Which plan is right for you?
That depends on your healthcare needs, favorite doctors, and budget. Here are some considerations.
- Kaiser High ($2,500 deductible)
- Kaiser Mid ($4,500 deductible)
- Kaiser Low ($5,500 deductible)
- UHC PPO: High ($2,450 deductible)
- UHC Mid ($2,800 deductible)
- UHC Low ($6,000 deductible)
Kaiser High | Kaiser Mid | Kaiser Low |
|
|---|---|---|---|
| In-Network Only | |||
| Annual Deductible Individual / Family | $2,500 / $5,000 | $4,500 / $9,000 | $5,500 / $11,000 |
| Annual Out-of-Pocket Max Individual / Family | $5,000 / $10,000 | $6,250 / $12,500 | $7,000 / $14,000 |
| Member Co-Insurance | 20% | 40% | 40% |
| Physician Services | |||
| Primary Care | $20 after deductible | $40 after deductible | $50 after deductible |
| Specialist Visits | $20 after deductible | $50 after deductible | $50 after deductible |
| Preventative Care | $0* | $0* | $0* |
| Hospital Services | |||
| Inpatient Hospitalization | 20% after deductible | 40% after deductible | 40% after deductible |
| Outpatient Surgery | 20% after deductible | 40% after deductible | 40% after deductible |
| Diagnostic X-Ray & Lab | |||
| X-Ray/Lab | $10 after deductible | 40% after deductible | 40% after deductible |
| Urgent and Emergency Care Visits | |||
| Emergency Room (copay waived, if admitted) | 20% after deductible | $250 after deductible | 40% after deductible |
| Urgent Care | $20 after deductible | $40 after deductible | $50 after deductible |
| Prescriptions | |||
| Deductible | None | Combined with Medical Deductible | |
| Generic | $10 copay | $15 after deductible | $15 after deductible |
| Preferred Brand | $30 copay | $35 after deductible | 40% after deductible |
| Non-Preferred Brand | 20% co-insurance Up to $250 max | 30% after deductible Up to $250 max | 40% after deductible Up to $250 max |
UHC High | UHC Mid | UHC Low |
|
|---|---|---|---|
| Showing In-Network Only* | |||
| Annual Deductible Individual / Family | $2,450 / $4,900 | $2,800 / $3,200 | $6,000 / $12,000 |
| Annual Out-of-Pocket Max Individual / Family | $9,450 / $18,900 | $8,000 / $16,000 | $9,450 / $18,900 |
| Member Co-Insurance | 30% | 40% | 40% |
| Physician Services | |||
| Primary Care | $55 Copay | 40% after deductible | 40% after deductible |
| Specialist Visits | $95 Copay | 40% after deductible | 40% after deductible |
| Preventative Care | $0 | $0 | $0 |
| Hospital Services | |||
| Inpatient Hospitalization | $250 + 40% after deductible | 40% after deductible | 40% after deductible |
| Outpatient Surgery | 40% after deductible | 40% after deductible | 40% after deductible |
| Diagnostic X-Ray & Lab | |||
| X-Ray/Lab | 40% after deductible | 40% after deductible | 40% after deductible |
| Urgent and Emergency Care Visits | |||
| Emergency Room (copay waived, if admitted) | 40% after deductible | 40% after deductible | 40% after deductible |
| Urgent Care | $80 Copay | 40% after deductible | 40% after deductible |
| Prescriptions | |||
| Rx Deductible Individual / Family | $300 / $700 | Combined with the medical ded. | $500 / $1,000 |
| Generic | $20 copay | $20 after deductible | $20 Copay |
| Preferred Brand | $85 after Rx ded. | $85 after deductible | $85 after Rx ded. |
| Non-Preferred Brand | $135 after Rx ded. | $135 after deductible | $135 after Rx ded. |
** Please refer to the carrier summary for full details
Do you prefer specific doctors or hospitals?
If you want to stay with your favorite doctors and facilities, check whether they are in the plan’s network. If they are not, but you are comfortable paying a bit more to see them, consider a plan with both in-network and out-of- network benefits.
What are your usual healthcare needs?
Do you have frequent doctor or urgent care visits? Do you have a condition that requires a specialist? Do you take prescription medications? Compare how each plan covers the services you need most often.
Consider the bottom line
How much is the monthly payroll deduction? Do you have to meet a deductible? What is the out-of-pocket maximum? How much of the cost is covered by the plan? How much are any copayments for office visits, prescriptions, etc. All of these factors together affect your total cost for healthcare.
Understanding Your Options:
HMO stands for Health Maintenance Organization. Kaiser’s integrated care delivery system offers care and coverage together in one package, under one roof. The HMO requires you to choose a Kaiser Primary Care Physician (PCP) to direct your care including referrals to in-network specialists, when necessary.
You will pay a copayment (copay) or coinsurance for most services. There is no out-of-network care. If you are traveling outside the Kaiser California network, they offer extended emergency room care through the Cigna Network. Telehealth visits are available to ensure you and your covered dependents have many convenient ways to access care.
PPO stands for Preferred Provider Organization. A PPO plan allows you to seek care in and outside of the United HealthCare provider network. You do not need a referral and are not required to select a Primary Care Provider (PCP). You or your covered dependents will pay less out of your pocket by obtaining care in the UHC provider network.
The HRA is a health reimbursement account set up and solely funded by your employer to help you pay for your out-of-pocket costs qualified medical expenses. All medical plans are HRA eligible. If you enroll in medical, you will automatically be enrolled in an HRA plan. See HRA page for employer contributions.