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.
Plan Documents
Plan Contacts

Kaiser HMO (CA)

Benefit Highlights
In-Network

Deductible (Individual/Family)
$250/$500 

Out-of-Pocket Max (Individual/Family)
$7,800/$15,600 

Preventive Care
$0 

Primary Care Visit
$35 copay 

Specialist Visit
$55 copay 

Urgent Care
$35 copay 

Emergency Room
$250 copay (waived if admitted) 

Retail Rx (Up to 30-Day Supply)

$15 copay 

Preferred Brand
$40 copay 

Non-Preferred Brand
$40 copay (with prior authorization) 

Specialty
20% up to a $250 maximum 

Mail-Order Rx (Up to 100-Day Supply)

Generic
$30 copay 

Preferred Brand
$80 copay 

Non-Preferred Brand
$80 copay  (with prior authorization) 

Specialty
Not covered

Monthly Plan Cost

Employee Only:  15% Employee of age banded rate

Employee and Spouse/DP:  15% Employee of age banded rate / 65% Dependents of age banded rate

Employee and Child(ren):  15% Employee of age banded rate / 65% Dependents of age banded rate

Employee and Family:  15% Employee of age banded rate / 65% Dependents of age banded rate

Kaiser HDHP – HSA Compatible (CA)

Benefit Highlights
In-Network Only

Deductible (Individual/Individual in a Family/Family)
$1,900/$3,400/$3,800

Out-of-Pocket Max (Individual/Family)
$4,500 / $9,000

Preventive Care
$0 

Primary Care Visit
15% after deductible 

Specialist Visit
15% after deductible 

Urgent Care
15% after deductible 

Emergency Room
15% after deductible (waived if admitted) 

Retail Rx (Up to 30-Day Supply) 

Generic
$15 copay after deductible 

Preferred Brand
$45 copay after deductible 

Non-Preferred Brand
$45 copay after deductible (with prior authorization) 

Specialty
15% up to a $250 maximum 

Mail-Order Rx (Up to 100-Day Supply) 

Generic
$30 copay 

Preferred Brand
$90 copay 

Non-Preferred Brand
$90 copay (with prior authorization) 

Specialty
Not covered 

Monthly Plan Cost

Employee Only:  5% Employee of age banded rate

Employee and Spouse/DP:  5% Employee of age banded rate / 55% Dependents of age banded rate 

Employee and Child(ren):  5% Employee of age banded rate / 55% Dependents of age banded rate  

Employee and Family:  5% Employee of age banded rate / 55% Dependents of age banded rate 

Kaiser DHMO (CO)

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
$30 copay

Urgent Care
$30 copay

Emergency Room
$250 copay

Retail Rx (Up to 30-Day Supply) 

Generic
$10 copay

Preferred Brand
$30 copay 

Non-Preferred Brand
$60 copay  

Specialty
20% up to a $250 maximum 

Mail-Order Rx (Up to 100-Day Supply) 

Generic
$20 copay 

Preferred Brand
$60 copay 

Non-Preferred Brand
$120 copay 

Specialty
Not covered

Monthly Plan Cost

Employee Only:  10% Employee of age banded rate 

Employee and Spouse/DP:  10% Employee of age banded rate / 60% Dependents of age banded rate 

Employee and Child(ren):  10% Employee of age banded rate / 60% Dependents of age banded rate 

Employee and Family:  10% Employee of age banded rate / 60% Dependents of age banded rate

Kaiser HDHP (CO)

Benefit Highlights
In-Network

Deductible (Individual/Family)
$1,700/$3,400

Out-of-Pocket Max (Individual/Family)
$4,000/$8,000 

Preventive Care
$0 

Primary Care Visit
20% after deductible 

Specialist Visit
2o% after deductible 

Urgent Care
20% after deductible 

Emergency Room
20% after deductible 

Retail Rx (Up to 30-Day Supply) 

Generic
$10 copay after deductible 

Preferred Brand
$30 copay after deductible 

Non-Preferred Brand
$60 copay after deductible 

Specialty
20% after deductible up to a $250 maximum 

Mail-Order Rx (Up to 100-Day Supply) 

Generic
$20 copay after deductible

Preferred Brand
$60 copay after deductible 

Non-Preferred Brand
$120 copay after deductible

Specialty
Not covered

Monthly Plan Cost

Employee Only:  0%

Employee and Spouse/DP:  0% of Employee age banded rate / 50% of Dependents age banded rate

Employee and Child(ren):  0% of Employee age banded rate / 50% of Dependents age banded rate

Employee and Family:  0% of Employee age banded rate / 50% of Dependents age banded rate

Kaiser HMO (HI)

Benefit Highlights
In-Network

Deductible (Individual/Family)
$0/$0 

Out-of-Pocket Max (Individual/Family)
$2,500/$7,500 

Preventive Care
$0 

Primary Care Visit
$15 copay 

Specialist Visit
$15 copay

Urgent Care
$15 copay

Emergency Room
20% coinsurance

Retail Rx (Up to 30-Day Supply) 

Generic
$10 copay  

Preferred Brand
$45 copay  

Non-Preferred Brand
$45 copay 

Specialty
$200 copay 

Mail-Order Rx (Up to 100-Day Supply) 

Generic
$20 copay

Preferred Brand
$90 copay 

Non-Preferred Brand
$90 copay  

Specialty
Not covered

Monthly Plan Cost

Employee Only:  0% Employee of age banded rate 

Employee and Spouse/DP:  0% Employee of age banded rate / 30% Dependents of age banded rate 

Employee and Child(ren):  0% Employee of age banded rate / 30% Dependents of age banded rate 

Employee and Family:  0% Employee of age banded rate / 30% Dependents of age banded rate

Kaiser HMO (NW)

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
$5 for first 3 visits; then $20 for additional visits in the same year

Specialist Visit
$30 copay

Urgent Care
$30 copay

Emergency Room
$250 copay

Retail Rx (Up to 30-Day Supply) 

Generic
$10 copay 

Preferred Brand
$30 copay 

Non-Preferred Brand
$60 copay

Specialty
20% up to a $250 maximum 

Mail-Order Rx (Up to 100-Day Supply) 

Generic
$20 copay 

Preferred Brand
$60 copay 

Non-Preferred Brand
$120 copay (with prior authorization) 

Specialty
Not covered

Monthly Plan Cost

Employee Only:  10% Employee of age banded rate 

Employee and Spouse/DP:  10% Employee of age banded rate / 60% Dependents of age banded rate 

Employee and Child(ren):  10% Employee of age banded rate / 60% Dependents of age banded rate 

Employee and Family:  10% Employee of age banded rate / 60% Dependents of age banded rate

Kaiser HDHP (NW)

Benefit Highlights
In-Network Only

Deductible (Individual/Family)
$1,700/$3,400

Out-of-Pocket Max (Individual/Family)
$4,000/$8,000 

Preventive Care
$0 

Primary Care Visit
20% after deductible 

Specialist Visit
2o% after deductible 

Urgent Care
20% after deductible 

Emergency Room
20% after deductible 

Retail Rx (Up to 30-Day Supply) 

Generic
$10 copay after deductible 

Preferred Brand
$30 copay after deductible 

Non-Preferred Brand
$60 copay after deductible 

Specialty
20% after deductible up to a $250 maximum 

Mail-Order Rx (Up to 100-Day Supply) 

Generic
$20 copay after deductible

Preferred Brand
$60 copay after deductible 

Non-Preferred Brand
$120 copay after deductible

Specialty
Not covered

Monthly Plan Cost

Employee Only:  0%

Employee and Spouse/DP:  0% of Employee age banded rate / 50% of Dependents age banded rate

Employee and Child(ren):  0% of Employee age banded rate / 50% of Dependents age banded rate

Employee and Family:  0% of Employee age banded rate / 50% of Dependents age banded rate

Kaiser HMO (WA)

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
$30 copay

Urgent Care
$20 copay 

Emergency Room
$250 copay

Retail Rx (Up to 30-Day Supply) 

Generic
$10 copay  

Preferred Brand
$30 copay  

Non-Preferred Brand
$60 copay 

Specialty
20% up to a $250 maximum 

Mail-Order Rx (Up to 100-Day Supply) 

Generic
$20 copay 

Preferred Brand
$60 copay 

Non-Preferred Brand
$120 copay 

Specialty
Not covered

Monthly Plan Cost

Employee Only:  10% Employee of age banded rate 

Employee and Spouse/DP:  10% Employee of age banded rate / 60% Dependents of age banded rate 

Employee and Child(ren):  10% Employee of age banded rate / 60% Dependents of age banded rate 

Employee and Family:  10% Employee of age banded rate / 60% Dependents of age banded rate

Kaiser HDHP (WA)

Benefit Highlights
In-Network Only

Deductible (Individual/Family)
$1,700/$3,400

Out-of-Pocket Max (Individual/Family)
$4,000/$8,000 

Preventive Care
$0 

Primary Care Visit
20% after deductible 

Specialist Visit
20% after deductible 

Urgent Care
20% after deductible 

Emergency Room
20% after deductible 

Retail Rx (Up to 30-Day Supply) 

Generic
$10 copay after deductible 

Preferred Brand
$30 copay after deductible 

Non-Preferred Brand
$60 copay after deductible (with prior authorization) 

Specialty
20% up to a $250 maximum 

Mail-Order Rx (Up to 100-Day Supply) 

Generic
$20 copay after deductible

Preferred Brand
$60 copay after deductible

Non-Preferred Brand
$120 copay after deductible 

Specialty
Not covered 

Monthly Plan Cost

Employee Only:  0%

Employee and Spouse/DP:  0% of Employee age banded rate / 50% of Dependents age banded rate

Employee and Child(ren):  0% of Employee age banded rate / 50% of Dependents age banded rate

Employee and Family:  0% of Employee age banded rate / 50% of Dependents age banded rate

Cigna PPO

Benefit Highlights
In-Network

Deductible (Individual/Family)
$750/$1,500

Out-of-Pocket Max (Individual/Family)
$7,800/$15,600 

Preventive Care
$0 

Primary Care Visit
$35 copay 

Specialist Visit
$35 copay 

Urgent Care
$35 copay 

Emergency Room
$200 copay/visit + 20% coinsurance (copay is waived if admitted)

Retail Rx (Up to 30-Day Supply) 

Generic
$20 copay after

Preferred Brand
$40 copay 

Non-Preferred Brand
$60 copay

Specialty
30% coinsurance up to a $150 maximum 

Mail-Order Rx (Up to 90-Day Supply) 

Generic
$40 copay

Preferred Brand
$80 copay

Non-Preferred Brand
$120 copay 

Specialty
30% coinsurance up to a $450 maximum

Out-of-Network

Deductible (Individual/Family)
$3,000/$9,000

Out-of-Pocket Max (Individual/Family)
$15,600/$31,200 

Preventive Care
50% coinsurance

Primary Care Visit
50% coinsurance 

Specialist Visit
50% coinsurance

Urgent Care
50% coinsurance

Emergency Room
$200 copay/visit + 20% coinsurance (copay is 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 

Monthly Plan Cost

Employee Only:  10% Employee of age banded rate

Employee and Spouse/DP:  10% Employee of age banded rate / 55% Dependent of age banded rate 

Employee and Child(ren):  10% Employee of age banded rate / 55% Dependent of age banded rate 

Employee and Family:  10% Employee of age banded rate / 55% Dependent of age banded rate

Cigna HDHP

Benefit Highlights
In-Network Only

Deductible (Individual/Family)
$1,700/$3,400

Out-of-Pocket Max (Individual/Family)
$4,000/$8,000 

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
$60 copay

Specialty
20% coinsurance up to a $250 maximum 

Mail-Order Rx (Up to 90-Day Supply) 

Generic
$20 copay

Preferred Brand
$60 copay

Non-Preferred Brand
$120 copay 

Specialty
20% coinsurance up to a $750 maximum 

Monthly Plan Cost

Employee Only:  0% Employee of age banded rate

Employee and Spouse/DP:  0% Employee of age banded rate / 50% Dependent of age banded rate 

Employee and Child(ren):  0% Employee of age banded rate / 50% Dependent of age banded rate 

Employee and Family:  0% Employee of age banded rate / 50% Dependent of age banded rate

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