Medical Plan Options
Active Participants
Active participants may select from two medical plans: Kaiser HMO, and the Health Net HMO.
Under the HMO options (Kaiser and Health Net), you must select a Primary Care Physician. This is the doctor you must always visit for all of your care. If you need to see a Specialist, your doctor will send you to another doctor for the necessary services. Kaiser participants must visit Kaiser facilities.
This chart can help you to compare many plan features side-by-side:
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| Network |
Enrollees in Kaiser must receive all their care at Kaiser clinics and hospitals. |
Enrollees in the Health Net HMO must receive all care at the Medical Group in which you enroll. Each family member may select a different Primary Care Physician (PCP) as long as they work at the same Medical Clinic. Care not authorized by your Medical Group is not covered. |
| Calendar Year Deductible |
$500 per person (2 per family maximum).
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None |
| Coinsurance/Co-Pays |
Office Visits: $20 (deductible does not apply to office visits).
Inpatient Hospital: Plan pays 80% coinsurance.
Emergency Room: Plan pays 80%.
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Office Visits: $40
Hospitalization: Plan pays 60%
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| Out of Pocket Maximum per calendar year |
$3,000 per person/$6,000 per family
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$3,500 per person/$7,000 per family
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| Prescription Drug |
$10 generic/$30 brand up to a 100-day supply. $100 calendar year deductible for brand name drugs.
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$15 generic/$30 brand fomulary/$50 brand non-formulary up to a 30-day supply. Additional calendar year deductible of $100 for brand-name drugs.
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Retired Participants
Retired participants in the Trust have a different selection of medical plans. Medicare retirees can choose between the Health Net COB Plan, Kaiser Senior Advantage, and Health Net Seniority Plus.
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| Network |
Participants in the COB plan may visit any provider who accepts Medicare assignment. This plan is available only to those Medicare retirees who wish to enroll in a Health Net plan and who reside outside the Seniority Plus service area. |
Enrollees in Kaiser must receive all their care at Kaiser clinics and hospitals. |
Enrollees in Seniority Plus must receive all care at the Medical Group in which you enroll. Each family member may select a different Primary Care Physician (PCP) as long as they work at the same Medical Clinic. Care not authorized by your Medical Group is not covered. |
| Calendar Year Deductible |
None |
None |
None |
| Coinsurance/Co-Pays |
Office Visits: $15
Inpatient Hospital: $350 per admit
Emergency Room: $75
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Office Visits: $15
Emergency Room: $50
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Office Visits: $15
Inpatient Hospital: $300 per admit
Emergency room: $50
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| Prescription Drug |
$10 generic/ $25 preferred brand/ $50 non-preferred brand up to a 30-day supply
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$5 generic/$15 brand, for up to a 100-day supply
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$10 generic/ $20 preferred brand/$ 50 non-preferred brand up to a 30-day supply
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Non-medicare retirees can choose between the Health Net PPO, Kaiser HMO, and Health Net HMO.
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| Network |
Enrollees in Kaiser must receive all their care at Kaiser clinics and hospitals. |
Enrollees in Health Net must receive all care at the Medical Group in which you enroll. Each family member may select a different Primary Care Physician (PCP) as long as they work at the same Medical Clinic. Care not authorized by your Medical Group is not covered. |
| Calendar Year Deductible |
$500 per person (2 per family maximum)
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None |
| Coinsurance/Co-Pays |
Office Visits: $20 (deductible does not apply to office visits).
Inpatient Hospital: Plan pays 80% coinsurance.
Emergency Room: Plan pays 80%.
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Office Visit $40
Hospitalization: Plan pays 60%
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| Out of Pocket Maximum per calendar year |
$3,000 per person/$6,000 per family
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$3,500 per person/$7,000 per family
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| Prescription Drug |
$10 generic/$20 brand-formulary/ $50 brand non-formulary up to a 30-day supply.
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$15 generic/$30 brand fomulary/$50 brand non-formulary up to a 30-day supply. There will be an additional calendar year deductible of $100 for brand-name drugs.
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This group health plan believes it is a “grandfathered health plan” under the Patient Protection and Affordable Care Act. Because of this, certain provisions under the Affordable Care Act do not apply to this group health plan. See
here for more information.