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.
2027 Medical Benefits
Meritain HDHP POS
2027 Benefit Highlights
| In-Network | Out-Of-Network | |
|---|---|---|
| Annual Deductible | $2,000 per individual $3,500 per individual within a family $4,000 per family |
$4,000 per individual $8,000 per family |
| Annual Out-of-Pocket Maximum | $4,000 per individual $8,000 per family |
$8,000 per individual $16,000 per family |
| Coinsurance | You pay 10% | You pay 30% |
| Office Visit | ||
| Primary Provider | 10% after deductible | 30% after deductible |
| Specialist | 10% after deductible | 30% after deductible |
| Preventive Services | No charge | 30% after deductible |
| Lab and X-ray | 10% after deductible | 30% after deductible |
| Complex Imaging | 10% after deductible | 30% after deductible |
| Inpatient Hospitalization | 10% after deductible | 30% after deductible |
| Outpatient Surgery | 10% after deductible | 30% after deductible |
| Emergency Room | 10% after deductible | 30% after deductible |
| Infertility Services | 10% coinsurance for IVF, GIFT, ZIFT, cryopreserved embryo transfers, intracytoplasmic sperm injection (ICSI), or ovum microsurgery up to $15,000 per lifetime | 30% coinsurance for IVF, GIFT, ZIFT, cryopreserved embryo transfers, intracytoplasmic sperm injection (ICSI), or ovum microsurgery up to $15,000 per lifetime |
2027 Per-Pay-Period Plan Cost
2027 per-pay-period contributions
Employee Only: $0.00
Employee and Spouse/DP: $63.15
Employee and Child(ren): $51.81
Employee and Family: $94.99
Meritain POS
2027 Benefit Highlights
| In-Network | Out-Of-Network | |
|---|---|---|
| Annual Deductible | $500 per individual $1,000 per family |
$1,500 per individual $4,500 per family |
| Annual Out-of-Pocket Maximum | $3,000 per individual $4,500 per family |
$10,000 per individual $30,000 per family |
| Coinsurance | You pay 10% | You pay 30% |
| Office Visit | ||
| Primary Provider | $15 per visit | 30% after deductible |
| Specialist | $30 per visit | 30% after deductible |
| Preventive Services | No charge | 30% after deductible |
| Lab and X-ray | No charge | 30% after deductible |
| Complex Imaging | 10% after deductible | 30% after deductible |
| Inpatient Hospitalization | 10% after deductible | 30% after deductible |
| Outpatient Surgery | 10% after deductible | 30% after deductible |
| Emergency Room | $350 per visit (waived if admitted) | $350 per visit (waived if admitted) |
| Infertility Services | 10% coinsurance for IVF, GIFT, ZIFT, cryopreserved embryo transfers, intracytoplasmic sperm injection (ICSI), or ovum microsurgery up to $15,000 per lifetime | 30% coinsurance for IVF, GIFT, ZIFT, cryopreserved embryo transfers, intracytoplasmic sperm injection (ICSI), or ovum microsurgery up to $15,000 per lifetime |
2027 Per-Pay-Period Plan Cost
2027 per-pay-period contributions
Employee Only: $28.07
Employee and Spouse/DP: $128.45
Employee and Child(ren): $105.24
Employee and Family: $185.66
Meritain EPO
2027 Benefit Highlights
| In-Network | |
|---|---|
| Annual Deductible | $500 per individual $1,000 per family |
| Annual Out-of-Pocket Maximum | $5,000 per individual $10,000 per family |
| Coinsurance | You pay 10% |
| Office Visit | |
| Primary Provider | $15 per visit |
| Specialist | $30 per visit |
| Preventive Services | No charge |
| Lab and X-ray | 10% after deductible |
| Complex Imaging | 10% after deductible |
| Inpatient Hospitalization | 10% after deductible |
| Outpatient Surgery | 10% after deductible |
| Emergency Room | $300 per visit + 10% (waived if admitted) |
| Infertility Services | 10% coinsurance for IVF, GIFT, ZIFT, cryopreserved embryo transfers, intracytoplasmic sperm injection (ICSI), or ovum microsurgery up to $15,000 per lifetime |
2027 Per-Pay-Period Plan Cost
2027 per-pay-period contributions
Employee Only: $21.59
Employee and Spouse/DP: $96.07
Employee and Child(ren): $78.80
Employee and Family: $141.94
Kaiser HMO (CA)
2027 Benefit Highlights
| In-Network | |
|---|---|
| Annual Deductible | None |
| Annual Out-of-Pocket Maximum | $1,750 per individual $3,500 per family |
| Office Visit | |
| Primary Provider | $15 per visit |
| Specialist | $25 per visit |
| Preventive Services | No charge |
| Lab and X-ray | $10 per visit |
| Complex Imaging | $75 per procedure |
| Inpatient Hospitalization | $250 per admission |
| Outpatient Surgery | $125 per procedure |
| Emergency Room | $200 per visit |
| Infertility Services | Cost share is determined by place of service. Includes IVF, GIFT & ZIFT. Includes Infertility drugs at applicable pharmacy cost share. |
2027 Per-Pay-Period Plan Cost
2027 per-pay-period contributions
Employee Only: $21.65
Employee and Spouse/DP: $95.46
Employee and Child(ren): $86.58
Employee and Family: $129.87
Kaiser HMO (CO)
2027 Benefit Highlights
| In-Network | |
|---|---|
| Annual Deductible | None |
| Annual Out-of-Pocket Maximum | $1,750 per individual $3,500 per family |
| Office Visit | |
| Primary Provider | $15 per visit |
| Specialist | $25 per visit |
| Preventive Services | No charge |
| Lab and X-ray | $10 per visit |
| Complex Imaging | $75 per procedure |
| Inpatient Hospitalization | $250 per admission |
| Outpatient Surgery | $125 per procedure |
| Emergency Room | $200 per visit |
| Infertility Services | Cost share is determined by place of service. Includes IVF, GIFT & ZIFT. Includes Infertility drugs at applicable pharmacy cost share. |
2027 Per-Pay-Period Plan Cost
2027 per-pay-period contributions
Employee Only: $21.65
Employee and Spouse/DP: $95.46
Employee and Child(ren): $86.58
Employee and Family: $129.87
Kaiser HMO (GA)
2027 Benefit Highlights
| In-Network | |
|---|---|
| Annual Deductible | None |
| Annual Out-of-Pocket Maximum | $1,750 per individual $3,500 per family |
| Office Visit | |
| Primary Provider | $15 per visit |
| Specialist | $25 per visit |
| Preventive Services | No charge |
| Lab and X-ray | $10 per visit |
| Complex Imaging | $75 per procedure |
| Inpatient Hospitalization | $250 per admission |
| Outpatient Surgery | $125 per procedure |
| Emergency Room | $200 per visit |
| Infertility Services | 10% Coinsurance. Includes IVF, GIFT & ZIFT up to $15,000 per lifetime. Includes Infertility drugs up to $15,000 per lifetime. |
2027 Per-Pay-Period Plan Cost
2027 per-pay-period contributions
Employee Only: $21.65
Employee and Spouse/DP: $95.46
Employee and Child(ren): $86.58
Employee and Family: $129.87
Kaiser HMO (Mid-Atlantic)
2027 Benefit Highlights
| In-Network | |
|---|---|
| Annual Deductible | None |
| Annual Out-of-Pocket Maximum | $1,750 per individual |
| Office Visit | $3,500 per family |
| Primary Provider | |
| Specialist | $15 per visit |
| Preventive Services | $25 per visit |
| Lab and X-ray | No charge |
| Complex Imaging | $10 per visit |
| Inpatient Hospitalization | $75 per procedure |
| Outpatient Surgery | $250 copay per admission |
| Emergency Room | $125 per procedure |
| Infertility Services | 10% coinsurance for IVF up to $100,000 per lifetime Includes infertility drugs |
2027 Per-Pay-Period Plan Cost
2027 per-pay-period contributions
Employee Only: $21.65
Employee and Spouse/DP: $95.46
Employee and Child(ren): $86.58
Employee and Family: $129.87
Kaiser HMO (Northwest)
2027 Benefit Highlights
| In-Network | |
|---|---|
| Annual Deductible | None |
| Annual Out-of-Pocket Maximum | $1,750 per individual |
| Office Visit | $3,500 per family |
| Primary Provider | |
| Specialist | $15 per visit |
| Preventive Services | $25 per visit |
| Lab and X-ray | No charge |
| Complex Imaging | $10 per visit |
| Inpatient Hospitalization | $75 per procedure |
| Outpatient Surgery | $250 copay per admission |
| Emergency Room | $125 per procedure |
| Infertility Services | 10% Coinsurance. Includes IVF, GIFT & ZIFT up to $15,000 per lifetime Includes Infertility drugs up to $15,000 per lifetime |
2027 Per-Pay-Period Plan Cost
2027 per-pay-period contributions
Employee Only: $21.65
Employee and Spouse/DP: $95.46
Employee and Child(ren): $86.58
Employee and Family: $129.87
Kaiser HMO (WA)
2027 Benefit Highlights
| In-Network | |
|---|---|
| Annual Deductible | None |
| Annual Out-of-Pocket Maximum | $1,750 per individual |
| Office Visit | $3,500 per family |
| Primary Provider | |
| Specialist | $15 per visit |
| Preventive Services | $25 per visit |
| Lab and X-ray | No charge |
| Complex Imaging | $10 per visit |
| Inpatient Hospitalization | $75 per procedure |
| Outpatient Surgery | $250 copay per admission |
| Emergency Room | $125 per procedure |
| Infertility Services | 10% Coinsurance. Includes IVF, GIFT & ZIFT up to $15,000 per lifetime Includes Infertility drugs up to $15,000 per lifetime |
2027 Per-Pay-Period Plan Cost
2027 per-pay-period contributions
Employee Only: $21.65
Employee and Spouse/DP: $95.46
Employee and Child(ren): $86.58
Employee and Family: $129.87
2026 Medical Benefits
Meritain HDHP POS
Benefit Highlights
In-Network
Deductible (Individual/Individual in a Family/Family)
$2,000/$3,400/$4,000
Out-of-Pocket Max (Individual/Family)
$4,000 /$8,000
Preventive Care
$0
Primary Care Visit
20% after deductible
Specialist Visit
20% after deductible
Emergency Room
20% after deductible
Infertility Services
20% coinsurance for IVF, GIFT, ZIFT, cryopreserved embryo transfers, intracytoplasmic sperm injection (ICSI), or ovum microsurgery up to $15,000 per lifetime
Retail Rx (Up to 31-Day Supply)
Generic
$10 copay after deductible
Preferred Brand
$30 copay after deductible
Non-Preferred Brand
$50 copay after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay after deductible
Preferred Brand
$60 copay after deductible
Non-Preferred Brand
$100 copay after deductible
Out-of-Network
Deductible (Individual/Family)
$4,000 /$8,000
Out-of-Pocket Max (Individual/Family)
$8,000/$16,000
Preventive Care
40% after deductible
Primary Care Visit
40% after deductible
Specialist Visit
40% after deductible
Emergency Room
20% after deductible
Infertility Services
40% coinsurance for IVF, GIFT, ZIFT, cryopreserved embryo transfers, intracytoplasmic sperm injection (ICSI), or ovum microsurgery up to $15,000 per lifetime
Retail Rx (Up to 31-Day Supply)
Generic
40% after deductible
Preferred Brand
40% after deductible
Non-Preferred Brand
40% after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
40% after deductible
Preferred Brand
40% after deductible
Non-Preferred Brand
40% after deductible
Per-Pay-Period Plan Cost
Employee Only: $0.00
Employee and Spouse/DP: $58.50
Employee and Child(ren): $48.00
Employee and Family: $88.00
Meritain POS
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,000
Out-of-Pocket Max (Individual/Family)
$3,000/$4,500
Preventive Care
$0
Primary Care Visit
$25
Specialist Visit
$50
Emergency Room
$350 per visit (waived if admitted)
Infertility Services
10% coinsurance for IVF, GIFT, ZIFT, cryopreserved embryo transfers, intracytoplasmic sperm injection (ICSI), or ovum microsurgery up to $15,000 per lifetime
Retail Rx (Up to 31-Day Supply)
Generic
$15 copay
Preferred Brand
$50 copay
Non-Preferred Brand
$85 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay
Preferred Brand
$100 copay
Non-Preferred Brand
$170 copay
Out-of-Network
Deductible (Individual/Family)
$1,500/$4,500
Out-of-Pocket Max (Individual/Family)
$10,000/$30,000
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Emergency Room
$350 per visit (waived if admitted)
Infertility Services
30% coinsurance for IVF, GIFT, ZIFT, cryopreserved embryo transfers, intracytoplasmic sperm injection (ICSI), or ovum microsurgery up to $15,000 per lifetime
Retail Rx (Up to 31-Day Supply)
Generic
You pay 20%
Preferred Brand
You pay 20%
Non-Preferred Brand
You pay 20%
Mail-Order Rx (Up to 90-Day Supply)
Generic
You pay 20%
Preferred Brand
You pay 20%
Non-Preferred Brand
You pay 20%
Per-Pay-Period Plan Cost
Employee Only: $26.00
Employee and Spouse/DP: $119.00
Employee and Child(ren): $97.50
Employee and Family: $172.00
Meritain EPO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$500/$1,000
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
$0
Primary Care Visit
$25
Specialist Visit
$50
Emergency Room
$300 per visit + 10% (waived if admitted)
Infertility Services
10% coinsurance for IVF, GIFT, ZIFT, cryopreserved embryo transfers, intracytoplasmic sperm injection (ICSI), or ovum microsurgery up to $15,000 per lifetime
Retail Rx (Up to 31-Day Supply)
Generic
$15 copay
Preferred Brand
$50 copay
Non-Preferred Brand
$85 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay
Preferred Brand
$100 copay
Non-Preferred Brand
$170 copay
Per-Pay-Period Plan Cost
Employee Only: $20.00
Employee and Spouse/DP: $89.00
Employee and Child(ren): $73.00
Employee and Family: $131.50
Kaiser HMO (CA)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,750/$3,500
Preventive Care
$0
Primary Care Visit
$15 copay
Specialist Visit
$25 copay
Emergency Room
$200 (waived if admitted)
Infertility Services
Cost share is determined by place of service. Includes IVF, GIFT & ZIFT. Includes Infertility drugs at applicable Pharmacy Cost Shares
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Per-Pay-Period Plan Cost
Employee Only: $19.50
Employee and Spouse/DP: $86.00
Employee and Child(ren): $78.00
Employee and Family: $117.00
Kaiser HMO (CO)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,750/$3,500
Preventive Care
$0
Primary Care Visit
$15 copay
Specialist Visit
$25 copay
Emergency Room
$200 (waived if admitted)
Infertility Services
Cost share is determined by place of service. Includes IVF, GIFT & ZIFT. Includes Infertility drugs at applicable Pharmacy Cost Shares
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Per-Pay-Period Plan Cost
Employee Only: $19.50
Employee and Spouse/DP: $86.00
Employee and Child(ren): $78.00
Employee and Family: $117.00
Kaiser HMO (GA)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,750/$3,500
Preventive Care
$0
Primary Care Visit
$15 copay
Specialist Visit
$25 copay
Emergency Room
$200 (waived if admitted)
Infertility Services
10% Coinsurance. Includes IVF, GIFT & ZIFT up to $15,000 per lifetime. Includes Infertility drugs up to $15,000 per lifetime
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Per-Pay-Period Plan Cost
Employee Only: $19.50
Employee and Spouse/DP: $86.00
Employee and Child(ren): $78.00
Employee and Family: $117.00
Kaiser HMO (Mid-Atlantic)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,750/$3,500
Preventive Care
$0
Primary Care Visit
$15 copay
Specialist Visit
$25 copay
Emergency Room
$200 (waived if admitted)
Infertility Services
10% coinsurance for IVF up to $100,000 per lifetime. Includes infertility drugs
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Per-Pay-Period Plan Cost
Employee Only: $19.50
Employee and Spouse/DP: $86.00
Employee and Child(ren): $78.00
Employee and Family: $117.00
Kaiser HMO (Northwest)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,750/$3,500
Preventive Care
$0
Primary Care Visit
$15 copay
Specialist Visit
$25 copay
Emergency Room
$200 (waived if admitted)
Infertility Services
10% Coinsurance. Includes IVF, GIFT & ZIFT up to $15,000 per lifetime. Includes Infertility drugs up to $15,000 per lifetime
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Per-Pay-Period Plan Cost
Employee Only: $19.50
Employee and Spouse/DP: $86.00
Employee and Child(ren): $78.00
Employee and Family: $117.00
Kaiser HMO (WA)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,750/$3,500
Preventive Care
$0
Primary Care Visit
$15 copay
Specialist Visit
$25 copay
Emergency Room
$200 (waived if admitted)
Infertility Services
10% coinsurance for IVF, GIFT, and ZIFT up to $15,000 per lifetime. Includes infertility drugs at 10% coinsurance up to separate $15,000 per lifetime.
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Per-Pay-Period Plan Cost
Employee Only: $19.50
Employee and Spouse/DP: $86.00
Employee and Child(ren): $78.00
Employee and Family: $117.00