Page 32 - 2020 Benefit

A Guide to Your Health and Wellness Benefits | 2020

Medical Coverage – HMO and PPO options

The Company offers a choice of medical plan options through Kaiser Permanente and Anthem Blue Cross so you can choose the plan
that best meets your needs – and those of your family. Each plan includes comprehensive health care benefits, including free
preventive care services and coverage for prescription drugs.

Deductible HMO
Deductible HMO
Medic
Kaiser Plans al Coverage – HMO and PPO options $1,500/$40 Copay
Traditional HMO 30
$1,000/$20 Copay
The Company offers a choice of medical plan options through Blue Shield of California so you can choose the plan that best meets
Annual deductible (Individual/family) None $1,000/$2,000 $1,500/$3,000
your needs – and those of your family. Each plan includes comprehensive health care benefits, including free preventive care
services and coverage for prescription drugs.
Out-of-pocket maximum (Includes $3,000/$6,000 $3,000/$6,000 $4,000/$8,000
deductible)
Lifetime maximum Unlimited Unlimited Unlimited

Preventive care 100% 100% 100%

Primary physician office visit $30 copay $20 copay $40 copay

Specialist office visit
With referral from PCP $30 copay $20 copay $40 copay

Inpatient hospital services $500 per day Ded, then 20% coinsurance Ded, then 30% coinsurance

Outpatient surgery
$250 copay
Surgery Center Ded, then 20% coinsurance Ded, then 30% coinsurance
Urgent care $30 copay $20 copay $40 copay

Emergency room care $150 copay Ded, then 20% coinsurance Ded, then 30% coinsurance

Prescription drug deductible None None None
(Individual/family)
Retail prescription drugs
(30-day supply)
 Generic $10 copay $10 copay $10 copay
 Brand $30 copay $30 copay $30 copay

Mail order prescription drugs
(100-day supply)
$20 copay $20 copay $20 copay
 Generic $60 copay $60 copay $60 copay
 Brand

3 | 2020 Benefit Guide