Medical
Medical coverage offers healthcare protection for you and your family. You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.
Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers. The key difference between the plans is the amount of money you’ll pay each pay period and when you need care.
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 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Cigna HDHP
Plan Information
Plan Name: Cigna HDHP
Policy Number: 00627843
Effective Date: 01/01/2025
Network: Cigna
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,300/$6,000
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
$0
Primary Care Visit
20% after deductible
Specialist Visit
20% after deductible
Urgent Care
20% after deductible
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
20% after deductible
Preferred Brand
20% after deductible
Non-Preferred Brand
20% after deductible
Specialty
20% after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
20% after deductible
Preferred Brand
20% after deductible
Non-Preferred Brand
20% after deductible
Specialty
20% after deductible
Out-of-Network
Deductible (Individual/Family)
$6,600/$12,000
Out-of-Pocket Max (Individual/Family)
$10,000/$20,000
Preventive Care
40% after deductible
Primary Care Visit
40% after deductible
Specialist Visit
40% after deductible
Urgent Care
40% after deductible
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Plan Documents
Contact Information
Cigna One Guide: (888) 806-5094
Member Services: (800) 244-6224
Specialty Medications: (877) 505-3681
Cigna PPO
Plan Information
Plan Name: Cigna PPO
Policy Number: 00627843
Effective Date: 01/01/2025
Network: Cigna
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,000/$2,000
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
$0
Primary Care Visit
$25 copay
Specialist Visit
$40 copay
Urgent Care
$50 copay
Emergency Room
$150 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay
Specialty
20% up to $200
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Specialty
20% up to $400 maximum
Out-of-Network
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$8,000/$16,000
Preventive Care
40% after deductible
Primary Care Visit
40% after deductible
Specialist Visit
40% after deductible
Urgent Care
$100 copay
Emergency Room
$150 copay
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Plan Documents
Contact Information
Cigna One Guide: (888) 806-5094
Member Services: (800) 244-6224
Specialty Medications: (877) 505-3681
Kaiser HDHP
Plan Information
Plan Name: Kaiser HDHP
Policy Number:
California (CA): 608225
California (CA): SCAL 236842
Colorado (CO): 47365
Georgia (GA): 10771
Mid-Atlantic: (MD) 34401
Northwest (OR/WA): 25947
Washington (WA): TBD
Effective Date: 01/01/2025
Provider Network: Kaiser
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,300/$6,600
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
No charge
Primary Care Visit
20% after deductible
Specialist Visit
20% after deductible
Urgent Care
20% after deductible
Emergency Room
20% after deductible
Retail RX (Up to 30-Day Supply)
Generic
Deductible then $15 copay
Preferred Brand
Deductible then $35 copay
Non-Preferred Brand
Deductible then $70 copay for CO/GA/MD/OR/WA; Deductible then $35 copay for CA
Specialty
Deductible then 20% up to $250 for CA/CO/GA/OR/WA; Deductible then 20% up to $150 for MD (Mid-Atlantic)
Mail-Order RX (Up to 90-Day Supply)
Generic
Deductible then $30 copay
Preferred Brand
Deductible then $70 copay
Non-Preferred Brand
Deductible then $140 copay for CO/GA/MD/OR/WA; Deductible then $70 copay for CA
Specialty
Deductible then 20% up to $250 for CA/CO/GA/OR/WA; Deductible then 20% up to $150 for MD (Mid-Atlantic)
Plan Documents
2025 Kaiser HDHP Summary of Benefits & Coverage (CO)
2025 Kaiser HDHP Summary of Benefits & Coverage (GA)
2025 Kaiser HDHP Summary of Benefits & Coverage (MAS)
2025 Kaiser HDHP Summary of Benefits & Coverage (NCAL)
2025 Kaiser HDHP Summary of Benefits & Coverage (NW)
Contact Information
California (CA)
NCAL Policy No. 608225
SCAL policy No. 236842
kp.org/ca
Member services: (800) 464-4000
Colorado (CO)
Policy No. 47365
kp.org/colorado
Member services: (800) 464-4000
Georgia (GA)
Policy No. 10771
kp.org/georgia
Member services: (888) 865-5813
Mid-Atlantic (MD)
Policy No. 34401
kp.org/mid-atlantic
Member services: (800) 777-7902
Northwest (OR/WA)
Policy No. 25947
kp.org/northwest
Member services:
Portland (503) 813-2000
Outside Portland (800) 813-2000
SW Washington (800) 813-2000
Washington (WA)
Policy No. TBD
kp.org/wa
Member services: (888) 901-4636
Kaiser DHMO
Plan Information
Plan Name: Kaiser DHMO
Policy Number:
California (CA): 608225
California (CA): SCAL 236842
Colorado (CO): 47365
Georgia (GA): 10771
Mid-Atlantic: (MD) 34401
Northwest (OR/WA): 25947
Washington (WA): TBD
Effective Date: 01/01/2025
Provider Network: Kaiser
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,000/$2,000
Out-of-Pocket Max (Individual/Family)
$3,500/$7,000
Preventive Care
No charge
Primary Care Visit
$20 copay
Specialist Visit
$30 copay
Urgent Care
$30 copay for CO/GA/MD/OR;
$20 copay for CA & WA
Emergency Room
$200 copay waived if admitted
Retail RX (90-day supply for CO/GA/MD/OR/WA; 100-day supply for CA)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay for CO/GA/MD/OR/WA; $30 copay for CA
Specialty
20% up to $250 for CA/CO/GA/OR/WA; 20% up to $150 for MD (Mid-Atlantic)
Mail-Order RX (90-day supply for CO/GA/MD/OR/WA; 100-day supply for CA)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay for CO/GA/MD/OR/WA; $60 copay for CA
Specialty
20% up to $250 for CA/CO/GA/OR/WA;
20% up to $150 for MD (Mid-Atlantic)
Plan Documents
2025 Kaiser DHMO Summary of Benefits & Coverage (CO)
2025 Kaiser DHMO Summary of Benefits & Coverage (GA)
2025 Kaiser DHMO Summary of Benefits & Coverage (MAS)
2025 Kaiser DHMO Summary of Benefits & Coverage (NCAL)
2025 Kaiser DHMO Summary of Benefits & Coverage (NW)
Contact Information
California (CA)
NCAL Policy No. 608225
SCAL policy No. 236842
kp.org/ca
Member services: (800) 464-4000
Colorado (CO)
Policy No. 47365
kp.org/colorado
Member services: (800) 464-4000
Georgia (GA)
Policy No. 10771
kp.org/georgia
Member services: (888) 865-5813
Mid-Atlantic (MD)
Policy No. 34401
kp.org/mid-atlantic
Member services: (800) 777-7902
Northwest (OR/WA)
Policy No. 25947
kp.org/northwest
Member services:
Portland (503) 813-2000
Outside Portland (800) 813-2000
SW Washington (800) 813-2000
Washington (WA)
Policy No. TBD
kp.org/wa
Member services: (888) 901-4636