Plan-Comparison

Kaiser Permanente Bronze HMO C 2020 Kaiser Permanente Silver HMO B Kaiser Permanente Gold HMO B Anthem Blue Cross Silver HMO A (Network: Select) Anthem Blue Cross Silver HMO B (Network: CaliforniaCare) Anthem Blue Cross Gold HMO A (Network: Select) Anthem Blue Cross Gold HMO B (Network: CaliforniaCare) Anthem Blue Cross Bronze PPO A - HSA Compatible (Network: Prudent Buyer)

Per Pay Period (Semi-Monthly) $39.13 $67.78 $97.52 $72.83 $95.70 $109.16 $137.77 $108.87

Deductible Individual: $6,900

Individual: $1,650
Individual: $250
Individual: $2,200
Individual: $2,200
Individual: $0
Individual: $0
Individual: $5,400

Family: $13,800 Family: $3,300 Family: $500 Family: $4,400 Family: $4,400 Family: $0 Family: $0 Family: $10,800

O ce Visit Primary Care/Specialist: 100% after deductible Primary Care: $55 copay, deductible waived
Primary Care: $25 copay, deductible waived
Primary Care: $60 copay, deductible waived
Primary Care: $60 copay, deductible waived
Primary Care: $30 copay
Primary Care: $30 copay
35% after deductible
Specialist: $80 copay, deductible waived Specialist: $50 copay, deductible waived Specialist: $110 copay, deductible waived Specialist: $110 copay, deductible waived Specialist: $55 copay Specialist: $55 copay

Inpatient 100% after deductible 40% after deductible Facility Fee: $600 copay per day; 5 days max per admission
Facility Fee: 45% after deductible
Facility Fee: 45% after deductible
Facility Fee: $500 copay per day; 4 days max per admission
Facility Fee: $500 copay per day; 4 days max per admission
35% after deductible
Physician Fee: no charge, deductible waived Physician Fee: no charge, deductible waived Physician Fee: no charge, deductible waived Physician Fee: no charge Physician Fee: no charge

Outpatient 100% after deductible 40% after deductible $340 copay per procedure, deductible waived 45% after deductible 45% after deductible $500 copay per admission $500 copay per admission 35% after deductible

Emergency Room 100% after deductible, waived if admitted 40% after deductible, waived if admitted $250 copay per visit, waived if admitted $350 copay and then 45% after deductible, copay waived if admitted $350 copay and then 45% after deductible, copay waived if admitted $300 copay per visit, waived if admitted $300 copay per visit, waived if admitted 35% after deductible

Rx Rx Deductible: Medical deductible applies

Rx Deductible: $350
Rx Deductible: $0
Rx Deductible: $300
Rx Deductible: $300
Rx Deductible: $0
Rx Deductible: $0
Rx Deductible: Medical deductible applies

All Tiers: 100% after deductible Generic: $20 copay, deductible waived
Generic: $15 copay
Generic: $20 copay, deductible waived
Generic: $20 copay, deductible waived
Generic: $15 copay
Generic: $15 copay
All Tiers: 35% after deductible up to $500 per prescription
Formulary Brand: $75 copay after deductible
Formulary Brand: $50 copay
Formulary Brand: $80 copay after deductible
Formulary Brand: $80 copay after deductible
Formulary Brand: $40 copay
Formulary Brand: $40 copay

Non-Formulary Brand: $75 copay after deductible

Non-Formulary Brand: $50 copay

Non-Formulary Brand: $110 copay after deductible
Non-Formulary Brand: $110 copay after deductible
Non-Formulary Brand: $80 copay
Non-Formulary Brand: $80 copay

Specialty: 20% after deductible up to $250 perSpecialty:

prescription
20% up to $250 per prescription Specialty: 30% after deductible up to $250 per prescription Specialty: 30% after deductible up to $250 per prescription Specialty: 30% up to $250 per prescription Specialty: 30% up to $250 per prescription

Lab & X-Ray 100% after deductible Lab: $25 copay, deductible waived
Lab: $25 copay, deductible waived
Lab: $55 copay, deductible waived
Lab: $55 copay, deductible waived
Lab: $25 copay
Lab: $25 copay
35% after deductible
X-ray: $75 copay X-ray: $65 copay, deductible waived X-ray: $90 copay, deductible waived X-ray: $90 copay, deductible waived X-ray: $40 copay X-ray: $40 copay

Out-of-Network

Out-of-Pocket Maximum Individual: $6,900

Individual: $7,800
Individual: $7,800
Individual: $8,150
Individual: $8,150
Individual: $5,800
Individual: $5,800
Individual: $6,900

Family: $13,800 Family: $15,600 Family: $15,600 Family: $16,300 Family: $16,300 Family: $11,600 Family: $11,600 Family: $13,800

1
ffi
 Anthem Blue Cross Silver PPO A (Network: Advantage) Anthem Blue Cross Gold PPO E (Network: Prudent Buyer) Oscar Bronze EPO A - HSA Compatible Oscar Silver EPO C Oscar Gold EPO B UnitedHealthcare Bronze HMO B - HSA Quali ed - (Network: Alliance) UnitedHealthcare Silver HMO B (Network: Advantage) UnitedHealthcare Gold HMO A (Network: SignatureValue)

$137.04 $174.01 $49.56 $67.04 $100.29 $42.59 $69.38 $108.13

Individual: $1,600
Individual: $500
Individual: $6,900
Individual: $1,500
Individual: $250
Individual: $6,900
Individual: $2,250
Individual: $1,250

Family: $3,200 Family: $1,500 Family: $13,800 Family: $3,000 Family: $500 Family: $13,800 Family: $4,500 Family: $2,500

Primary Care: $45 copay, deductible waived

Primary Care: $30 copay, deductible waived
Primary Care/Specialist: 100% after deductible Primary Care: $50 copay, deductible waived
Primary Care: $25 copay, deductible waived
Primary Care/Specialist: 100% after deductible Primary Care: $55 copay, deductible waived
Primary Care: $30 copay, deductible waived

Specialist: $90 copay, deductible waived Specialist: $60 copay, deductible waived Specialist: $75 copay, deductible waived Specialist: $50 copay, deductible waived Specialist: $80 copay, deductible waived Specialist: $60 copay, deductible waived

Tier 1: Facility Fee/Physician Fee: 40% after deductible

20% after deductible 100% after deductible 50% after deductible Facility Fee: $600 copay per day; 5 days max per admission
100% after deductible Facility Fee: 40% after deductible
Facility fee: 30% after deductible

Tier 2: Facility Fee: $500 copay per admission, then 40% after deductible
Physician Fee: no charge, deductible waived Physician Fee: 40%, deductible waived Physician fee: 30%, deductible waived
Physician Fee: 40% after deductible

Tier 1: 40% after deductible

$250 copay per admission, then 20% after deductible 100% after deductible 50% after deductible $300 copay per visit, deductible waived 100% after deductible 40% after deductible 30% after deductible
Tier 2: $250 copay per admission, then 40% after deductible

$350 copay and then 40% after deductible; copay waived if admitted $250 copay and then 20% after deductible, copay waived if admitted 100% after deductible, waived if admitted $750 copay (deductible waived), waived if admitted $250 copay per visit, waived if admitted 100% after deductible, waived if admitted 40% after deductible, waived if admitted 30% after deductible, waived if admitted

Rx Deductible: $350
Rx Deductible: $200
Rx Deductible: Medical deductible applies
Rx Deductible: Medical deductible applies
Rx Deductible:$ 0
Rx Deductible: Medical deductible applies
Rx Deductible: $300
Rx Deductible: $250

Generic: $20 copay, deductible waived

Generic: $15, deductible waived
All Tiers: 100% after deductible Generic: $25 copay, deductible waived
Generic: $15 copay
All Tiers: 100% after deductible Generic: $20 copay, deductible waived
Generic: $15 copay, deductible waived

Formulary Brand: $50 copay after deductible

Formulary Brand: $40 copay after deductible
Formulary Brand: $55 copay, deductible waived
Formulary Brand: $50 copay
Formulary Brand: $50 copay after deductible
Formulary Brand: $40 copay after deductible

Non-Formulary Brand: $90 copay after deductible

Non-Formulary Brand: $80 copay after deductible
Non-Formulary Brand: $125 copay, deductible waived
Non-Formulary Brand: $80 copay
Non-Formulary Brand: $100 copay after deductible
Non-Formulary Brand: $80 copay after deductible

Specialty: 30% after deductible up to $250 per prescription Specialty: 30% after deductible up to $250 per prescription Specialty: 50% after deductible up to $250 per prescription
Specialty: 20% up to $250 per prescription Specialty: 25% after deductible up to $250 per prescriptionSpecialty: 25% after deductible up to $250 per prescription

Lab: $45 copay, deductible waived

Lab: $30 copay, deductible waived
100% after deductible $75 copay, deductible waived Lab: $25 copay, deductible waived
100% after deductible $45 copay, deductible waived $30 copay, deductible waived
X-ray: $90 copay, deductible waived X-ray: $60 copay, deductible waived X-ray: $65 copay, deductible waived

Individual: $8,000
Individual: $5,100
Individual: $6,900
Individual: $8,150
Individual: $7,800
Individual: $6,900
Individual: $8,150
Individual: $6,500

Family: $16,000 Family: $10,200 Family: $13,800 Family: $16,300 Family: $15,600 Family: $13,800 Family: $16,300 Family: $13,000

2
fi