| KEY FEATURES |
Kaiser
Plan's Coverage |
Anthem Plan's Coverage |
Aetna
Plan's Coverage |
|
Estimated Monthly Base Rate
|
$285 |
$302 |
$307 |
|
How accurate is this estimate? |
You may be charged more.
1% received surcharged quotes. |
79% received surcharged quotes. |
You may be charged more.
23% received surcharged quotes. |
|
How many applications are denied? |
21% who applied were turned down.
|
10% who applied were turned down |
13% who applied were turned down |
|
Deductible
|
Individual:$5,000
Out-of-Network: Shared with in-network
Prescriptions:
None
|
Individual:$5,000
Out-of-Network: 5000/10000
Prescriptions: $7500 Individual applies to
Brand, Non-Formulary
|
Individual:$8,000
Out-of-Network: 10000/20000
Prescriptions:
None
|
|
In-Network
Out-of-Pocket Limit
|
Individual:$7,500 Includes
deductible |
Individual:$4,500 Includes deductible |
Individual:$12,500 Includes deductible |
|
Does in-network out-of-pocket limit
include deductible? |
Yes |
Yes |
Yes |
|
Coverage Limits
|
Check the plan. Sometimes there is a
limit on the number or cost of benefits that will be covered
within a year. |
Check the plan. Sometimes there is a
limit on the number or cost of benefits that will be covered
within a year. |
Check the plan. Sometimes there is a
limit on the number or cost of benefits that will be covered
within a year. |
|
Is this plan Health Savings Account (HSA)
eligible? |
No |
No |
No |
|
How can I find a doctor in this plan's
network? |
Find your Doctor
|
Find your Doctor |
Find your Doctor |
|
Doctor Choice
|
EPO |
PPO |
PPO |
|
Do I need a permission from my primary
care doctor to see a specialist? |
Yes |
No |
No |
|
Do I need authorization before seeing
an out-of-network doctor? |
Yes |
No |
No |
|
Excluded
Services
|
Chiropractic
Prescription Drug Coverage
Maternity Coverage |
Chiropractic
Mental Health Coverage
Substance Abuse Coverage
Maternity Coverage |
Maternity Coverage |
|
COMMON MEDICAL EVENT |
SERVICES YOU MAY NEED |
Your Cost Sharing |
|
Kaiser |
Anthem |
Aetna |
|
If you are sick and go to the doctor's
office or need other services? |
Primary care
physician office visit |
$50 Copay after deductible |
$40 Copay |
Visits 1-3 $50 copay;
deductible waived.
Visits 4+ member pays 100% Aetna discount applies Aetna pays
100% once OOP is met |
|
Specialty
physician office visit |
$50 Copay after deductible |
$40 Copay |
Visits 1-3 $50 copay;
deductible waived.
4+ member pays 100% Aetna discount applies. Aetna pays 100% once
OOP is met |
|
Outpatient X-rays /lab testing/imaging |
$10 Copay after deductible |
no charge (after out of pocket maximum) |
30% Coinsurance after deductible
(Non-Preventive) |
|
If you go for a checkup visit? |
Periodic health exam |
No charge (deductible waived) |
No Charge |
No Charge |
|
If you need minor surgery? |
|
30% after deductible |
40% Coinsurance after deductible |
40% after deductible |
|
If you stay overnight in the hospital? |
Hospitalization |
30% after deductible |
40% Coinsurance after deductible |
40% Coinsurance after deductible |
|
If you have an emergency? |
Emergency room fees |
$150 Copay after deductible (waived if
admitted) |
$100 Copay (waived if admitted), plus 40%
Coinsurance after deductible |
$100 Copay (waived if admitted), plus 30%
Coinsurance after deductible |
|
If you need drugs?
|
PURCHASE FROM PHARMACY: |
|
Generic Drugs
|
Not Covered |
|
$20 Copay |
|
Brand Drugs
|
Not Covered |
|
Not Covered |
|
Non-formulary Drugs
|
Not Covered |
|
Not Covered |
|
Prescription Drugs (other coverage) |
Not Available |
25% Coinsurance for
Specialty/Self-administered injectable drugs after deductible |
Not Available |
|
PURCHASE FROM MAIL ORDER: |
|
Generic Drugs
|
Not Available |
$45 Copay |
$40 Copay |
|
Brand Drugs
|
Not Available |
$120 Copay after deductible |
Not Covered |
|
Non-formulary Drugs
|
Not Available |
Not Covered |
Not Covered |
|
Prescription Drugs (other coverage) |
Not Available |
Not Covered |
Not Available |
|
Mail order days supply |
Not Available |
90 days |
60 days |
|
Is there a drug deductible? |
|
None |
$7500 Individual applies to Brand,
Non-Formulary |
None |
|
What drugs are covered in the
formulary? |
|
Check the Formulary
|
No Link Provided
|
Check the Formulary |
|
If you have mental health or substance
abuse needs? |
Mental health coverage |
$50 Copay Individual Visit / $25 Copay
Group Visit, 20 Visits per year (after deductible) |
Not Covered |
Inpatient and Outpatient:
coverage is only provided for severe, biologically based mental
or nervous disorders. Deductible and co-insurance/copay apply.
|
|
Substance Abuse Coverage |
$50 per visit after deductible/$5 group
visit after deductible Inpatient Detoxification: 30% coinsurance
after deductible |
Not Covered |
Inpatient and Outpatient:
coverage is only provided for treatment of drug and alcohol
dependencies associated with severe, biologically based mental
or nervous disorders. Deductible and co-insurance/copay apply.
|
|
If you become pregnant? |
Prenatal and postnatal care |
Not Covered |
Not Covered |
Not Covered (except for
pregnancy complications) |
|
Labor & Delivery hospital stay |
Not Covered |
Not Covered |
Not Covered (except for
pregnancy complications) |
|
Well Baby Care |
No charge (deductible waived)
|
No Charge |
No Charge |
Co-payments:
A flat dollar amount you must pay for a particular covered service. For
example, you may have to pay a $15 copayment for each covered visit to a
primary care doctor. Some or all copayments may count toward a plan's
annual in-network out-of-pocket limit. For example, copayments for
prescription drugs might not be limited by this annual maximum. In other
cases, you may have to pay a "balance bill" amount for covered services,
or covered services out-of-network, if the total charge is more than the
allowed charge. You will need to read the plan to learn more.
Co-insurance:
The percentage of allowed charges for covered services that you're
required to pay. For example, the health insurance may cover 80% of
charges for a covered hospital stay, leaving you responsible for the
other 20%. This 20% is known as co-insurance. Not all co-insurance may
count toward a plan's annual in-network out-of-pocket limit. For
example, co-insurance for out-of-network care, or for specified
benefits, might not be limited by this annual maximum. In other cases,
you may have to pay a "balance bill" for out-of-network covered
services, if the total charge is more than the allowed charge under your
plan. You will need to read the plan to learn more.
Out-of-network:
A health care provider or facility, such as a hospital, that has not
contracted with your health insurance to provide services to you. Using
an out-of-network provider or facility will usually incur a higher or
additional cost to you. Sometimes, use of these services is not
reimbursable whatsoever.
