Medical Plan Summaries

Description

Anthem

HMO

Kaiser Permanente HMO

Anthem PPO

Anthem

HRA

Kaiser HMO

HRA

In Network

In PPO Network

In Network

Lifetime Maximum

Unlimited

Unlimited

Unlimited

Unlimited

Unlimited

Annual Deductible

None

None

$500/Member

$1,500/Family

$3,000/Member $6,000/Family

$2,500/Member

$5,000/Family

Annual Out-of-Pocket Maximum

$2,500/Member $5,000/Family

$1,500/Member

$3,000/Family

$4,000/Member

$8,000/Family

$4,000/Member

$8,000/Family

$5,000/Member

$10,000/Family

Professional

·         Physician Visit

$30 Copay

$20 Copay

$35 Copay; Ded Waived

No Copay

$20 Copay after Ded

·         Specialist

$40 Copay

$20 Copay

$35 Copay; Ded Waived

No Copay

$20 Copay after Ded

·         Physical Therapy

$30 Copay; 60 days

$20 Copay

20%/24 Visits

No Copay/24 Visits

$20 Copay after Ded

·         Home Health Care

$30 Copay

100 visits per year

No Copay,

100 visits per year

20%

100 visits per year

No Copay

100 visits per year

No Copay,

100 visits/year; Ded waived

Hospital Services

·         Inpatient

$500/Admit

No Copay

20%

No Copay

20% Coinsurance after Ded

·         Outpatient

$250/Admit

$20/Procedure

20%

No Copay

20% Coinsurance after Ded

·         Emergency Room

$150 Copay,

waived if admitted

$100 Copay,

waived if admitted

$150 Deductible, waived if admitted / 20% coinsurance

No Copay

20% Coinsurance after Ded

Lab & X-Ray

No Copay

$10 Copay

20%

No Copay

$10 Copay after Ded

Durable Medical Equip

50% Coinsurance

20% Coinsurance

50% Coinsurance

50% Coinsurance

20% Coins.; Ded Waived

Preventive Care

·         Adult

No Copay

No Copay

No Copay; Ded Waived

No Copay; Ded Waived

No Copay; Ded Waived

·         Children

No Copay

No Copay

No Copay; Ded Waived

No Copay; Ded Waived

No Copay; Ded Waived

Maternity

·         Office Visits

$30 Copay

No Copay

$35 Copay; Ded Waived

No Copay

No Copay; Ded Waived

Mental Health / Substance Abuse

·         Inpatient

$500/admit Facility; No Copay/Hosp Visit

No Copay

20%

No Copay

$20% Coinsurance after Ded

·         Outpatient

$30 Copay/Visit;

No Copay Facility

$20/Visit

$35 Copay/Visit – Ded Waived; 20% Facility

No Copay

$20 Copay/Visit after Ded

Chiropractic Benefit

$30/visit; 60 day period

$15 Copay/30 visits

20%/24 visits

No Copay/24 visits

None

Vision Benefit

Covered thru VSP Plan

Covered thru VSP Plan

Covered thru VSP Plan

Prescription Drug

·         Generic

$15 Copay

$15 Copay

$15 Copay

$10 Copay after Ded

$10 Copay; Ded Waived

·         Brand

$30 Copay

$35 Copay

$30 Copay

$30 Copay after Ded

$30 Copay; Ded Waived

·         Brand Non-Formulary

$50 Copay

Must be Formulary

$50 Copay

$50 Copay after Ded

Must be Formulary

·         Brand Name Deduct.

$250 Deductible

None

None

None

None

Notes

See Plan for more details

Kaiser NW has lower Co-pays; see Plan

Out-Of-Network is generally 40% Copay; see Plan

Out-Of-Network is generally 30% Copay; see Plan

See Plan for more details