Medical
Medical coverage provides healthcare protection for you and your family. When utilizing an HMO you can visit only in-network doctors. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100%. The main differences between plan options are the deductible and plan cost sharing, and how much you pay per paycheck.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-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
Benefit Highlights
In-Network
Deductible (Individual/Family)
None
Out-of-Pocket Max (Individual/Family)
$2,500 / $5,000
Preventive Care
No charge
Primary Care Visit
$20 per visit
Specialist Visit
$20 per visit
Urgent Care
$20 per visit
Emergency Room
$200 per visit (waived if admitted; inpatient cost share applies)
Retail Rx (Up to 30-Day Supply)
Generic (Tier 1)
$15
Preferred Brand (Tier 2)
$35
Specialty
30% coinsurance (max $250 per fill)
Mail-Order Rx (Up to 90–100-Day Supply)
Generic (Tier 1)
$30
Preferred Brand (Tier 2)
$70
Specialty (Tier 4)
30% coinsurance (max $250 per fill)
Plan Cost (Semi-Monthly)
Full-Time
Employee Only: $95.00
Employee + One: $255.00
Employee and Family: $405.00
Part-Time
Employee Only: $130.00
Employee + One: $395.00
Employee and Family: $585.00
Kaiser HDHP with HSA
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,500 / $5,000
Out-of-Pocket Max (Individual/Family)
$4,600 / $9,200
Preventive Care
No charge
Primary Care Visit
$30 after deductible
Specialist Visit
$50 after deductible
Urgent Care
$30 after deductible
Emergency Room
$200 per visit (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic (Tier 1)
$10 after deductible
Preferred Brand (Tier 2)
$30 after deductible
Specialty (Tier 4)
$20% coinsurance (max $250)
Mail-Order Rx (Up to 90–100-Day Supply)
Generic (Tier 1)
$20 after deductible
Preferred Brand (Tier 2)
$60 after deductible
Plan Cost (Semi-Monthly)
Full-Time
Employee Only: $0.00
Employee + One: $90.00
Employee and Family: $195.00
Part-Time
Employee Only: $90.00
Employee + One: $235.00
Employee and Family: $385.00
Sutter Health Plus HMO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0 / $0
Out-of-Pocket Max (Individual/Family)
$2,500 / $5,000
Preventive Care
No charge
Primary Care Visit
$30 per visit
Specialist Visit
$60 per visit
Urgent Care
$15 per visit
Emergency Room
$200 per visit (facility); professional services no charge
Retail Rx (Up to 30-Day Supply)
Generic (Tier 1)
$10
Preferred Brand (Tier 2)
$30
Non-Preferred Brand (Tier 3)
$75
Specialty (Tier 4)
20% coinsurance, up to $250 per prescription
Mail-Order Rx (Up to 90–100-Day Supply)
Generic (Tier 1)
$20
Preferred Brand (Tier 2)
$60
Non-Preferred Brand (Tier 3)
$150
Specialty (Tier 4)
Not covered
Plan Cost (Semi-Monthly)
Full-Time
Employee Only: $100.00
Employee + One: $270.00
Employee and Family: $440.00
Part-Time
Employee Only: $140.00
Employee + One: $425.00
Employee and Family: $630.00
Sutter Health Plus HDHP with HSA
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,500 / $5,000
Out-of-Pocket Max (Individual/Family)
$4,000 / $8,000
Preventive Care
No charge
Primary Care Visit
$40 after deductible
Specialist Visit
$80 after deductible
Urgent Care
$80 after deductible
Emergency Room
$200 per visit (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic (Tier 1)
$10 after deductible
Preferred Brand (Tier 2)
$30 after deductible
Non-Preferred Brand (Tier 3)
$75 after deductible
Mail-Order Rx (Up to 90–100-Day Supply)
Generic (Tier 1)
$20 after deductible
Preferred Brand (Tier 2)
$60 after deductible
Non-Preferred Brand (Tier 3)
$150 after deductible
Plan Cost (Semi-Monthly)
Full-Time
Employee Only: $0.00
Employee + One: $95.00
Employee and Family: $210.00
Part-Time
Employee Only: $95.00
Employee + One: $255.00
Employee and Family: $415.00