Plan Feature |
Anthem Basic HDHP |
Anthem Consumer Choice HDHP |
Anthem Exclusive Care EPO |
Kaiser California – Northern and Southern |
Kaiser Northwest |
Kaiser High Deductible HMO California – Northern and Southern |
Kaiser High Deductible HMO – Northwest |
Anthem Traditional Choice (offered where no networks are available) |
|
Medical |
In-Network Out-of-Network |
In-Network Out-of-Network |
In-Network Only |
In-Network Only |
In-Network Only |
In-Network Only |
In-Network Only |
|
|
Annual Deductible
|
Employee - $3,000 Family - $6,000 Employee - $6,000 Family - $12,000 Aggregate |
Employee - $1,650 Family - $3,300 Employee - $3,300 Family - $6,600 Aggregate |
Employee - $500 Family - $1,000
Individual |
Employee - $500 Family - $1,000
Individual |
Employee - $500 Family - $1,500
Individual |
Employee - $1,650 $3,300 each member in a family $3,300 entire family |
Employee - $1,650 Family - $3,300 |
Employee - $500 Family - $1,000
Individual |
|
Out-of-Pocket Maximums | Employee - $6,000 Family - $12,000 Employee - $12,000 Family - $24,000 |
Employee - $4,000 Family - $8,000 Employee - $8,000 Family - $16,000 |
Employee - $2,750 Family - $8,250 |
Employee - $4,000 Family - $8,000 |
Employee - $4,000 Family - $12,000 |
Employee - $3,425 $3,425 each member in a family $6,850 entire family |
Employee - $3,000 Family - $6,000 |
Employee - $2,750 Family - $8,250 |
|
Company Contribution to HSA | $0 |
$500 individual/$1,100 family Not available to employees earning $150,000 or more |
Not Available |
Not Available |
Not Available |
$500 individual/$1,100 family Not available to employees earning $150,000 or more |
$500 individual/$1,100 family Not available to employees earning $150,000 or more |
Not Available |
|
Coverage | In and out-of-network; save money when you stay in-network. |
In and out-of-network; save money when you stay in-network. |
In-network
only |
In-network only |
In-network
only |
In-network only |
In-network
only |
Any provider |
|
Office Visit (copays do not apply toward deductible)
| You pay 20% after deductible You pay 40% of R&C after deductible |
You pay 15% after deductible You pay 40% of R&C after deductible |
PCP - $25 copay
Specialist - $40 copay
|
PCP - $25 copay
Specialist - $40 copay
|
PCP - $25 copay
Specialist - $40 copay
|
You pay 20% after deductible
|
You pay 20% after deductible
|
You pay 20% after deductible |
|
Preventive Care and Wellness
|
You pay nothing You pay 40% of R&C after deductible |
You pay nothing You pay 40% of R&C after deductible |
You pay nothing |
You pay nothing |
You pay nothing |
You pay nothing |
You pay nothing |
You pay nothing |
|
Outpatient Surgery
| You pay 20% after deductible
You pay 40% of R&C after deductible |
You pay 15% after deductible
You pay 40% of R&C after deductible |
You pay 20%
after deductible |
You pay 20% after deductible
|
You pay 20% after deductible
|
You pay 20% after deductible
|
You pay 20% after deductible
|
You pay 20% after deductible |
|
Hospitalization
| You pay 20% after deductible
You pay 40% of R&C after deductible |
You pay 15% after deductible
You pay 40% of R&C after deductible |
You pay 20%
after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
|
Emergency Room |
You pay 20% after deductible
You pay 20% after deductible |
$100 copay then you pay 15% after deductible; must be true emergency. Copay waived if admitted.
$100 copay then you pay 15% after deductible; must be true emergency. Copay waived if admitted. |
You pay 20% after deductible PLUS a $100 copay per visit (copay waived if admitted) |
You pay 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
|
Urgent Care | You pay 20% after deductible
You pay 40% after deductible |
You pay 15% after deductible
You pay 40% after deductible |
$40 copay (deductible waived) |
$25 copay (deductible waived) |
$40 copay (deductible waived) |
You pay 20% after deductible |
You pay 20% after deductible |
You pay 20% after deductible |
|
Prescription Drugs |
|
|
|
|
|
|
|
|
|
Annual Deductible
| Included in medical deductible |
Included in medical deductible |
$400 per
household |
$200 per
calendar year |
Included in medical deductible |
Included in medical deductible |
Included in medical deductible |
$400 per
household |
|
Annual Out-of-Pocket Maximums | Included in medical out-of-pocket maximum |
Included in medical out-of-pocket maximum |
Employee - $5,800 Family - $8,850 (deductible included) |
Included in medical out-of-pocket maximum |
Included in medical out-of-pocket maximum |
Included in medical out-of-pocket maximum |
Included in medical out-of-pocket maximum |
Employee - $5,400 Family - $8,050 (deductible included) |
|
Retail Pharmacy
|
Generic
Formulary
Non-Formulary
30-day supply $10 (after deductible)
You pay 30% ($30 minimum, $90 maximum) (after deductible)
You pay 50% ($75 minimum, $225 maximum) (after deductible |
Generic
Formulary
Non-Formulary
30-day supply $10 (after deductible)
You pay 30% ($30 minimum, $90 maximum) (after deductible)
You pay 50% ($75 minimum, $225 maximum) (after deductible |
Generic
Formulary
Non-Formulary
30-day supply $10
(deductible waived)
You pay 30% ($30 minimum, $90 maximum) (after deductible)
You pay 50% ($75 minimum, $225 maximum) (after deductible) |
Generic
Formulary
Non-Formulary
100-day supply
$15 (deductible waived)
$35 after deductible
$35 after deductible - Covered only if medically necessary at level of Formulary
|
Generic
Formulary
Non-Formulary
30-day supply $15
(deductible waived)
$35 (deductible waived)
$50 (deductible waived) - Covered only if medically necessary at level of Formulary |
Generic
Formulary
Non-Formulary
You pay 20% after deductible
You pay 20% after deductible
20% coinsurance (up to $100 /prescription) - Covered when approved through the formulary exception process
|
Generic
Formulary
Non-Formulary
$10
$30
$45 |
Generic
Formulary
Non-Formulary
30-day supply $10 (deductible waived)
You pay 30% ($30 minimum, $90 maximum)(after deductible)
You pay 50% ($75 minimum, $225 maximum)(after deductible)
|
|
Mail-order Pharmacy
| Generic
Formulary
Non-Formulary
90-day supply $25 (after deductible)
You pay 30% ($75 minimum, $225 maximum) (after deductible)
You pay 50% ($185 minimum, $550 maximum) (after deductible |
Generic
Formulary
Non-Formulary
90-day supply $25 (after deductible)
You pay 30% ($75 minimum, $225 maximum) (after deductible)
You pay 50% ($185 minimum, $550 maximum) (after deductible |
Generic
(deductible waived)
Formulary
Non-Formulary
90-day supply $25
(deductible waived)
You pay 30% ($75 minimum, $225 maximum) (after deductible)
You pay 50% ($185 minimum, $550 maximum) (after deductible |
Generic
Formulary
Non-Formulary
100-day supply
$15 (deductible waived)
$35 after deductible
$35 after deductible - Covered only if medically necessary at level of Formulary
|
Generic
Formulary
Non-Formulary
90-day supply
$30 (deductible
waived)
$70 (deductible waived)
$100 (deductible waived) - Covered only if medically necessary at level of Formulary |
Generic
Formulary
Non-Formulary
You pay 20% after deductible
You pay 20% after deductible
20% coinsurance (up to $100 /prescription) - Covered when approved through the formulary exception process
|
Generic
Formulary
Non-Formulary
$20
$60
$90 - When approved through exception process |
Generic
Formulary
Non-Formulary
90-day supply $25 (deductible waived)
You pay 30% ($75 minimum, $225 maximum)(after deductible)
You pay 50% ($185 minimum, $550 maximum)(after deductible)
|
|
Preventive Medications Covered by Health Care Reform and/or a High Deductible Plan Preventive Medications list
| Covered by ACA or Generic
Formulary
Non-Formulary $0 (deductible
waived)
$10 (deductible waived)
$20
(deductible waived)
|
Covered by ACA or Generic
Formulary
Non-Formulary $0 (deductible
waived)
$10 (deductible waived)
$20
(deductible waived)
|
Covered by ACA
$0 (deductible
waived) |
Covered by ACA
$0 (deductible
waived) |
Covered by ACA
$0 (deductible
waived) |
Covered by ACA
$0 (deductible
waived) |
Covered by ACA
$0 (deductible
waived) |
Covered by ACA
$0 (deductible
waived) |
|