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| Plan | Bronze 60 HDHP 7000/0 (shop) | Bronze 60 HMO 5400/60 (shop) | Bronze 60 HMO 6300/65 (shop) | Silver 70 HMO 2600/55 (shop) | Silver 70 HMO 2100/55 (shop) | Silver 70 HMO 2250/55 (shop) | Silver 70 HMO 1650/55 (shop) |
| Metal | Bronze | Bronze | Bronze | Silver | Silver | Silver | Silver |
| Network | Kaiser Permanente | Kaiser Permanente | Kaiser Permanente | Kaiser Permanente | Kaiser Permanente | Kaiser Permanente | Kaiser Permanente |
| Deductible | $7000/$14,000 family | $5400/$10,800 family | $6300/$12,600 family | $2600/$5200 family | $2100/$4200 family | $2250/$4500 family | $1650/$3300 family |
| Coinsurance | 100% coverage for most services | 50% coverage for most services | 60% coverage for most services | 55% coverage for most services | 55% coverage for most services | 70% coverage for most services | 60% coverage for most services |
| Out of Pocket Mzx | $7000/$14,000 family | $8200/16,400 family | $8200/16,400 family | $8200/16,400 family | $8200/16,400 family | $8200/16,400 family | $8200/16,400 family |
| Ambulance | 100% coverage (after deductible) | 50% coverage (after ded) | 60% coverage (after ded) | 55% coverage (ded applies) | 55% coverage (after ded) | 70% coverage (ded applies) | 60% coverage (after ded) |
| Chiropractor | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered |
| Durable Med Equip | 100% coverage (after deductible) | 50% coverage (after ded) | 60% coverage (after ded) | 55% coverage | 55% coverage | 70% coverage | 60% coverage (after ded) |
| Emergency Room | 100% coverage (after deductible) | 50% coverage (after ded) | 60% coverage (after ded) | 55% coverage (ded applies) | 55% coverage (after ded) | 70% coverage (ded applies) | 60% coverage (after ded) |
| Hospital | 100% coverage (after deductible) | 50% coverage (after ded) | 60% coverage (after ded) | 55% coverage (ded applies) | 55% coverage (after ded) | 70% coverage (ded applies) | 60% coverage (after ded) |
| Infertility | Optional | Optional | Optional | Optional | Optional | Optional | Optional |
| Lab & X-Ray | 100% coverage (after deductible) | 50% coverage (after ded) | Lab $40/X-ray 60% coverage (after ded) | $30 lab/$75 X-ray | $30 lab/$75 X-ray | $55 lab/$90 X-ray | $30 lab/$75 X-ray after ded |
| Office Visit | 100% coverage (after deductible) | $60 copay first 3 visits then deductible applies | $65 copayment first 3 visits then deductible applies | $55 copayment | $55 copayment | $55 copayment | $55 copayment |
| Specialist | 100% coverage (after deductible) | $80 copay first 3 visits then deductible applies | $95 copayment first 3 visits then deductible applies | $80 copayment | $80 copayment | $90 copayment | $80 copayment |
| Outpatient Surgery | 100% coverage (after deductible) | 50% coverage (after ded) | 60% coverage (after ded) | 55% coverage (ded applies) | 55% coverage (after ded) | 70% coverage (ded applies) | 60% coverage (after ded) |
| Physical Therapy | 100% coverage (after deductible) | $65 copayment | $65 copayment | $65 copayment | $65 copayment | $55 copayment | $65 copayment |
| Inpatient Psych | 100% coverage (after deductible) | 50% coverage (after ded) | 60% coverage (after ded) | 55% coverage (ded applies) | 55% coverage (after ded) | 70% coverage (ded applies) | 60% coverage (after ded) |
| Outpatient Psych | 100% coverage (after deductible) | $60 copay first 3 visits then deductible applies | $65 copayment first 3 visits then deductible applies | $55 copayment | $55 copayment | $55 copayment | $55 copayment |
| Rx Tier 1 | 100% coverage (after deductible) | $20 copay | $500 Rx ded then $18 ded per Rx | $20 copay | $20 copay | $500 Rx ded then $17 ded per Rx | $20 copay |
| Rx Tier 2 | 100% coverage (after deductible) | 50% coverage to $500 (med ded applies) | 60% coverage to $500 (med ded applies) | $75 copay (after med ded) | $75 copay (after $500 Rx ded) | $65 copay (after $300 Rx ded) | $75 copay (after $350 Rx ded) |
| Rx Tier 3 | 100% coverage (after deductible) | 50% coverage to $500 (med ded applies) | 60% coverage to $500 (med ded applies) | $75 copay (after med ded) | $75 copay (after $500 Rx ded) | $65 copay (after $300 Rx ded) | $75 copay (after $350 Rx ded) |
| Rx Tier 4 | 100% coverage (after deductible) | 50% coverage to $500 (med ded applies) | 60% coverage to $500 (med ded applies) | 55% coverage to $250 (plan ded applies) | 80% cov $250 max (after $500 Rx ded) | 80% cov $250 max ben (after $300 Rx ded) | 80% cov $250 max ben (after $350 Rx ded) |
| Links | Brochure Formulary Providers | Brochure Formulary Providers | Brochure Formulary Providers | Brochure Formulary Providers | Brochure Formulary Providers | Brochure Formulary Providers | Brochure Formulary Providers |
| Bandon Miller | 367.55 fam 1378.12 | 384.93 fam 1441.32 | 392.63 fam 1469.3 | 447.48 fam 1668.7 | 455.12 fam 1696.47 | 460.25 fam 1715.12 | 463.53 fam 1727.05 |
| Darren Virassammy | 313.15 fam 1040.69 | 327.96 fam 1088.59 | 334.52 fam 1109.8 | 381.25 fam 1260.93 | 387.76 fam 1281.98 | 392.13 fam 1296.11 | 394.93 fam 1305.16 |
| Theresa Maalouf | 250.91 | 262.78 | 268.03 | 305.48 | 310.69 | 314.19 | 316.44 |
| Zane Grace | 256.79 | 268.94 | 274.31 | 312.64 | 317.97 | 321.56 | 323.85 |
| Total | 1188.40 w deps 2926.51 | 1244.61 w deps 3061.63 | 1269.49 w deps 3121.44 | 1446.85 w deps 3547.75 | 1471.54 w deps 3607.11 | 1488.13 w deps 3646.98 | 1498.75 w deps 3672.50 |