Zip: 92804 Apply Apply Apply
Monthly Total 2542.49 2617.44 2630.48
Plan Name Silver 70 Trio HMO Exchange Bronze 60 HDHP PPO Gold 80 HMO Coinsurance
Deductible $5200 ($10,400 family) $7200 ($14,400 per family) None
Coinsurance 70% coverage for most services Not applicable 70% coverage for most services
Out of Pocket Max $9800 (19,600 family) $7200 ($14,400 per family) $9200($18,400 per family)
Ambulance $250 copayment 100% coverage after deductible is met $250 copayment
Chiropractic Not covered Not covered Not covered
Durable Medical Equipt 80% coverage 100% coverage after deductible is met 80% coverage
Emergency Room $400 copay 100% coverage after deductible is met $350 copay
Hospital Stay 70% coverage (ded applies) 100% coverage after deductible is met 70% coverage
Lab & X-ray $50 lab/$95 x-ray 100% coverage after deductible is met $40 lab/$75 x-ray
Office Visit $50 copayment 100% coverage after deductible is met $40 copayment
Specialist $90 copayment 100% coverage after deductible is met $70 copayment
Physical Therapy $50 copayment 100% coverage after deductible is met $40 copayment
Outpatient Surgery 70% coverage (ded waived) 100% coverage after deductible is met 70% coverage
Psych (Inpatient) 70% coverage 100% coverage after deductible is met 70% coverage
Psych (Outpatient) $50 copayment 100% coverage after deductible is met $40 copayment
Rx Tier 1 $19 copayment 100% coverage after deductible is met $18 copayment
Rx Tier 2 $60 copayment (after $50 Rx ded) 100% coverage after deductible is met $60 copayment
Rx Tier 3 $90 copayment (after $50 Rx ded) 100% coverage after deductible is met $60 copayment
Rx Tier 4 80% coverage up to $250 per Rx (after $50 Rx ded) 100% coverage after deductible is met 80% coverage up to $250 per Rx
Links Brochure Providers Formulary Brochure Providers Formulary Brochure Providers Formulary
Subscriber (55) 908.61 935.40 940.06
Spouse (53) 831.20 855.70 859.96
Child (22) 407.45 419.46 421.55
Child (20) 395.23 406.88 408.90
Annual Premium Tota $ 30,510 $ 31,409 $ 31,566
Annual Max Exposure $ 40,310Family: $ 50,110 $ 38,609Family: $ 45,809 $ 40,766Family: $ 49,966
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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