Overview

Review the chart below to compare the coverage provided by each plan.* The chart below shows what you pay out-of-pocket.

Plan features $900 $900 $1,500 $1,500 $2,850 $2,850 $4,500 $4,500 $6,550 $6,550
HSA eligible? No No No No Yes Yes Yes Yes Yes Yes
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Annual deductible
Individual $900 $3,000 $1,500 $3,000 $2,850 $5,700 $4,500 $9,000 $6,550 $13,100
Family $1,800 $6,000 $3,000 $6,000 $5,700 $11,400 $9,000 $18,000 $13,100 $26,200
Out-of-pocket maximum (includes deductible)
Individual $4,800 $9,600 $5,200 $10,400 $6,550 $13,100 $6,550 $13,100 $6,550 $13,100
Family $9,600 $19,200 $10,400 $20,800 $13,100 $26,200 $13,100 $26,200 $13,100 $26,200
Coinsurance 20% 40% 20% 40% 30% 50% 30% 50% 0% 0%
Preventive 100% 60% 100% 60% 100% 50% 100% 50% 100% 100%
Primary care doctor/specialist 20% 40% 20% 40% 30% 50% 30% 50% 0% 0%
Hospital facility (inpatient, outpatient, emergency room) 20% 40% 20% 40% 30% 50% 30% 50% 0% 0%
* If you live in Hawaii, your medical plan options will be available on the enrollment site.

Meeting the family deductible and out-of-pocket maximum

In all of the medical plans, if you enroll in family coverage, once one family member meets the individual deductible, the plan begins paying coinsurance for that person. When that family member meets the individual out-of-pocket maximum, the plan will pay the full cost for any expenses incurred by that one person for the rest of the year.

Once the family deductible is met, the plan will pay coinsurance for all covered family members. The same applies to the out-of-pocket maximum.

Summaries of Benefits and Coverage

You have access to a Summary of Benefits and Coverage (SBC) and Plan Summaries for each of your medical plan options. These documents provide detailed information about coverage and costs to help you compare plans and make informed decisions. To access the SBCs and Plan Summaries, see Forms and Guides.