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.
UHC HDHP/HSA
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,300 / $6,600
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
No charge
Primary Care Visit
10% after deductible
Specialist Visit
10% after deductible
Urgent Care
10% after deductible
Emergency Room
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay after deductible
Preferred Brand
$35 copay after deductible
Non-Preferred Brand
$70 copay after deductible
Specialty
Tier 1: $10 copay after deductible
Tier 2: $150 copay after deductible
Tier 3: $250 copay after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
$25 copay after deductible
Preferred Brand
$87.50 copay after deductible
Non-Preferred Brand
$175 copay after deductible
Specialty
Not covered
Out-of-Network
Deductible (Individual/Family)
$6,000/$12,000
Out-of-Pocket Max (Individual/Family)
$10,000/$20,000
Preventive Care
No charge
Primary Care Visit
50% after deductible
Specialist Visit
50% after deductible
Urgent Care
50% after deductible
Emergency Room
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay after deductible
Preferred Brand
$35 copay after deductible
Non-Preferred Brand
$70 copay after deductible
Specialty
Tier 1: $10 copay after deductible
Tier 2: $150 copay after deductible
Tier 3: $250 copay after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Monthly Plan Cost
Employee Only: $0.00
Employee and Spouse/DP: $229.69
Employee and Child(ren): $173.70
Employee and Family: $393.76
UHC PPO 500
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,000
Out-of-Pocket Max (Individual/Family)
$3,500/$7,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$40 copay
Urgent Care
$50 copay
Emergency Room
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$35 copay
Non-Preferred Brand
$60 copay
Specialty
Tier 1: $10 copay
Tier 2: $150 copay
Tier 3: $250 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$25 copay
Preferred Brand
$87.50 copay
Non-Preferred Brand
$150 copay
Specialty
Not Covered
Out-of-Network
Deductible (Individual/Family)
$1,500/$3,000
Out-of-Pocket Max (Individual/Family)
$10,500/$21,000
Preventive Care
50% after deductible
Primary Care Visit
50% after deductible
Specialist Visit
50% after deductible
Urgent Care
50% after deductible
Emergency Room
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$35
Non-Preferred Brand
$60
Specialty
Tier 1: $10 copay
Tier 2: $150 copay
Tier 3: $250 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Monthly Plan Cost
Employee Only: $45.41
Employee and Spouse/DP: $369.63
Employee and Child(ren): $290.63
Employee and Family: $601.23
Kaiser HMO (CA Only)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,500/$3,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$35 copay
Urgent Care
$20 copay
Emergency Room
$100 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Brand Name
$35 copay
Specialty
20% (not to exceed $150)
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Brand Name
$70 copay
Specialty
Not available
Monthly Plan Cost (N. CA)
Employee Only: $0.00
Employee and Spouse/DP: $361.65
Employee and Child(ren): $287.11
Employee and Family: $560.41
Monthly Plan Cost (S. CA)
Employee Only: $0.00
Employee and Spouse/DP: $368.15
Employee and Child(ren): $292.27
Employee and Family: $570.50