Medical
Medical coverage offers healthcare protection for you and your family. You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.
Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers. The key difference between the plans is the amount of money you’ll pay each pay period and when you need 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.
Kaiser HMO (CA)
Plan Information
Plan Name: Kaiser HMO (CA)
Policy Number: 600140
Effective Date: 01/01/2025
Network: Kaiser
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
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
Plan Documents
Contact Information
Anthem HDHP (CA & Non-CA)
Plan Information
Plan Name: Anthem HDHP (CA & Non-CA)
Policy Number: 165049
Effective Date: 01/01/2025
Network: Prudent Buyer PPO
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Individual within a Family/Family)
$1,650/$3.300/$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)
$1,650/$3.300/$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
Contact Information
Anthem PPO (CA & Non-CA)
Plan Information
Plan Name: Anthem PPO (CA & Non-CA)
Policy Number: 165049
Effective Date: 01/01/2025
Network: Prudent Buyer PPO
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
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
Contact Information
BCBS of AL PPO (AL)
Plan Information
Plan Name: BCBS of AL PPO (AL)
Policy Number: 4225
Effective Date: 01/01/2025
Network: BCBS of AL
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
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
Contact Information
BCBS of AL HDHP (AL)
Plan Information
Plan Name: BCBS of AL HDHP (AL)
Policy Number: 4225
Effective Date: 01/01/2025
Network: BCBS of AL
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,650/$3,300
Out-of-Pocket Max (Individual/Family)
$1,650/$3,300
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 after deductible
Preferred Brand
$30 after deductible
Non-Preferred Brand
$50 after deductible
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10 after deductible
Preferred Brand
$60 after deductible
Non-Preferred Brand
$100 after deductible
Specialty
Not covered
Out-of-Network
Deductible (Individual/Family)
$1,650/$3,330
Out-of-Pocket Max (Individual/Family)
$1,650/$3,300
Preventive Care
Not covered
Primary Care Visit
50% after deductible; Outside AL: 30% after deductible
Specialist Visit
50% after deductible; Outside AL: 30% after deductible
Urgent Care
50% after deductible; Outside AL: 30% after deductible
Emergency Room
10% after deductible
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