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 HMO (CA Only)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,500/$5,000
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
No charge
Primary Care Visit
$40 copay
Specialist Visit
$50 copay
Urgent Care
$40 copay
Emergency Room
30% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$15 copay
Preferred Brand
$35 copay
Non-Preferred Brand
$35 copay
Specialty
20% up to $250 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay
Preferred Brand
$70 copay
Non-Preferred Brand
$70 copay
Specialty
Not covered
Plan Cost
Under $50K
Employee Only: $121.33
Employee and Spouse/DP: $409.02
Employee and Child(ren): $371.79
Employee and Family: $558.11
$50K to $74.9K
Employee Only: $136.81
Employee and Spouse/DP: $458.64
Employee and Child(ren): $416.89
Employee and Family: $625.77
$75K +
Employee Only: $147.61
Employee and Spouse/DP: $494.71
Employee and Child(ren): $449.68
Employee and Family: $674.97
Aetna Value HMO – Low Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,000/$6,000
Out-of-Pocket Max (Individual/Family)
$6,500/$13,000
Preventive Care
No charge
Primary Care Visit
$50 copay
Specialist Visit
$60 copay
Urgent Care
$75 copay
Emergency Room
$200 copay after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$20 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$60 copay
Specialty
30% up to $250 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$40 copay
Preferred Brand
$80 copay
Non-Preferred Brand
$120 copay
Specialty
Not covered
Plan Cost
Under $50K
Employee Only: $87.30
Employee and Spouse/DP: $324.22
Employee and Child(ren): $291.68
Employee and Family: $487.44
$50K to $74.9K
Employee Only: $108.26
Employee and Spouse/DP: $384.09
Employee and Child(ren): $345.55
Employee and Family: $577.24
$75K +
Employee Only: $115.24
Employee and Spouse/DP: $404.05
Employee and Child(ren): $363.52
Employee and Family: $607.18
Aetna Value HMO – High Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,500/$3,000
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
No charge
Primary Care Visit
$40 copay
Specialist Visit
$60 copay
Urgent Care
$35 copay
Emergency Room
$200 copay
Retail Rx (Up to 30-Day Supply)
Generic
$20 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$60 copay
Specialty
30% up to $250 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$40 copay
Preferred Brand
$80 copay
Non-Preferred Brand
$120 copay
Specialty
Not covered
Plan Cost
Under $50K
Employee Only: $157.30
Employee and Spouse/DP: $478.42
Employee and Child(ren): $430.50
Employee and Family: $718.53
$50K to $74.9K
Employee Only: $176.42
Employee and Spouse/DP: $536.32
Employee and Child(ren): $482.60
Employee and Family: $805.37
$75K +
Employee Only: $182.81
Employee and Spouse/DP: $555.63
Employee and Child(ren): $499.96
Employee and Family: $834.31
Aetna HMO (NV Only)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,500/$3,000
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
No charge
Primary Care Visit
$40 copay
Specialist Visit
$60 copay
Urgent Care
$50 copay
Emergency Room
$150 copay after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
30% up to $250 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$100 copay
Specialty
Not covered
Plan Cost
Under $50K
Employee Only: $116.25
Employee and Spouse/DP: $519.99
Employee and Child(ren): $467.92
Employee and Family: $780.87
$50K to $74.9K
Employee Only: $183.26
Employee and Spouse/DP: $582.87
Employee and Child(ren): $524.51
Employee and Family: $875.19
$75K +
Employee Only: $198.74
Employee and Spouse/DP: $603.84
Employee and Child(ren): $543.38
Employee and Family: $906.64
Aetna Managed Choice POS (All States)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,500/$3,000
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
No charge
Primary Care Visit
$25 copay
Specialist Visit
$50 copay
Urgent Care
$50 copay
Emergency Room
$300 copay + 20%
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$30
Non-Preferred Brand
$50
Specialty
30% up to $250 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$60
Non-Preferred Brand
$100
Specialty
Not Covered
Out-of-Network
Deductible (Individual/Family)
$4,000/$8,000
Out-of-Pocket Max (Individual/Family)
$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
$300 copay + 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
Under $50K
Employee Only: $428.99
Employee and Spouse/DP: $990.59
Employee and Child(ren): $891.44
Employee and Family: $1,486.81
$50K to $74.9K
Employee Only: $480.73
Employee and Spouse/DP: $1,109.96
Employee and Child(ren): $998.88
Employee and Family: $1,665.89
$75K +
Employee Only: $497.97
Employee and Spouse/DP: $1,149.77
Employee and Child(ren): $1,034.70
Employee and Family: $1,725.58