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Medical Coverage Level

In a hurry? Get the highlights the easy way—just watch the video! (Closed captioning is available.)

Which Coverage Level Is Best?

You get to choose how much coverage you need and how you want to pay for it. It’s up to you! When you choose your coverage level, you get to pick the one with the features you want. If you’re enrolling again, consider what changes you may be facing. Change is constant, so make sure you do your homework before sticking with what you had in the past.

Your coverage level determines how much you pay out of your paycheck (premiums). It also determines how much you pay out of your pocket when you receive care (deductibles, coinsurance, copays).

Don’t let the names of the coverage levels fool you. One option isn’t better than another. The coverage levels are designed to give you choices. It’s up to you to find the one that makes sense for your situation.


Medical Coverage Level Options

You have several coverage levels to choose from. Each coverage level is available from different insurance carriers at different costs.

When you enroll, you’ll find plenty of tools and resources to help you choose a coverage level.

Bronze Bronze Plus Silver Gold Platinum
Option type High-deductible option with HSA High-deductible option with HSA High-deductible option with HSA PPO 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 $250 / $500
Out-of-network (individual / family) $3,300 / $6,600 $2,450 / $4,900 $1,500 / $3,000 $1,600 / $3,200 $5,000 / $10,000
Traditional or true family? Traditional True family True family Traditional 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 $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 $11,500 / $23,000
Traditional or true family? Traditional True family True family 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%, 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, 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 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 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 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 You pay 15% after deductible

Prescription Drug Coverage

Bronze Bronze Plus Silver Gold Platinum
Preventive drugs 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 $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 $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 $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 $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 $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 $125


California Residents: Your options will be different, depending on the insurance carrier you choose. See what's different.

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.


Make It Yours To Go