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| Plan | Silver Priority Select HMO 60/2500/45 WH 6BWN | Silver Priority Select HMO 55 6BR7 | Salud HMO Silver $50 | SmartCare HMO Silver $50 | Silver Select HMO 60/2500/45 6BRP | Silver Select HMO 60/2500/45 WH 6BWJ | PureCare Bronze 60 HSP 6300/65 + Child Dental | Silver HMO 60/2500/45 6BRT | Silver Select HMO 55 6BR3 | Silver Local Access HMO 2750/65 OffEx | Full Network HMO Silver $50 | Silver Local Access HMO 2000/60 OffEx | Silver AccessPlus HMO 2750/65 OffEx | WholeCare HMO Silver $50 | Silver HMO 55 6BQZ | Silver AccessPlus HMO 2000/60 OffEx | Bronze 60 PPO 6300/65 + Child Dental | PureCare Silver 70 HSP 2250/50 + Child Dental | Silver 70 PPO 2250/50 + Child Dental |
| Metal | Silver | Silver | Silver | Silver | Silver | Silver | Bronze | Silver | Silver | Silver | Silver | Silver | Silver | Silver | Silver | Silver | Bronze | Silver | Silver |
| Network | Priority Select HMO | Priority Select HMO | Salud HMO | SmartCare HMO | Select HMO | Select HMO | PureCare HSP | CaliforniaCare HMO | Select HMO | Local Access HMO Network | Full Network HMO | Local Access HMO Network | AccessPlus HMO | Wholecare HMO | CaliforniaCare HMO | AccessPlus HMO | Full PPO | PureCare HSP | Full PPO |
| Deductible | $2500/$5000 family | None | None | None | $2500/$5000 family | $2500/$5000 family | $6300/$12,600 family | $2500/$5000 family | None | $2750/$5500 family | None | $2000/$4000 family | $2750/$5500 family | None | None | $2000/$4000 family | $6300/$12,600 famly | $2250/$4500 famly | $2250/$4500 family |
| Coinsurance | 55% coverage for most services | Fixed copays for most services | 50% coverage for most services | 50% coverage for most services | 55% coverage for most services | 55% coverage for most services | 60% coverage for most services | 55% coverage for most services | Fixed copays for most services | Fixed copays for most services | 50% coverage for most services | Fixed copays for most services | Fixed copays for most services | 50% coverage for most services | Fixed copays for most services | Fixed copays for most services | 60% coverage for most services | 80% coverage for most services | 60% coverage for most services |
| Out of Pocket Mzx | $8700/$17,400 family | $8700/$17,400 family | $7950/$15,900 family | $7950/$15,900 family | $8700/$17,400 family | $8700/$17,400 family | $8200/$16,400 family | $8700/$17,400 family | $8700/$17,400 family | $8350/$16,700 family | $7950/$15,900 family | $8350/$16,700 family | $8350/$16,700 family | $7950/$15,900 family | $8700/$17,400 family | $8350/$16,700 family | $8200/$16,400 family | $8200/$16,400 family | $8200/$16,000 failily |
| Ambulance | $350 copay then 55% coverage | $500 copayment | 50% coverage | 50% coverage | $350 copay then 55% coverage | $350 copay then 55% coverage | 60% coverage (ded applies) | $350 copay then 55% coverage | $500 copayment | $175 copayment (after ded) | 50% coverage | $175 copayment (after ded) | $175 copayment (after ded) | 50% coverage | $500 copayment | $175 copayment (after ded) | 60% coverage (ded applies) | 70% coverage (ded applies) | 60% coverage (ded applies) |
| Chiropractor | 20 visits max (other limitations apply) | 20 visits max (other limitations apply) | Optional | Optional | 20 visits max (other limitations apply) | 20 visits max (other limitations apply) | Optional | 20 visits max (other limitations apply) | 20 visits max (other limitations apply) | $15 copayment (20 visits max) | Optional | $15 copayment (20 visits max) | $15 copayment (20 visits max) | Optional | 20 visits max (other limitations apply) | $15 copayment (20 visits max) | Optional | Optional | Optional |
| Durable Med Equip | 50% coverage (ded applies) | 50% coverage (ded applies) | 50% coverage | 50% coverage | 50% coverage (ded applies) | 50% coverage (ded applies) | 60% coverage (ded applies) | 50% coverage (ded applies) | 50% coverage (ded applies) | 50% coverage (after deductible) | 50% coverage | 50% coverage (after deductible) | 50% coverage (after deductible) | 50% coverage | 50% coverage (ded applies) | 50% coverage (after deductible) | 60% coverage (ded applies) | 70% coverage (ded applies) | 60% coverage (ded applies) |
| Emergency Room | $350 copay then 55% coverage | $500 copayment | 50% coverage | 50% coverage | $350 copay then 55% coverage | $350 copay then 55% coverage | 60% coverage (ded applies) | $350 copay then 55% coverage | $500 copayment | 50% coverage (after deductible) | 50% coverage | 50% coverage (after deductible) | 50% coverage (after deductible) | 50% coverage | $500 copayment | 50% coverage (after deductible) | 60% coverage (ded applies) | 70% coverage (ded applies) | 60% coverage (ded applies) |
| Hospital | 55% coverage (ded applies) | $650 daily 1st 5 days | 50% coverage | 50% coverage | 55% coverage (ded applies) | 55% coverage (ded applies) | 60% coverage (ded applies) | 55% coverage (ded applies) | $650 daily 1st 5 days | 55% coverage (after deductible) | 50% coverage | 60% coverage (after deductible) | 55% coverage (after deductible) | 50% coverage | $650 daily 1st 5 days | 60% coverage (after deductible) | 60% coverage (ded applies) | 70% coverage (ded applies) | 60% coverage (ded applies) |
| Infertility | Optional | Optional | Optional | Optional | Optional | Optional | Optional | Optional | Optional | Optional | Optional | Optional | Optional | Optional | Optional | Optional | Optional | Optional | Optional |
| Lab & X-Ray | $20 lab/$350 X-ray copayment | $20 lab/$350 X-ray copayment | Lab: $40 copay/X-ray $50 copay | Lab: $40 copay/X-ray $50 copay | $20 lab/$350 X-ray copayment | $20 lab/$350 X-ray copayment | Lab: $40 copay (ded waived)/X-ray 60% cov (ded applies) | $20 lab/$350 X-ray copayment | $20 lab/$350 X-ray copayment | Lab: $55 copay/X-ray: $115 | Lab: $40 copay/X-ray $50 copay | Lab: $55 copay/X-ray: $100 | Lab: $55 copay/X-ray: $115 | Lab: $40 copay/X-ray $50 copay | $20 lab/$350 X-ray copayment | Lab: $55 copay/X-ray: $100 | Lab: $40 copay (ded waived)/X-ray $60% cov (ded applies) | Lab: $50 copay /X-ray $85 copay | Lab: $50 copay (ded waived)/X-ray $85 copay (ded waived) |
| Office Visit | $60 copayment | $55 copayment | $50 copayment | $50 copayment | $60 copayment | $60 copayment | $65 copay 1st 3 visits then ded applies | $60 copayment | $55 copayment | $65 copayment | $50 copayment | $60 copayment | $65 copayment | $50 copayment | $55 copayment | $60 copayment | $65 copay 1st 3 visits then ded applies | $50 copayment | $50 copayment |
| Specialist | $110 copayment | $110 copayment | $70 copayment | $70 copayment | $110 copayment | $110 copayment | $95 copay 1st 3 visits then ded applies | $110 copayment | $110 copayment | $80 copayment | $70 copayment | $80 copayment | $80 copayment | $70 copayment | $110 copayment | $80 copayment | $95 copay 1st 3 visits then ded applies | $85 copayment | $85 copayment |
| Outpatient Surgery | 55% coverage (ded applies) | $600 copayment | 50% coverage | 50% coverage | 55% coverage (ded applies) | 55% coverage (ded applies) | 60% coverage (ded applies) | 55% coverage (ded applies) | $600 copayment | $250 or $1000 copay after ded | 50% coverage | $250 or $1000 copay after ded | $250 or $1000 copay after ded | 50% coverage | $600 copayment | $250 or $1000 copay after ded | 60% coverage (ded applies) | 70% coverage (ded applies) | 60% coverage (ded applies) |
| Physical Therapy | $60 copayment | $55 copayment | $50 copayment | $50 copayment | $60 copayment | $60 copayment | $65 copayment | $60 copayment | $55 copayment | $65 copayment | $50 copayment | $55 copayment | $65 copayment | $50 copayment | $55 copayment | $55 copayment | $65 copayment | $50 copayment | $50 copayment |
| Inpatient Psych | 55% coverage (ded applies) | $650 daily 1st 5 days | 50% coverage | 50% coverage | 55% coverage (ded applies) | 55% coverage (ded applies) | 60% coverage (ded applies) | 55% coverage (ded applies) | $650 daily 1st 5 days | 55% coverage (after deductible) | 50% coverage | 60% coverage (after deductible) | 55% coverage (after deductible) | 50% coverage | $650 daily 1st 5 days | 60% coverage (after deductible) | 60% coverage (ded applies) | 70% coverage (ded applies) | 60% coverage (ded applies) |
| Outpatient Psych | $60 copayment | $55 copayment | $50 copayment | $50 copayment | $60 copayment | $60 copayment | $65 copay 1st 3 visits then ded applies | $60 copayment | $55 copayment | $65 copayment | $50 copayment | $60 copayment | $65 copayment | $50 copayment | $55 copayment | $60 copayment | $95 copay 1st 3 visits then ded applies | $50 copayment | $50 copayment |
| Rx Tier 1 | $15 copayment | $15 copayment | $20 copayment | $20 copayment | $15 copayment | $15 copayment | $18 copay after $500 Rx ded | $15 copayment | $15 copayment | $20 copayment | $20 copayment | $20 copayment | $20 copayment | $20 copayment | $15 copayment | $20 copayment | $18 copay after ded | $17 copay | $17 copayment |
| Rx Tier 2 | $70 copay (after $200 Rx ded) | $90 copay (after $400 Rx ded) | 50% (after $750 Rx ded) | 50% (after $750 Rx ded) | $70 copay (after $200 Rx ded) | $70 copay (after $200 Rx ded) | 60% cov after $500 Rx ded | $70 copay (after $200 Rx ded) | $90 copay (after $400 Rx ded) | $85 copayment | 50% (after $750 Rx ded) | $85 copayment (after $400 Rx ded) | $85 copayment | 50% (after $750 Rx ded) | $90 copay (after $400 Rx ded) | $85 copayment (after $400 Rx ded) | 60% cov up to $500 per Rx after Rx ded | $70 copay (after $300 RX ded) | $70 copayment after $300 Rx ded |
| Rx Tier 3 | $70 copay (after $200 Rx ded) | $120 copay (after $400 Rx ded) | 50% (after $750 Rx ded) | 50% (after $750 Rx ded) | $70 copay (after $200 Rx ded) | $70 copay (after $200 Rx ded) | 60% cov after $500 Rx ded | $70 copay (after $200 Rx ded) | $120 copay (after $400 Rx ded) | $115 copayment (after medical ded) | 50% (after $750 Rx ded) | $115 copayment (after $400 Rx ded) | $115 copayment (after medical ded) | 50% (after $750 Rx ded) | $120 copay (after $400 Rx ded) | $115 copayment (after $400 Rx ded) | 60% cov up to $500 per Rx after Rx ded | $100 copay (after $300 RX ded) | $100 copayment ($300 Rx ded applies) |
| Rx Tier 4 | 70% coverage to $250 max ($200 Rx ded applies) | 70% coverage to $250 max ($400 Rx ded applies) | 50% (after $750 Rx ded) | 50% (after $750 Rx ded) | 70% coverage to $250 max ($200 Rx ded applies) | 70% coverage to $250 max ($200 Rx ded applies) | 60% cov up to $500 per Rx after $500 Rx ded | 70% coverage to $250 max ($200 Rx ded applies) | 70% coverage to $250 max ($400 Rx ded applies) | 55% cov to $250 after medical ded | 50% (after $750 Rx ded) | 60% cov to $250 after $35 Rx ded | 55% cov to $250 after medical ded | 50% (after $750 Rx ded) | 70% coverage to $250 max ($400 Rx ded applies) | 60% cov to $250 after $35 Rx ded | 60% cov up to $500 per Rx after Rx ded | 70% coverage up to $300 per Rx after $300 Rx ded | 60% coverage (up to $300 per Rx after ded) |
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| Elenor | 368.03 fam 693.12 | 379.91 fam 715.49 | 401.73 fam 756.59 | 403.91 fam 760.69 | 407.04 fam 766.59 | 428.57 fam 807.14 | 429.02 fam 807.98 | 441.83 fam 832.11 | 443.25 fam 834.79 | 460.07 fam 866.46 | 471.8 fam 888.55 | 474.75 fam 894.11 | 475.73 fam 895.95 | 476.82 fam 898.01 | 481.19 fam 906.24 | 490.97 fam 924.66 | 498.89 fam 939.57 | 549.33 fam 1034.57 | 581 fam 1094.21 |
| Kim | 332.94 | 343.69 | 363.43 | 365.4 | 368.24 | 387.71 | 388.12 | 399.7 | 400.99 | 416.21 | 426.82 | 429.49 | 430.37 | 431.36 | 435.31 | 444.16 | 451.32 | 496.96 | 525.61 |
| Total | 700.97 w deps 1026.06 | 723.60 w deps 1059.18 | 765.16 w deps 1120.02 | 769.31 w deps 1126.09 | 775.28 w deps 1134.83 | 816.28 w deps 1194.85 | 817.14 w deps 1196.10 | 841.53 w deps 1231.81 | 844.24 w deps 1235.78 | 876.28 w deps 1282.67 | 898.62 w deps 1315.37 | 904.24 w deps 1323.60 | 906.10 w deps 1326.32 | 908.18 w deps 1329.37 | 916.50 w deps 1341.55 | 935.13 w deps 1368.82 | 950.21 w deps 1390.89 | 1046.29 w deps 1531.53 | 1106.61 w deps 1619.82 |