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.
Plan Documents
Plan Contacts

Kaiser HMO (CA)

w/ Dental & Vision

Benefit Highlights
In-Network

Deductible (Individual/Family)
None

Out-of-Pocket Max (Individual/Family)
$1,500/$3,000

Preventive Care
No charge

Primary Care Visit
$10 copay

Specialist Visit
$10 copay

Urgent Care
$10 copay

Emergency Room
$50 copay (waived if admitted)

Retail Rx (Up to 30-Day Supply)

Generic
$10

Preferred Brand  
$20

Non-Preferred Brand  
$20

Specialty
$20

Mail-Order Rx (Up to 100-Day Supply)

Generic
$20

Preferred Brand 
$40

Non-Preferred Brand  
$40

Specialty
Not covered

Monthly Plan Cost

Employee Only: $181.00

Employee and Spouse/DP: $396.00

Employee and Child(ren): $359.00

Employee and Family: $542.00

Anthem HDHP (CA & Non-CA)

w/ Dental & Vision

Benefit Highlights
In-Network

Deductible (Individual/Individual within a Family/Family)
$1,700/$3,400/$4,100

Out-of-Pocket Max (Individual/Individual within a Family/Family)
$4,250/$4,250/$8,500

Preventive Care
No charge (deductible waived)

Primary Care Visit
10% after deductible

Specialist Visit
10% after deductible

Urgent Care
10% after deductible

Emergency Room
10% after deductible

Retail Rx (Up to 30-Day Supply)

Generic
$10

Preferred Brand
$30

Non-Preferred Brand
$50

Specialty
30% up to $150 per prescription

Mail-Order Rx (Up to 90-Day Supply)

Generic
$10

Preferred Brand
$60

Non-Preferred Brand
$100

Specialty
30% up to $300 per prescription

Out-of-Network

Deductible (Individual/Individual within a Family/Family)
$1,700/$3,400/$4,100

Out-of-Pocket Max (Individual/Individual within a Family/Family)
$5,000/$5,000/$10,000

Preventive Care
Not covered

Primary Care Visit
30% after deductible

Specialist Visit
30% after deductible

Urgent Care
30% after deductible

Emergency Room
10% after deductible

Retail Rx (Up to 30-Day Supply)

Generic
30% after deductible (limited to $250 per Rx ) + costs in excess of maximum allowed amount

Preferred Brand 
30% after deductible (limited to $250 per Rx ) + costs in excess of maximum allowed amount

Non-Preferred Brand 
30% after deductible (limited to $250 per Rx ) + costs in excess of maximum allowed amount

Specialty
Not covered

Mail-Order Rx (Up to 90-Day Supply)

Generic
Not covered

Preferred Brand
Not covered

Non-Preferred Brand
Not covered

Specialty
Not covered

Monthly Plan Cost

Employee Only: $220.00

Employee and Spouse/DP: $486.00

Employee and Child(ren): $399.00

Employee and Family: $684.00

Anthem PPO (CA & Non-CA)

w/ Dental & Vision

Benefit Highlights
In-Network

Deductible (Individual/Family)
$150/$450

Out-of-Pocket Max (Individual/Family)
$1,000/$2,000

Preventive Care
No charge (deductible waived)

Primary Care Visit
$10 copay (deductible waived)

Specialist Visit
$10 copay (deductible waived)

Urgent Care
$10 copay (deductible waived)

Emergency Room
10% after deductible + $100 copay (copay waived if admitted)

Retail Rx (Up to 30-Day Supply)

Generic
$10

Preferred Brand
$20

Non-Preferred Brand
$20

Specialty
Not covered

Mail-Order Rx (Up to 90-Day Supply)

Generic
$10

Preferred Brand
$40

Non-Preferred Brand
$40

Specialty
Not covered

Out-of-Network

Deductible (Individual/Family)
$150/$450

Out-of-Pocket Max (Individual/Family)
$3,000/$6,000

Preventive Care
Not covered

Primary Care Visit
30% after deductible

Specialist Visit
30% after deductible

Urgent Care
30% after deductible

Emergency Room
10% after deductible + $100 copay (copay waived if admitted)

Retail Rx (Up to 30-Day Supply)

Generic
50% of allowed amount after $10 copay, plus any amount exceeding allowed amount

Preferred Brand 
50% of allowed amount after $20 copay, plus any amount exceeding allowed amount

Non-Preferred Brand  
50% of allowed amount after $20 copay, plus any amount exceeding allowed amount

Specialty
Not covered

Mail-Order Rx (Up to 90-Day Supply)

Generic
Not covered

Preferred Brand
Not covered

Non-Preferred Brand
Not covered

Specialty
Not covered

Monthly Plan Cost

Employee Only: $328.00

Employee and Spouse/DP: $724.00

Employee and Child(ren): $594.00

Employee and Family: $995.00

BCBS of AL PPO (AL)

w/ Dental & Vision

Benefit Highlights
In-Network

Deductible (Individual/Family)
$200 per individual (combined with out-of-network)

Out-of-Pocket Max (Individual/Family)
$400 per individual + deductible/copays (combined with out-of-network)

Preventive Care
No charge

Primary Care Visit
$20 copay (deductible waived)

Specialist Visit
$20 copay (deductible waived)

Urgent Care
$20 copay (deductible waived)

Emergency Room
No charge (copay waived if accident)

Retail Rx (Up to 30-Day Supply)

Generic
$10

Preferred Brand 
$20

Non-Preferred Brand  
$35

Specialty
Not covered

Mail-Order Rx (Up to 90-Day Supply)

Generic
Not covered

Preferred Brand  
Not covered

Non-Preferred Brand 
Not covered

Specialty
Not covered

Out-of-Network

Deductible (Individual/Family)
$200 per individual (combined with in-network)

Out-of-Pocket Max (Individual/Family)
$400 per individual + deductible/copays (combined with in-network)

Preventive Care
Not covered

Primary Care Visit
50% after deductible; Outside AL: 20% after deductible

Specialist Visit
50% after deductible; Outside AL: 20% after deductible

Urgent Care
50% after deductible; Outside AL: 20% after deductible

Emergency Room
Not covered

Retail Rx (Up to 30-Day Supply)

Generic
Not covered

Preferred Brand
Not covered

Non-Preferred Brand
Not covered

Specialty
Not covered

Mail-Order Rx (Up to 90-Day Supply)

Generic
Not covered

Preferred Brand
Not covered

Non-Preferred Brand
Not covered

Specialty
Not covered

Monthly Plan Cost

Employee Only: $53.00

Employee and Spouse/DP: $108.00

Employee and Child(ren): $103.50

Employee and Family: $131.20

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