Medical Plans & Pharmacy
Benefits Overview
We are pleased to announce that we will continue offering a comprehensive Benefits Program for the 2024-2025 plan year. We will continue with our existing carriers and plans in addition to adding an HMO plan with Kaiser Permanente! The following benefit plans are available to you (and your eligible dependents):
Select Your Medical Plan to Learn More:
Traditional HMO
| Traditional HMO | |
|---|---|
| In-Network | |
| Annual Deductible | None |
| Individual/Family | |
| Annual Out-of-Pocket | $3,000/Individual |
| Individual/Family | $6,000/Family |
| Physician Services | |
| Primary Care | $20 Copay |
| Specialist Visits | $40 Copay |
| Preventive Care | No Copay |
| Hospital Services | |
| Inpatient Hospitalization | $250 Copay ($750 copay max per admission) |
| Outpatient Surgery | $125 Copay |
| Diagnostic X-Ray & Lab | |
| X-Ray/Lab | $10 Copay |
| Infertility Services | |
| Diagnosis and treatment of infertility and artificial insemination (such as outpatient procedures or laboratory tests) | 50% |
| Urgent and Emergency Care Visits | |
| Emergency Room (copay waived if admitted) | $100 Copay |
| Urgent Care | $20 Copay |
| Prescriptions (30-day supply) | |
| Deductible | None |
| Generic | $10 Copay |
| Brand-name | $30 Copay |
Full PPO Combined Deductible Value 15-1500 80/50
| Full PPO Combined Deductible Value 15-1500 80/50 | ||
|---|---|---|
| In-Network | Out-of-Network | |
| Annual Deductible | $1,500/Individual | $1,500/Individual |
| Individual/Family | $3,000/Family | $3,000/Family |
| Annual Out-of-Pocket | $5,000/Individual | $7,500/Individual |
| Individual/Family | $10,000/Family | $15,000/Family |
| Physician Services | ||
| Primary Care | $15 Copay* | 50% after Deductible |
| Specialist Visits | $20 Copay* | 50% after Deductible |
| Preventive Care | No Copay* | Not Covered |
| Chiropractic Care (20 visits max per year) | $15 Copay* | 50% after Deductible |
| Acupuncture Services (20 visits max per year) | $15 Copay* | 50% after Deductible |
| Hospital Services | ||
| Inpatient Hospitalization | 20% after Deductible | 50% after Deductible (up to $600/day max benefit) |
| Outpatient Surgery | 25% after Deductible | 50% after Deductible (up to $350/day max benefit) |
| Diagnostic X-Ray & Lab | ||
| X-Ray/Lab | $15 Copay after Deductible | 50% after Deductible |
| Infertility Services | ||
| Services are not subject to the deductible and do not count towards the Calendar Year Out-of-Pocket Maximum For covered procedures and limitations please refer to the carriers benefit summary | 50% of the allowable amount | Not Covered |
| Urgent and Emergency Care Visits | ||
| Emergency Room (copay waived if admitted) | $150 Copay + 20%* | $150 Copay + 20%* |
| Urgent Care | $15 Copay* | 50% after Deductible |
| Prescriptions (30-day supply) | ||
| Deductible | $250/Individual | $250/Individual |
| Tier 1 | $20 Copay* | 25% + $20 Copay* |
| Tier 2 | $40 Copay | 25% + $40 Copay |
| Tier 3 | $60 Copay | 25% + $60 Copay |
Full PPO Split Deductible 20-500 80/60
| Full PPO Split Deductible 20-500 80/60 | ||
|---|---|---|
| In-Network | Out-of-Network | |
| Annual Deductible | $500/Individual | $1,500/Individual |
| Individual/Family | $1,500/Family | $4,500/Family |
| Annual Out-of-Pocket | $3,000/Individual | $5,000/Individual |
| Individual/Family | $6,000/Family | $10,000/Family |
| Physician Services | ||
| Primary Care | $20 Copay* | 40% after Deductible |
| Specialist Visits | $25 Copay* | 40% after Deductible |
| Preventive Care | No Copay* | Not Covered |
| Chiropractic Care (20 visits max per year) | $20 Copay* | 40% after Deductible |
| Acupuncture Services (20 visits max per year) | $20 Copay* | 40% after Deductible |
| Hospital Services | ||
| Inpatient Hospitalization | 20% after Deductible | 40% after Deductible (up to $600/day max benefit) |
| Outpatient Surgery | 25% after Deductible | 40% after Deductible (up to $350/day max benefit) |
| Diagnostic X-Ray & Lab | ||
| X-Ray/Lab | $20 Copay after Deductible | 40% after Deductible |
| Infertility Services | ||
| Services are not subject to the deductible and do not count towards the Calendar Year Out-of-Pocket Maximum or covered procedures and limitations please refer to the carriers benefit summary | 50% of the allowable amount | Not Covered |
| Urgent and Emergency Care Visits | ||
| Emergency Room (copay waived if admitted) | $150 Copay + 20%* | $150 Copay + 20%* |
| Urgent Care | $20 Copay* | 40% after Deductible |
| Prescriptions (30-day supply) | ||
| Deductible | $250/Individual | $250/Individual |
| Tier 1 | $20 Copay* | 25% + $20 Copay* |
| Tier 2 | $40 Copay | 25% + $40 Copay |
| Tier 3 | $60 Copay | 25% + $60 Copay |
Full PPO Combined Deductible 15-250 90/70
| Full PPO Combined Deductible 15-250 90/70 |
||
|---|---|---|
| In-Network | Out-of-Network | |
| Annual Deductible | $250/Individual | $250/Individual |
| Individual/Family | $750/Family | $750/Family |
| Annual Out-of-Pocket | $2,750/Individual | $10,250/Individual |
| Individual/Family | $5,500/Family | $20,500/Family |
| Physician Services | ||
| Primary Care | $15 Copay* | 30% after Deductible |
| Specialist Visits | $20 Copay* | 30% after Deductible |
| Preventive Care | No Copay* | Not Covered |
| Chiropractic Care (20 visits max per year) | $15 Copay* | 30% after Deductible |
| Acupuncture Services (20 visits max per year) | $15 Copay* | 30% after Deductible |
| Hospital Services | ||
| Inpatient Hospitalization | 10% after Deductible | 30% after Deductible (up to $600/day max benefit) |
| Outpatient Surgery | 15% after Deductible | 30% after Deductible (up to $350/day max benefit) |
| Diagnostic X-Ray & Lab | ||
| X-Ray/Lab | $15 Copay after Deductible | 30% after Deductible |
| Infertility Services | ||
| Services are not subject to the deductible and do not count towards the Calendar Year Out-of-Pocket Maximum or covered procedures and limitations please refer to the carriers benefit summary | 50% of the allowable amount | Not Covered |
| Urgent and Emergency Care Visits | ||
| Emergency Room (copay waived if admitted) | $150 Copay + 10%* | |
| Urgent Care | $15 Copay* | 30% after Deductible |
| Prescriptions (30-day supply) | ||
| Deductible | None | None |
| Tier 1 | $10 Copay | 25% + $10 Copay |
| Tier 2 | $30 Copay | 25% + $30 Copay |
| Tier 3 | $50 Copay | 25% + $50 Copay |
Explore all Benefits