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 OAMC HDHP (HSA eligible)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,400 / $6,800
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
$0
Primary Care Visit
20% coinsurance
Specialist Visit
20% coinsurance
Urgent Care
20% coinsurance
Emergency Room
20% coinsurance
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
30% up to $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$100 copay
Specialty
Not covered
Out-of-Network
Deductible (Individual/Family)
$5,000/$10,000
Out-of-Pocket Max (Individual/Family)
$8,000/$16,000
Preventive Care
40% coinsurance
Primary Care Visit
40% coinsurance
Specialist Visit
40% coinsurance
Urgent Care
40% coinsurance
Emergency Room
20% coinsurance
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
Employee Only: $0.00
Employee and Spouse: $116.77
Employee and Child(ren): $79.85
Employee and Family: $186.00
Aetna OAMC 500
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,000
Out-of-Pocket Max (Individual/Family)
$2,500/$5,000
Preventive Care
$0
Primary Care Visit
$20 copay*
Specialist Visit
$20 copay*
Urgent Care
$35 copay*
Emergency Room
20% after $200 copay* (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay*
Preferred Brand
$40 copay
Non-Preferred Brand
$60 copay
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay*
Preferred Brand
$80 copay
Non-Preferred Brand
$120 copay
Specialty
N/A
*deductible waived
Out-of-Network
Deductible (Individual/Family)
$1,000/$2,000
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
40% coinsurance
Primary Care Visit
40% coinsurance
Specialist Visit
40% coinsurance
Urgent Care
40% coinsurance
Emergency Room
20% after $200 copay* (copay waived if admitted)
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
Employee Only: $76.15
Employee and Spouse: $288.46
Employee and Child(ren): $223.38
Employee and Family: $396.46
Kaiser HMO (CA Only)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$40 copay
Urgent Care
$20 copay
Emergency Room
$250 (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$15 copay
Preferred Brand
$35 copay
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay
Preferred Brand
$70 copay
Non-Preferred Brand
Not covered
Specialty
Not covered
*deductible waived
Plan Cost
Employee Only: $54.46
Employee and Spouse: $167.08
Employee and Child(ren): $149.54
Employee and Family: $240.00