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California Medical Coverage Level

Live in California?

Your options will be different, depending on the insurance carrier you choose.

For starters, each insurance carrier in California has the option to offer each coverage level either as an option that offers in- and out-of-network benefits (e.g., a PPO) or an option that offers in-network benefits only (e.g., an HMO).

Also, insurance carriers can choose to offer either the standard Gold option or a Gold II option—not both. The Gold II option offers only in-network benefits.

Review the table below to see which insurance carriers offer out-of-network benefits for the coverage levels you're considering.

Bronze Bronze Plus Silver Gold Gold II Platinum
Aetna

In- and out-of-network

In- and out-of-network

In- and out-of-network

In- and out-of-network

N/A

In- and out-of-network

Blue Cross Blue Shield of Illinois

In- and out-of-network

In- and out-of-network

In- and out-of-network

In- and out-of-network

N/A

In- and out-of-network

Cigna

In- and out-of-network

In- and out-of-network

In- and out-of-network

N/A

In-network only

In-network only

Health Net

Northern California
In-network only
Southern California
In- and out-of-network

Northern California
In-network only
Southern California
In- and out-of-network

Northern California
In-network only
Southern California
In- and out-of-network

N/A

In-network only

Northern California
In-network only
Southern California
In- and out-of-network

Kaiser Permanente

In-network only

In-network only

In-network only

N/A

In-network only

In-network only

United Healthcare

In- and out-of-network

In- and out-of-network

In- and out-of-network

In- and out-of-network

N/A

In- and out-of-network


Medical Coverage Level

Bronze Bronze Plus Silver Gold Gold II Platinum
Option type

High-deductible option with HSA

High-deductible option with HSA

High-deductible option with HSA

PPO

HMO

PPO that offers limited benefits for out-of-network care**

Paycheck contributions

$

$

$$

$$$

$$$

$$$$

Annual Deductible
In-network (individual / family)

$3,300 / $6,600

$2,450 / $4,900

$1,500 / $3,000

$800 / $1,600

N / A

$250 / $500

Out-of-network (individual / family)

$3,300 / $6,600

$2,450 / $4,900

$1,500 / $3,000

$1,600 / $3,200

N / A

$5,000 / $10,000

Traditional or true family?

Traditional

True family

True family

Traditional

N / A

Traditional

Annual Out-of-Pocket Maximum
In-network (individual / family)

$6,400 / $12,800

$3,900 / $7,800

$3,800 / $7,600

$3,600 / $7,200

$5,400 / $10,800

$2,300 / $4,600

Out-of-network (individual / family)

$12,800 / $25,600

$11,500 / $23,000

$8,000 / $16,000

$7,200 / $14,400

N / A

$11,500 / $23,000

Traditional or true family?

Traditional

True family

True family

Traditional

Traditional

Traditional

In-Network Benefits
Preventive care

Covered 100%, no deductible

Covered 100%, no deductible

Covered 100%, no deductible

Covered 100%, no deductible

Covered 100%

Covered 100%, no deductible

Doctor's office visit

You pay 25% after deductible

You pay 25% after deductible

You pay 25% after deductible

You pay $25 for PCP visit and $40 for specialist visit, no deductible

You pay $25 for PCP visit and $40 for specialist visit

You pay $25 for PCP visit and $40 for specialist visit, no deductible

Emergency room

You pay 25% after deductible

You pay 25% after deductible

You pay 25% after deductible

You pay 25% after deductible

You pay 30%

You pay 15% after deductible

Urgent care

You pay 25% after deductible

You pay 25% after deductible

You pay 25% after deductible

You pay 25% after deductible

You pay 30%

You pay 15% after deductible

Inpatient care

You pay 25% after deductible

You pay 25% after deductible

You pay 25% after deductible

You pay 25% after deductible

You pay 30%

You pay 15% after deductible

Outpatient care

You pay 25% after deductible

You pay 25% after deductible

You pay 25% after deductible

If not an office visit, you pay 25% after deductible

If not an office visit, you pay 30%

You pay 15% after deductible


Prescription Drug Coverage

Bronze Bronze Plus Silver Gold Gold II Platinum
Preventive drugs You pay $0** You pay $0** You pay $0** You pay $0** You pay $0** You pay $0**
30-Day Retail Supply
Tier 1 (generally lowest cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $10 You pay $10 You pay $8
Tier 2 (generally medium cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $40 You pay $40 You pay $30
Tier 3 (generally highest cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $60 You pay $60 You pay $50
90-Day Mail Order Supply
Tier 1 (generally lowest cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $25 You pay $25 You pay $20
Tier 2 (generally medium cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $100 You pay $100 You pay $75
Tier 3 (generally highest cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $150 You pay $150 You pay $125


Out-of-Area: Your specific options are based on your home zip code. If you live outside the service areas of all the insurance carriers, you can choose an out-of-area option at the Silver coverage level. Aetna will be the insurance carrier. (Note: The Silver option available to out-of-area individuals is different than the Silver option on this site. Refer to upoint.aon.com for details.)

Choosing a Primary Care Physician: Certain options require you to choose a primary care physician. You must designate a primary care physician to coordinate your care if you:

  • Choose Kaiser Permanente as your insurance carrier;
  • Live in Northern California and choose Health Net as your insurance carrier; or
  • Live in Southern California and choose Health Net as your insurance carrier and Gold II as your coverage level.

Do You Take Any Prescription Drugs?

This is really important! Your prescription drug coverage will be provided through your insurance carrier’s pharmacy benefit manager.

While your coverage level will determine your coverage for prescription drugs, each pharmacy benefit manager has its own rules. You need to make sure you’re comfortable with how the insurance carrier will cover any medications you and your covered family members need. Get the details.


Questions?

It’s easy to find answers! Check out the Frequently Asked Questions (PDF) and the Glossary.


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