MEDICAL COVERAGE OPTIONS: IN-NETWORK BENEFITS*

All options cover certain medical services and prescription drugs. Note that carriers can differ by price, in-network doctors/facilities, and more. Before you enroll, use the online tools to help you decide which coverage and carrier option combination work best for you and your family. And, if you have ongoing treatment and your enrollment will result in a carrier change, ask the new carrier about their transition-of-care policy.

Coverage Option

$500 Deductible

$2,000 Deductible

$3,500 Deductible

Available Account

Health Care FSA

◄ Health Savings Account (HSA) ►

Contribution Amount

$$

$

$

Note: If applicable, the current contribution amount you pay each pay period is on MyBenefits Online (tobacco user surcharge may also apply)

Preventive Care

◄ Covered 100% when you use in-network providers (no deductible) ►

You Pay

Deductible (Individual / Family)

$500 / $1,000

$2,000 / $4,000

$3,500 / $7,000

Coinsurance (After Deductible)

20%

20%

20%

Out-of-Pocket Maximum (Individual / Family; Includes Deductible)

$3,000 / $6,000

$4,000 / $8,000

$7,000 / $14,000

Deductible and Out-of-Pocket Maximum Type

Embedded

Aggregate

Embedded

* Out-of-network benefits are also available (except through Kaiser Permanente), but benefits are lower and your costs are higher. So, it’s worth it to stay in-network. For details, access MyBenefits Online.

$500 Deductible Coverage Option

Available Account: Health Care FSA

Contribution Amount: $$ Note: If applicable, the current contribution amount you pay each pay period is on MyBenefits Online (tobacco user surcharge may also apply)

Preventive Care: Covered 100% when you use in-network providers (no deductible)

You Pay:

  • Deductible (Individual / Family) = $500 / $1,000
  • Coinsurance (After Deductible) = 20%
  • Out-of-Pocket Maximum (Individual / Family; Includes Deductible) = $3,000 / $6,000
  • Deductible and Out-of-Pocket Maximum Type = Embedded

$2,000 Deductible Coverage Option

Available Account: Health Savings Account (HSA)

Contribution Amount: $ Note: If applicable, the current contribution amount you pay each pay period is on MyBenefits Online (tobacco user surcharge may also apply)

Preventive Care: Covered 100% when you use in-network providers (no deductible)

You Pay:

  • Deductible (Individual / Family) = $2,000 / $4,000
  • Coinsurance (After Deductible) = 20%
  • Out-of-Pocket Maximum (Individual / Family; Includes Deductible) = $4,000 / $8,000
  • Deductible and Out-of-Pocket Maximum Type = Aggregate

$3,000 Deductible Coverage Option

Available Account: Health Savings Account (HSA)

Contribution Amount: $ Note: If applicable, the current contribution amount you pay each pay period is on MyBenefits Online (tobacco user surcharge may also apply)

Preventive Care: Covered 100% when you use in-network providers (no deductible)

You Pay:

  • Deductible (Individual / Family) = $3,500 / $7,000
  • Coinsurance (After Deductible) = 20%
  • Out-of-Pocket Maximum (Individual / Family; Includes Deductible) = $7,000 / $14,000
  • Deductible and Out-of-Pocket Maximum Type = Embedded

* Out-of-network benefits are also available (except through Kaiser Permanente), but benefits are lower and your costs are higher. So, it’s worth it to stay in-network. For details, access MyBenefits Online.

More information

Access a detailed comparison of the coverage options.