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.
Blue Diamond HDHP with HSA
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$3,400/$6,000
Preventive Care
$0 (deductible does not apply)
Primary Care Visit
10% after deductible
Specialist Visit
10% after deductible
Urgent Care
10% after deductible
Emergency Room
10% after deductible
HSA Contribution
$1,000 individual / $2,000 family
Retail Rx (Up to 30-Day Supply)
Generic
$10 after deductible
Preferred Brand
$25 after deductible
Non-Preferred Brand
$40 after deductible
Specialty
$100 after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$50 copay
Non-Preferred Brand
$80 copay
Specialty
Not covered
Out-of-Network
Deductible (Individual/Family)
$4,000/$8,000
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
Not covered
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
10% after deductible
HSA Contribution
$1,000 individual / $2,000 family
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
Monthly Plan Cost
Employee Only: $55.00
Employee + 1: $254.40
Employee and Family: $385.80
Blue Diamond PPO with HRA
Benefit Highlights
$1,000/$2,000
In-Network
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0 (deductible does not apply)
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
Preferred Brand
$25
Non-Preferred Brand
$40
Specialty
$100
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$50
Non-Preferred Brand
$80
Out-of-Network
Deductible (Individual/Family)
$4,000/$8,000
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
Not covered
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
10% after deductible
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
Monthly Plan Cost
Employee Only: $55.00
Employee + 1: $265.90
Employee and Family: $405.80
Kaiser HMO with HRA
Benefit Highlights
Employer HRA Funding (Individual/Family)
$500/$1,000
The HRA will cover the following services: Inpatient Hospitalization, Outpatient Surgery, Emergency Room, Skilled Nursing Care and Durable Medical Equipment.
In-Network Only
Deductible (Individual/Family)
$4,000/$8,000
Out-of-Pocket Max (Individual/Family)
$7,000/$14,000
Preventive Care
$0
Primary Care Visit
$40 copay (deductible does not apply)
Specialist Visit
$50 copay after deductible
Urgent Care
$40 copay (deductible does not apply)
Emergency Room
30% coinsurance after deductible
Retail Rx (Up to 30-Day Supply) Deductible does not apply
Generic
$15 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$40 copay
Specialty
30% coinsurance, up to $250
Mail-Order Rx (Up to 100-Day Supply) Deductible does not apply
Generic
$30 copay
Preferred Brand
$80 copay
Non-Preferred Brand
$80 copay
Specialty
Not covered
Monthly Plan Cost
Employee Only: $55.00
Employee + 1: $250.60
Employee and Family: $390.90
Sutter Health Plus HMO with HRA
Benefit Highlights
Employer HRA Funding (Individual Family)
$500/$1,000
The HRA will cover the following services: Inpatient Hospitalization, Outpatient Surgery, Emergency Room, Skilled Nursing Care and Durable Medical Equipment.
In-Network Only
Deductible (Individual/Family)
$3,000/$6,000
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$40 copay
Urgent Care
$40 copay (deductible does not apply)
Emergency Room
30% coinsurance after deductible
Retail Rx (Up to 30-Day Supply) Deductible does not apply
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$75 copay
Specialty
30% coinsurance, up to $250
Mail-Order Rx (Up to 90-Day Supply) Deductible does not apply
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$150 copay
Specialty
Not covered
Monthly Plan Cost
Employee Only: $55.00
Employee + 1: $265.10
Employee and Family: $398.90