plan Cost
Retirees under age 65 contribute $80/month for all plans and tiers.
Anthem Blue Card (OOS)
Benefit Highlights
In-Network
Deductible (Per Individual)
$0
Out-of-Pocket Max (Per Individual)
$1,600
Preventive Care
20%
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: Preferred Brand
$15
Mail-Order Rx (Up to 100-Day Supply)
Tier 1: Generic
$10
Tier 2: Preferred Brand
$15
Out-of-Network
Deductible (Per Individual)
$0
Out-of-Pocket Max (Per Individual)
$1,600
Preventive Care
20%
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% up to $250
Tier 2: Preferred Brand
$15 + 50% up to $250
Mail-Order Rx (Up to 100-Day Supply)
Tier 1: Generic
$10 + 50% up to $250
Tier 2: Preferred Brand
$15 + 50% up to $250
Plan Cost
Retirees under age 65 contribute $80/month for all plans and tiers.
Kaiser Traditional HMO
Benefit Highlights
In-Network Only
Deductible
None
Out-of-Pocket Max (Individual/Individual within a Family/Family)
$1,500/$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 3: Specialty
$10
Mail-Order Rx (Up to 100-Day Supply)
Tier 1: Generic
$10
Tier 2: Brand
$10
Tier 3: Specialty
$10 (up to 30-day supply)
Plan Cost
Retirees under age 65 contribute $80/month for all plans and tiers.
UHC Signature Value HMO
Benefit Highlights
In-Network Only
Deductible
None
Out-of-Pocket Max (Individual/Family)
$2,000/$6,000
Preventive Care
$10
Primary Care Visit
$10
Specialist Visit
$10
Urgent Care
$10
Emergency Room
$50
Plan Cost
Retirees under age 65 contribute $80/month for all plans and tiers.
UHC Harmony HMO
Benefit Highlights
In-Network
Deductible
None
Out-of-Pocket Max (Individual/Family)
$2,000/$6,000
Preventive Care
$10
Primary Care Visit
$10
Specialist Visit
$10
Urgent Care
$10
Emergency Room
$50
Plan Cost
Retirees under age 65 contribute $80/month for all plans and tiers.
Medicare Retiree
Anthem MAPD
Benefit Highlights
In-Network
Deductible (Combined with Out-of-Network)
$0
Out-of-Pocket Max (Combined with Out-of-Network)
$1,500
Preventive Care
$0
Primary Care Visit
$0
Specialist Visit
$0
Urgent Care
$20
Emergency Room
$75
Medicare Part B Prescription Drugs
$20
Out-of-Network
Deductible (Combined with In-Network)
$0
Out-of-Pocket Max (Combined with In-Network)
$1,500
Preventive Care
$0
Primary Care Visit
$0
Specialist Visit
$0
Urgent Care
$20
Emergency Room
$75
Medicare Part B Prescription Drugs
$20
Plan Cost
Retirees over age 65 contribute $60/month for all plans and tiers.
Anthem PDP Rx Plan
Benefit Highlights
In-Network
Deductible
$0
Out-of-Pocket Max
$2,000
Retail Rx (Up to 100-Day Supply)
Tier 1: Select Generics
$0
Tier 1: Generics
$10
Tier 2: Preferred Drugs
$15
Tier 3: Non-Preferred Drugs, including Specialty Drugs
$15
Diabetic Supplies – Insulin Syringes and Alcohol Swabs
$10
Mail-Order Rx (Up to 100-Day Supply)
Tier 1: Select Generics
$0
Tier 1: Generics
$10
Tier 2: Preferred Drugs
$15
Tier 3: Non-Preferred Drugs, including Specialty Drugs
$15
Diabetic Supplies – Insulin Syringes and Alcohol Swabs
$10
Plan Cost
Retirees over age 65 contribute $60/month for all plans and tiers.
Kaiser Sr Adv (KPSA)
Benefit Highlights
In-Network Only
Deductible
None
Out-of-Pocket Max (Per Individual)
$1,000
Preventive Care
$0
Primary Care Visit
$10
Specialist Visit
$10
Urgent Care
$10
Emergency Room
$25
Prescription Drug Coverage
Prescription Drug Out-of-Pocket Max (Per Individual)
$2,000
Medicare Part D Prescription Drugs (up to 100-day supply)
$10
Plan Cost
Retirees over age 65 contribute $60/month for all plans and tiers.