Medical
Medical coverage offers healthcare protection for you and your family. You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.
Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers. The key difference between the plans is the amount of money you’ll pay each pay period and when you need care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums – the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Blue Diamond HDHP with HSA
Plan Information
Plan Name: HDHP with HSA
Policy Number: N/A
Effective Date: 01/01/2025
Network: Anthem Blue Cross
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$3,300/$6,000
Preventive Care
$0 (deductible does not apply)
Primary Care Visit
10% after deductible
Specialist Visit
10% after deductible
Urgent Care
10% after deductible
Emergency Room
10% after deductible
HSA Contribution
$1,000 individual / $2,000 family
Retail Rx (Up to 30-Day Supply)
Generic
$10 after deductible
Preferred Brand
$25 after deductible
Non-Preferred Brand
$40 after deductible
Specialty
$100 after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$50 copay
Non-Preferred Brand
$80 copay
Specialty
Not covered
Out-of-Network
Deductible (Individual/Family)
$4,000/$8,000
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
Not covered
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
10% after deductible
HSA Contribution
$1,000 individual / $2,000 family
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Plan Documents
Contact Information
Blue Diamond PPO with HRA
Plan Information
Plan Name: Blue Diamond PPO
Policy Number: N/A
Effective Date: 01/01/2025
Network: Anthem Blue Cross
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
$1,000/$2,000
In-Network
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0 (deductible does not apply)
Primary Care Visit
10% after deductible
Specialist Visit
10% after deductible
Urgent Care
10% after deductible
Emergency Room
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$25
Non-Preferred Brand
$40
Specialty
$100
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$50
Non-Preferred Brand
$80
Out-of-Network
Deductible (Individual/Family)
$4,000/$8,000
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
Not covered
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Plan Documents
Contact Information
Kaiser HMO with HRA
Plan Information
Plan Name: Kaiser HMO with HRA
Policy Number: 000603211
Effective Date: 01/01/2025
Network: Kaiser
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
Employer HRA Funding (Individual/Family)
$2,500/$5,000
In-Network Only
Deductible (Individual/Family)
$2,500/$5,000
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
$0
Primary Care Visit
$20 copay after deductible
Specialist Visit
$20 copay after deductible
Urgent Care
$20 copay after deductible
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply) Deductible does not apply
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$30 copay
Specialty
20% coinsurance, up to $250
Mail-Order Rx (Up to 100-Day Supply) Deductible does not apply
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$60 copay
Specialty
Not covered
Plan Documents
Contact Information
Sutter Health Plus HMO with HRA
Plan Information
Plan Name: Sutter Health + HMO
Policy Number: 224114
Effective Date: 01/01/2025
Network: Sutter Health
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
Employer HRA Funding (Individual Family)
$2,000/$4,000
The HRA will cover the following services: Inpatient Hospitalization, Outpatient Surgery, Emergency Room, Skilled Nursing Care and Durable Medical Equipment.
In-Network Only
Deductible (Individual/Family)
$2,500/$5,000
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$20 copay
Urgent Care
$20 copay
Emergency Room
$100 after deductible
Retail Rx (Up to 30-Day Supply) Deductible does not apply
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay
Specialty
20% coinsurance, up to $250
Mail-Order Rx (Up to 90-Day Supply) Deductible does not apply
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Specialty
Not covered