Credence Base Plan
Credence BCBS
Medical benefits are provided through Credence BCBS, United Healthcare Surest, and Kaiser (California Employees Only).
CREDENCE BASE PLAN
Plan Details
Carrier
Credence BCBS
Plan Type
Not specified
HSA Eligible
Yes
Healthcare FSA Eligible
No
Who Can Enroll
All benefits-eligible employees
Monthly Contributions
| Coverage Tier | Under $75K | $75K - <$125K | $125K+ |
|---|---|---|---|
| Employee Only | $120.05 | $142.49 | $176.15 |
| Employee + Spouse | $347.81 | $445.08 | $591.20 |
| Employee + Child(ren) | $280.37 | $358.78 | $476.56 |
| Employee + Family | $457.31 | $585.20 | $777.31 |
Employee Only
- Under $75K
- $120.05
- $75K - <$125K
- $142.49
- $125K+
- $176.15
Employee + Spouse
- Under $75K
- $347.81
- $75K - <$125K
- $445.08
- $125K+
- $591.20
Employee + Child(ren)
- Under $75K
- $280.37
- $75K - <$125K
- $358.78
- $125K+
- $476.56
Employee + Family
- Under $75K
- $457.31
- $75K - <$125K
- $585.20
- $125K+
- $777.31
Deductible, Out-of-Pocket & Coinsurance
| Feature | In-Network | Out-of-Network |
|---|---|---|
| Employee | $4,000 | $8,000 |
| Family | $8,000 | $16,000 |
| Pharmacy Deductible | N/A | N/A |
| Coinsurance | 80% | 50% |
| Annual Out-Of-Pocket Maximum - Employee | $6,250 | $12,500 |
| Annual Out-Of-Pocket Maximum - Family | $12,500 | $25,000 |
Employee
- In-Network
- $4,000
- Out-of-Network
- $8,000
Family
- In-Network
- $8,000
- Out-of-Network
- $16,000
Pharmacy Deductible
- In-Network
- N/A
- Out-of-Network
- N/A
Coinsurance
- In-Network
- 80%
- Out-of-Network
- 50%
Annual Out-Of-Pocket Maximum - Employee
- In-Network
- $6,250
- Out-of-Network
- $12,500
Annual Out-Of-Pocket Maximum - Family
- In-Network
- $12,500
- Out-of-Network
- $25,000
Covered Services
| Service | In-Network | Out-of-Network |
|---|---|---|
| Preventative Care | Fully covered | 50%* |
| Primary Care | 80%* | 50%* |
| Specialist Services | 80%* | 50%* |
| Diagnostic Care | 80%* | 50%* |
| Mental Health - Inpatient | 80%* | 50%* |
| Mental Health- Outpatient | 80%* | 50%* |
| Urgent Care | 80%* | 50%* |
| Emergency Room | $250 copay, then 80%* | $250 copay, then 80%* |
Preventative Care
- In-Network
- Fully covered
- Out-of-Network
- 50%*
Primary Care
- In-Network
- 80%*
- Out-of-Network
- 50%*
Specialist Services
- In-Network
- 80%*
- Out-of-Network
- 50%*
Diagnostic Care
- In-Network
- 80%*
- Out-of-Network
- 50%*
Mental Health - Inpatient
- In-Network
- 80%*
- Out-of-Network
- 50%*
Mental Health- Outpatient
- In-Network
- 80%*
- Out-of-Network
- 50%*
Urgent Care
- In-Network
- 80%*
- Out-of-Network
- 50%*
Emergency Room
- In-Network
- $250 copay, then 80%*
- Out-of-Network
- $250 copay, then 80%*
- *After deductible
Pharmacy Benefits
| Tier | Cost |
|---|---|
| Retail RX - Generic | $10 copay* |
| Retail RX - Preferred | 75% coinsurance ($200 max)* |
| Retail RX - Non-Preferred | 50% coinsurance ($200 max)* |
| Retail RX - Specialty Drugs | 70%* |
| Mail Order RX - Generic | $20 copay* |
| Mail Order RX - Preferred | 75% ($200 max)* |
| Mail Order RX - Non-Preferred | 50% ($200 max)* |
| Mail Order RX - Specialty Drugs | N/A |
Retail RX - Generic
- Cost
- $10 copay*
Retail RX - Preferred
- Cost
- 75% coinsurance ($200 max)*
Retail RX - Non-Preferred
- Cost
- 50% coinsurance ($200 max)*
Retail RX - Specialty Drugs
- Cost
- 70%*
Mail Order RX - Generic
- Cost
- $20 copay*
Mail Order RX - Preferred
- Cost
- 75% ($200 max)*
Mail Order RX - Non-Preferred
- Cost
- 50% ($200 max)*
Mail Order RX - Specialty Drugs
- Cost
- N/A
- *After deductible
Plan Notes
- You’ll pay less in premiums.
- You’ll pay for the full cost of non-preventive medical services until you reach your deductible.