Medical
Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.
Garner Health
Garner Health pairs alongside the PPO and HDHP plans at no cost to you. Garner uses data analytics to help you find the highest quality in-network doctors near you. When you visit a Garner Top Provider, Garner will reimburse you for qualifying out-of-pocket medical costs. Find more details about this exciting benefit on the Garner Health page.
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 10% for services and the plan will pay 90% of the cost until you have reached your out-of-pocket maximum.
PREMERA BLUE CROSS HDHP
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,700/$3,400
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
0%
Primary Care Visit
10%*
Specialist Visit
10%*
Urgent Care
10%*
Emergency Room
10%*
Retail Rx (Up to 30-Day Supply)
Generic
10%*
Preferred Brand
10%*
Non-Preferred Brand
10%*
Specialty Preferred
10%*
Mail-Order Rx (Up to 90-Day Supply)
Generic
10%*
Preferred Brand
10%*
Non-Preferred Brand
10%*
Specialty Preferred
10%*
*After deductible
Out-of-Network
Deductible (Individual/Family)
$1,700/$3,400
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
50%*
Primary Care Visit
50%*
Specialist Visit
50%*
Urgent Care
50%*
Emergency Room
10%*
Retail Rx (Up to 30-Day Supply)
Generic
50%*
Preferred Brand
50%*
Non-Preferred Brand
50%*
Specialty Preferred
50%*
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty Preferred
Not covered
Semi-Monthly Plan Cost
Employee Only: $0.00
Employee and Spouse: $25.61
Employee and Child(ren): $19.99
Employee and Family: $47.88
PREMERA BLUE CROSS PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$850/$1,700
Out-of-Pocket Max (Individual/Family)
$2,250/$4,500
Preventive Care
0%
Primary Care Visit
$15 copay then 0%
Specialist Visit
$15 copay then 0%
Urgent Care
$15 copay
Emergency Room
$100 copay then 10%* (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$20 copay
Non-Preferred Brand
$40 copay
Specialty
30%
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10 copay
Preferred Brand
$20 copay
Non-Preferred Brand
$40 copay
Specialty
30%
*After deductible
Out-of-Network
Deductible (Individual/Family)
$1,000/$2,000
Out-of-Pocket Max (Individual/Family)
$5,000/$10,500
Preventive Care
50%*
Primary Care Visit
50%*
Specialist Visit
50%*
Urgent Care
50%*
Emergency Room
$100 copay then 10%* (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$20 copay
Non-Preferred Brand
$40 copay
Specialty
30%
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Semi-Monthly Plan Cost
Employee Only: $47.86
Employee and Spouse: $175.77
Employee and Child(ren): $147.72
Employee and Family: $287.02
HMSA Medical Plan (Hawaii Only)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$2,500/$7,500
Preventive Care
$0
Primary Care Visit
$14 copay
Specialist Visit
$14 copay
Urgent Care
$14 copay
Emergency Room
20% coinsurance
Retail Rx (Up to 30-Day Supply)
Generic
$7 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$30 copay
Preferred Specialty
$100 copay
Non-PreferredSpecialty
$200 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$11 copay
Preferred Brand
$65 copay
Non-Preferred Brand
$65 copay
Preferred Specialty
Not covered
Non-PreferredSpecialty
Not covered
Out-of-Network
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$3,600/$4,200
Preventive Care
$0
Primary Care Visit
$14 copay
Specialist Visit
$14 copay
Urgent Care
$14 copay
Emergency Room
20% coinsurance
Retail Rx (Up to 30-Day Supply)
Generic
$7 copay and 20% coinsurance
Preferred Brand
$30 copay and 20% coinsurance
Non-Preferred Brand
$30 copay and 20% coinsurance
Preferred Specialty
Not covered
Non-PreferredSpecialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Preferred Specialty
Not covered
Non-PreferredSpecialty
Not covered
Semi-Monthly Plan Cost
Employee Only: $41.54
Employee and Spouse: $144.11
Employee and 1 Child: $144.11
Employee and 2+ Children: $246.68
Employee and Family: $246.68