Which plan is right for you?
That depends on your healthcare needs, favorite doctors, and budget. Here are some considerations.
- Kaiser HDHP HMO: High ($2,500 deductible)
- Kaiser Mid ($4,500 deductible)
- Kaiser Low ($5,500 deductible)
- Sutter HRA PPO: High ($3,000 deductible)
- Sutter Mid ($4,000 deductible)
- Sutter Low ($5,5,00 deductible)
Kaiser High | Kaiser Mid | Kaiser Low |
|
|---|---|---|---|
| In-Network Only | |||
| Annual Deductible Individual / Family | $2,500 / $5,000 | $4,500 / $9,000 | $5,500 / $11,000 |
| Annual Out-of-Pocket Max Individual / Family | $5,000 / $10,000 | $6,250 / $12,500 | $7,000 / $14,000 |
| Member Co-Insurance | 20% | 40% | 40% |
| Physician Services | |||
| Primary Care | $20 after deductible | $40 after deductible | $50 after deductible |
| Specialist Visits | $20 after deductible | $50 after deductible | $50 after deductible |
| Preventative Care | $0* | $0* | $0* |
| Hospital Services | |||
| Inpatient Hospitalization | 20% after deductible | 40% after deductible | 40% after deductible |
| Outpatient Surgery | 20% after deductible | 40% after deductible | 40% after deductible |
| Diagnostic X-Ray & Lab | |||
| X-Ray/Lab | $10 after deductible | 40% after deductible | 40% after deductible |
| Urgent and Emergency Care Visits | |||
| Emergency Room (copay waived, if admitted) | 20% after deductible | $250 after deductible | 40% after deductible |
| Urgent Care | $20 after deductible | $40 after deductible | $50 after deductible |
| Prescriptions | |||
| Deductible | None | Combined with Medical Deductible | |
| Generic | $10 copay | $15 after deductible | $15 after deductible |
| Preferred Brand | $30 copay | $35 after deductible | 40% after deductible |
| Non-Preferred Brand | 20% co-insurance Up to $250 max | 30% after deductible Up to $250 max | 40% after deductible Up to $250 max |
Sutter High | Sutter Mid | Sutter Low |
|
|---|---|---|---|
| In-Network Only | |||
| Annual Deductible Individual / Family | $3,000 / $6,000 | $4,000 / $8,000 | $5,500 / $11,000 |
| Annual Out-of-Pocket Max Individual / Family | $6,000 / $12,000 | $6,500 / $13,000 | $6,500 / $13,000 |
| Member Co-Insurance | 30% | 30% | 30% |
| Physician Services | |||
| Primary Care | $20 Copay | $45 Copay | $50 Copay |
| Specialist Visits | $20 Copay | $45 Copay | $50 Copay |
| Preventative Care | $0 | $0 | $0 |
| Hospital Services | |||
| Inpatient Hospitalization | 30% after deductible | 30% after deductible | 30% after deductible |
| Outpatient Surgery | 30% after deductible | 30% after deductible | 30% after deductible |
| Diagnostic X-Ray & Lab | |||
| X-Ray/Lab | $20 / $10 Copay | $45 / $10 Copay | $50 / $10 Copay |
| Urgent and Emergency Care Visits | |||
| Emergency Room (copay waived, if admitted) | 30% after deductible | 30% after deductible | 30% after deductible |
| Urgent Care | $20 Copay | $45 Copay | $50 Copay |
| Prescriptions | |||
| Deductible | None | ||
| Generic | $10 copay | $10 Copay | $10 Copay |
| Preferred Brand | $30 copay | $30 Copay | $30 Copay |
| Non-Preferred Brand | $60 Copay | $60 Copay | $60 Copay |
Do you prefer specific doctors or hospitals?
If you want to stay with your favorite doctors and facilities, check whether they are in the plan’s network. If they are not, but you are comfortable paying a bit more to see them, consider a plan with both in-network and out-of- network benefits.
What are your usual healthcare needs?
Do you have frequent doctor or urgent care visits? Do you have a condition that requires a specialist? Do you take prescription medications? Compare how each plan covers the services you need most often.
Consider the bottom line
How much is the monthly payroll deduction? Do you have to meet a deductible? What is the out-of-pocket maximum? How much of the cost is covered by the plan? How much are any copayments for office visits, prescriptions, etc. All of these factors together affect your total cost for healthcare.
Understanding Your Options:
HMO stands for Health Maintenance Organization. Kaiser’s integrated care delivery system offers care and coverage together in one package, under one roof. The HMO requires you to choose a Kaiser Primary Care Physician (PCP) to direct your care including referrals to in-network specialists, when necessary.
You will pay a copayment (copay) or coinsurance for most services. There is no out-of-network care. If you are traveling outside the Kaiser California network, they offer extended emergency room care through the Cigna Network. Telehealth visits are available to ensure you and your covered dependents have many convenient ways to access care.
A Health Maintenance Organization (HMO) is a
group of medical providers that work together
to keep the cost of medical services down. In Network Coverage Only— Sutter Health contracts with private physicians and hospitals. The HMO plan maintains a network of preferred physicians, specialists, and hospitals that have agreed to contracted rates and will also complete and submit your benefit claims. You will need to specify who your PCP or IPA/Medical Group is.
1. 100% Employer-Funded: It’s employer’s money, not yours. And claims paid are also tax-free!
2. Use it or lose it: Unused funds at the end of the plan year will go back to the employer. And your bucket will be refilled to the full amount effective the first day of the next plan year, i.e., Jan 1st.
The HRA is a health reimbursement account set up and solely funded by your employer to help you pay for your out-of-pocket costs qualified medical expenses. All medical plans are HRA eligible. If you enroll in medical, you will automatically be enrolled in an HRA plan. See HRA page for employer contributions.
1. 100% Employer-Funded: It’s employer’s money, not yours. And claims paid are also tax-free!
2. Use it or lose it: Unused funds at the end of the plan year will go back to the employer. And your bucket will be refilled to the full amount effective the first day of the next plan year, i.e., Jan 1 st.