Zip: 92804 Apply Apply
Monthly Total 2134.14 2352.36
Plan Name Silver 70 HDHP HMO 3600/25% PCP Silver 70 HMO 2850/50 PCP
Deductible $3600 ($7200 family) $2850 ($5700 family)
Coinsurance 75% coverage for most services Fixed copayments for most services
Out of Pocket Max $7000 ($14,000 family) $8900 (17,800 family)
Ambulance 75% coverage (ded applies) $250 copayment after deductible
Chiropractic Not covered Not covered
Durable Medical Equipt 75% coverage (ded applies) 65% coverage (ded waived)
Emergency Room 75% coverage (ded applies) $350 copay (ded applies)
Hospital Stay 75% coverage (ded applies) 65% coverage (ded applies)
Lab & X-ray 75% coverage (ded applies) Lab $30 after ded/x-ray $70 after ded
Office Visit 75% coverage (ded applies) $50 copayment
Specialist 75% coverage (ded applies) $80 copayment
Physical Therapy 75% coverage (ded applies) $50 copayment
Outpatient Surgery 75% coverage (ded applies) $400 copay
Psych (Inpatient) 75% coverage (ded applies) 65% coverage (ded applies)
Psych (Outpatient) 75% coverage (ded applies) $50 copayment
Rx Tier 1 75% cov to $250 per Rx (med ded applies) $20 copayment
Rx Tier 2 75% cov to $250 per Rx (med ded applies) $75 copay (after $450 Rx ded)
Rx Tier 3 75% cov to $250 per Rx (med ded applies) $75 copay (after $450 Rx ded)
Rx Tier 4 75% cov to $250 per Rx (med ded applies) 65% cov up to $250 per Rx (after $450 Rx ded)
Links Brochure Providers Formulary Brochure Providers Formulary
Subscriber (55) 762.68 840.67
Spouse (53) 697.70 769.04
Child (22) 342.01 376.98
Child (20) 331.75 365.67
Annual Premium Tota $ 25,610 $ 28,228
Annual Max Exposure $ 32,610Family: $ 39,610 $ 37,128Family: $ 46,028
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RateMetalNetworkPlanDeductibleCoinsuranceOOP MaxOffice VisitSpecialistRx Tier 1Rx Tier 2Rx Tier 3Rx Tier 4
3,150.51 Platinum Kaiser Permanente Platinum 90 HMO 0/10 (shop) None Fixed copays for most services $3000/$6000 family $10 copayment $20 copayment $5 copayment $15 copayment $30 copayment 90% cov up to $250 per Rx
3,086.68 Platinum Kaiser Permanente Platinum 90 HMO 0/20 (shop) None Fixed copays for most services $4500/$9000 family $20 copayment $30 copayment $5 copayment $20 copayment $20 copayment 90% cov up to $250 per Rx
3,085.43 Platinum Kaiser Permanente Platinum 90 HMO 250/30 (shop) $250 ($500 family) Fixed copays for most services $3250/$6500 family $30 copay $50 copay (after ded) $10 copayment $20 copayment $20 copayment 90% cov up to $250 per Rx
3,368.60 Platinum Kaiser Permanente Platinum 90 0/10 KP HMO Plus None Fixed copays for most services $3000/$6000 family $10 copayment $20 copayment $5 copayment $15 copayment $15 copayment 90% cov up to $250 per Rx
2,954.27 Gold Kaiser Permanente Gold 80 HMO 0/40 (shop) None Fixed copays for most services $8500/17,000 family $40 copayment $60 copayment $15 copayment $50 copayment $50 copayment 80% coverage to $250 max
2,906.97 Gold Kaiser Permanente Gold 80 HMO 250/35 (shop) $250 ($500 family) Fixed copays for most services $7800/15,600 family $35 copayment $55 copayment $15 copayment $40 copayment $40 copayment 80% coverage to $250
2,862.91 Gold Kaiser Permanente Gold 80 HMO 500/35 (shop) $500 ($1000 family) Fixed copays for most services $8000/16,000 family $35 copayment $60 copayment $15 copayment $50 copayment $50 copayment 80% coverage to $250
2,770.56 Gold Kaiser Permanente Gold 80 HMO 1000/40 (shop) $1000 ($2000 family) Fixed copays for most services $8200/16,400 family $40 copayment $60 copayment $15 copayment $50 copay (after $250 Rx ded) $50 copay (after $250 Rx ded) 80% coverage to $250 (after $250 Rx ded)
2,526.89 Gold Kaiser Permanente Gold 80 HSA HMO 1950/15 (shop) $1900/34000/$3800 family 55% coverage for most services $4500/$9000 family 85% coverage (after ded) 85% coverage (after ded) $15 copay after ded $15 copay after ded $15 copay after ded $15 copay after ded
2,535.00 Gold Kaiser Permanente Gold 80 HRA HMO 2250 $2250/$4500 family 75% coverage for most services $8500/17,000 family $35 copayment $50 copayment $15 copayment $30 copayment (aftr $100 Rx ded) $30 copayment (aftr $100 Rx ded) 80% cov up to $250 per Rx after $100 Rx ded
3,124.37 Gold Kaiser Permanente Gold 80 250/35 KP HMO Plus $250 ($500 family) Fixed copays for most services $7800/15,600 family $35 copayment $55 copayment $15 copayment $40 copayment $40 copayment 80% coverage to $250
2,340.12 Silver Kaiser Permanente Silver 70 HMO 2000/65 (shop) $2000/$4000 family 55% coverage for most services $8900/178000 family $65 copayment $100 copayment $20 copay $100 copayment $100 copayment 80% cov $250 max ben (after medical ded)
2,375.88 Silver Kaiser Permanente Silver 70 HMO 2300/65 (shop) $2300/$4600 family 55% coverage for most services $9100/18,200 family $65 copayment $100 copayment $20 copay $100 copay (after $500 Rx ded) $100 copay (after $500 Rx ded) 80% cov $250 max (after $500 Rx ded)
2,391.79 Silver Kaiser Permanente Silver 70 HMO 2500/55 (shop) $2500/$5000 family Fixed copays for most services $8750/17,500 family $55 copayment $90 copayment $19 copay $85 copay (after $300 Rx ded) $85 copay (after $300 Rx ded) 65% cov $250 max (after $300 Rx ded)
2,295.13 Silver Kaiser Permanente Silver 70 HMO 3100/75 (shop) $3100/$6200 family Fixed copays for most services $9800/19,600 family $55 copayment $10 copayment 20 copay $100 copayment $100 copayment 65% cov $250 max (after $300 Rx ded)
2,217.20 Silver Kaiser Permanente Silver 70 HSA HMO 2850/25 (shop) $3200 or $3400 ($6400 family) 75% coverage for most services $7500/15,000 family 75% coverage (ded applies) 75% coverage (ded applies) 75% coverage to $250 (med ded applies) 75% coverage to $250 (med ded applies) 75% coverage to $250 (med ded applies) 75% coverage to $250 (med ded applies)
2,158.29 Bronze Kaiser Permanente Bronze 60 HMO 5800/60 (shop) $5800/$11,600 family 60% coverage for most services $9800/19,600 family $60 copay (ded waived) $95 copayment (ded applies) $25 copay 60% coverage to $500 ($450 Rx ded applies) 60% coverage to $500 ($450 Rx ded applies) 60% coverage to $500 ($450 Rx ded applies)
2,092.02 Bronze Kaiser Permanente Bronze 60 HMO HSA (shop) $6650/$13,300 family 100% coverage for most services $6650/$13,300 family 100% coverage (after deductible) 100% coverage (after deductible) 100% coverage (after deductible) 100% coverage (after deductible) 100% coverage (after deductible) 100% coverage (after deductible)
6,280.37 Platinum Kaiser PPO Platinum 90 PPO 0/15 None 90% coverage for most services $4500/$9000 family $15 copayment $30 copayment $10 copayment $25 copayment $25 copayment 90% cov up to $250 per Rx
5,758.96 Gold Kaiser PPO Gold 80 PPO 350/25 $350 ($700 family) 80% coverage for most services $7800/15,600 family $25 copayment $50 copayment $15 copayment $50 copayment $50 copayment 80% coverage to $250 (ded waived)
4,887.85 Silver Kaiser PPO Silver 70 PPO 2500/55 $2500/$5000 family 65% coverage for most services $8750/17,500 family $55 copayment $90 copayment $19 copay $85 copay (after $300 Rx ded) $85 copay (after $300 Rx ded) 70% cov $250 max (after $300 Rx ded)
4,450.18 Bronze Kaiser PPO Bronze 60 PPO 5800/60 $5800/$11,600 family 60% coverage for most services $9800/19,600 family $60 copayment $95 copay first 3 visits then deductible applies $20 copay 60% cov $500 max after $450 Rx ded 60% cov $500 max after $450 Rx ded 60% cov $500 max after $450 Rx ded