Kaiser Enhanced Plan

Kaiser

Medical benefits are provided through Credence BCBS, United Healthcare Surest, and Kaiser (California Employees Only).

KAISER ENHANCED PLAN

Plan Details

Carrier

Kaiser

Plan Type

Not specified

HSA Eligible

Healthcare FSA Eligible

Yes

Who Can Enroll

California employees only

Monthly Contributions

Coverage Tier	Monthly Contribution
Employee Only	$594.18
Employee + Spouse	$1,247.79
Employee + Child(ren)	$1,069.54
Employee + Family	$1,883.57

Employee Only

Monthly Contribution: $594.18

Employee + Spouse

Monthly Contribution: $1,247.79

Employee + Child(ren)

Monthly Contribution: $1,069.54

Employee + Family

Monthly Contribution: $1,883.57

Deductible, Out-of-Pocket & Coinsurance

Feature	In-Network
Employee	$2,000
Family	$3,000
Pharmacy Deductible	$250 per individual
Coinsurance	80%
Annual Out-Of-Pocket Maximum - Employee	$4,000
Annual Out-Of-Pocket Maximum - Family	$8,000

Employee

In-Network: $2,000

Family

In-Network: $3,000

Pharmacy Deductible

In-Network: $250 per individual

Coinsurance

In-Network: 80%

Annual Out-Of-Pocket Maximum - Employee

In-Network: $4,000

Annual Out-Of-Pocket Maximum - Family

In-Network: $8,000

Covered Services

Service	In-Network
Preventative Care	Fully covered
Primary Care	$30 copay
Specialist Services	$50 copay
Diagnostic Care	X-ray/Lab Tests: $10, Imaging: 80%, up to $50
Mental Health - Inpatient	80%*
Mental Health - Outpatient	Office visit: $30, Outpatient services: 80%
Urgent Care	$30
Emergency Room	$250

Preventative Care

In-Network: Fully covered

Primary Care

In-Network: $30 copay

Specialist Services

In-Network: $50 copay

Diagnostic Care

In-Network: X-ray/Lab Tests: $10, Imaging: 80%, up to $50

Mental Health - Inpatient

In-Network: 80%*

Mental Health - Outpatient

In-Network: Office visit: $30, Outpatient services: 80%

Urgent Care

In-Network: $30

Emergency Room

In-Network: $250

*After deductible

Pharmacy Benefits

Tier	Cost
Retail RX - Generic	$10
Retail RX - Preferred	$30*
Retail RX - Non-Preferred	$30*
Retail RX - Specialty Drugs	80%, up to $250/prescription*
Mail Order RX - Generic	$10
Mail Order RX - Preferred	$30*
Mail Order RX - Non-Preferred	$30*
Mail Order RX - Specialty Drugs	N/A

Retail RX - Generic

Cost: $10

Retail RX - Preferred

Cost: $30*

Retail RX - Non-Preferred

Cost: $30*

Retail RX - Specialty Drugs

Cost: 80%, up to $250/prescription*

Mail Order RX - Generic

Cost: $10

Mail Order RX - Preferred

Cost: $30*

Mail Order RX - Non-Preferred

Cost: $30*

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.