Which Medical Plan is Right?
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 your cost share 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.
Medical Plan Comparison
Meyers Nave gives you a choice between three plans through Anthem and two medical plans through Kaiser Permanente. Please note: HMO plans are for California Employees Only.
| Kaiser HMO | Kaiser HDHP | Anthem HMO HRA | Anthem PPO HRA | Anthem HDHP | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| In-Network | In-Network | In-Network | In-Network | Out-Of-Network | In-Network | Out-Of-Network | ||||||||
| Annual Deductible | None | Individual: $3,400 Family: $6,800 |
Individual: $3,000 Family: $6,000 |
Individual: $3,000 Family: $6,000 |
Individual: $9,000 Family: $18,000 |
Individual: $2,000 | Family: $5,000 If enrolled as Member + Family Coverage, then Deductibles are: Individual: $3,400 | Family: $5,000 |
Individual: 6,000 Family: $12,000 | |||||||
| Coinsurance | N/A | N/A | 70% | 70% | 50% | 90% | 70% | |||||||
| Lifetime Max | Unlimited | Unlimited | Unlimited | Unlimited | Unlimited | Unlimited | Unlimited | |||||||
| Office Visit | ||||||||||||||
| Primary Provider | $20 copay | No charge after deductible | $30 copay | $30 Copay | 50%* | 90%* | 70%* | |||||||
| Specialist | $20 copay | No charge after deductible | $50 copay | $60 copay | 50%* | 90%* | 70%* | |||||||
| Lab and X-ray | No charge | No charge after deductible | No charge | $60 copay | 50%* | 90%* | 70%* | |||||||
| Inpatient Surgery | $500 copay per admission | No charge after deductible | 70% | $750 Copay/Admin. | 50% | 90%* | 70%* | |||||||
| Outpatient Surgery | $20 copay per procedure | No charge after deductible | 70% | $500 Copay* | 50%* | 90%* | 70%* | |||||||
| Emergency Room | $50 copay | No charge after deductible | $250 copay then 70%* | $250 Copay* (Deductible Waived if Admitted) | $250 Copay* (Deductible Waived if Admitted) | 90%* | 70%* | |||||||
| Annual Out-of-Pocket Max | Individual: $1,500 Family: $3,000 |
Individual: $3,400 Family $6,800 |
Individual: $6,400 Family: $12,800 |
Individual: $8,000 Family: $16,000 |
Individual: $24,000 Family: $48,000 |
Individual: $4,250 Family: $8,500 |
Individual: $12,750 Family: $25,500 | |||||||