Page 5 - Marcus & Millichap EE Guide 2020

Medical Benefits - California

Kaiser Anthem Anthem
Plan Features
CA - HMO CA - Classic HMO CA - Classic PPO
Kaiser CaCare Prudent Buyer
Network Non-Network
Network Network Network
Health Benefits
Lifetime Maximum Benefit Unlimited Unlimited Unlimited
Deductible (Annual)
- Individual $0 $0 $250 $750
- Family $0 $0 $750 $2,250

Co-Insurance (Plan Pays) 100% 100% 80% after Ded 60% after Ded
Office Visit Copay
- Primary Care Physician $25 Copay $30 Copay $20 Copay 60%
- Specialist Office Visit $25 Copay $40 Copay $20 Copay 60%
- Online Visit $0 Copay $10 copay $10 Copay 60%
(Live Health App) (Live Health App)
Out-of-Pocket Maximum
- Individual $1,500 $2,500 $2,500 $7,500
- Family $3,000 $5,000 $5,000 $15,000

Hospitalization
- Inpatient $500/Admit $500/Admit 80% 60%, Max $1,000
Ben/Day
- Outpatient $25 Copay $250 Copay 80% 60%, Max $350
Ben/Admit
Lab and X-Ray (Advanced Imag- 100% 100% 80% 60%
ing may vary)
Emergency Services $50 Copay $100 Copay $150 Copay, 80%
Urgent Care $25 Copay $30 Copay $20 Copay 60%
Preventive Care 100% 100% 100% 60%

Chiropractic $10 Copay $30 Copay $20 Copay 60%
Max 30 Visits/Year 60-Day Period Max 30 Visits/Year
Pharmacy Benefits
Retail Pharmacy `
- Tier 1 (a or b) $10 Copay $5 T1a / $20 T1b $5 T1a / $20 T1b $5 or $20 + 50% 1
1
- Tier 2 $20 Copay $30 Copay $30 Copay $30 Copay + 50%
- Tier 3 N/A $50 Copay $50 Copay $50 Copay + 50% 1
- Tier 4 20%, Max $150 30% Max $250 30% Max $250 30% Max $250
- Supply Limit 30 Days 30 Days 30 Days 30 Days
Mail Order Pharmacy
- Tier 1 (a or b) Generic: $20 Copay $12.50 T1a / $50 T1b $12.50 T1a / $50 Not Covered
- Tier 2 Brand: $40 Copay $90 Copay T1b Not Covered
- Tier 3 N/A $150 Copay $90 Copay Not Covered
- Tier 4 N/A 30% Max $250 $150 Copay Not Covered
- Supply Limit 100 Days 90 Days 30% Max $250 N/A
90 Days
1. Copay + 50% of the remaining Rx drug max allowed & costs in excess of Rx drug max allowed.

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