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.
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