Kaiser Core Plan
Kaiser
Medical benefits are provided through Credence BCBS, United Healthcare Surest, and Kaiser (California Employees Only).
KAISER CORE PLAN
Plan Details
Carrier
Kaiser
Plan Type
Not specified
HSA Eligible
Yes
Healthcare FSA Eligible
No
Who Can Enroll
California employees only
Monthly Contributions
| Coverage Tier | Monthly Contribution |
|---|---|
| Employee Only | $472.02 |
| Employee + Spouse | $991.20 |
| Employee + Child(ren) | $849.59 |
| Employee + Family | $1,496.21 |
Employee Only
- Monthly Contribution
- $472.02
Employee + Spouse
- Monthly Contribution
- $991.20
Employee + Child(ren)
- Monthly Contribution
- $849.59
Employee + Family
- Monthly Contribution
- $1,496.21
Deductible, Out-of-Pocket & Coinsurance
| Feature | In-Network |
|---|---|
| Employee | $3,500 |
| Family | $7,000 |
| Pharmacy Deductible | N/A |
| Coinsurance | 80% |
| Annual Out-Of-Pocket Maximum - Employee | $7,000 |
| Annual Out-Of-Pocket Maximum - Family | $14,000 |
Employee
- In-Network
- $3,500
Family
- In-Network
- $7,000
Pharmacy Deductible
- In-Network
- N/A
Coinsurance
- In-Network
- 80%
Annual Out-Of-Pocket Maximum - Employee
- In-Network
- $7,000
Annual Out-Of-Pocket Maximum - Family
- In-Network
- $14,000
Covered Services
| Service | In-Network |
|---|---|
| Preventative Care | Fully covered |
| Primary Care | 80%* |
| Specialist Services | 80%* |
| Diagnostic Care | 80%* |
| Mental Health - Inpatient | 80%* |
| Mental Health - Outpatient | 80%* |
| Urgent Care | 80%* |
| Emergency Room | $250 copay, then 80%* |
Preventative Care
- In-Network
- Fully covered
Primary Care
- In-Network
- 80%*
Specialist Services
- In-Network
- 80%*
Diagnostic Care
- In-Network
- 80%*
Mental Health - Inpatient
- In-Network
- 80%*
Mental Health - Outpatient
- In-Network
- 80%*
Urgent Care
- In-Network
- 80%*
Emergency Room
- In-Network
- $250 copay, then 80%*
- *After deductible
Pharmacy Benefits
| Tier | Cost |
|---|---|
| Retail RX - Generic | $10 copay |
| Retail RX - Preferred | $30 copay* |
| Retail RX - Non-Preferred | $30 copay* |
| Retail RX - Specialty Drugs | 80%, up to $250/prescription* |
| Mail Order RX - Generic | $20 |
| Mail Order RX - Preferred | $60* |
| Mail Order RX - Non-Preferred | $60* |
| Mail Order RX - Specialty Drugs | N/A |
Retail RX - Generic
- Cost
- $10 copay
Retail RX - Preferred
- Cost
- $30 copay*
Retail RX - Non-Preferred
- Cost
- $30 copay*
Retail RX - Specialty Drugs
- Cost
- 80%, up to $250/prescription*
Mail Order RX - Generic
- Cost
- $20
Mail Order RX - Preferred
- Cost
- $60*
Mail Order RX - Non-Preferred
- Cost
- $60*
Mail Order RX - Specialty Drugs
- Cost
- N/A
- *After deductible
Plan Notes
- In-network services are paid with copays or coinsurance.
- You may seek care from in-network providers only.