|  | | | |
| Plan | Bronze 60 HMO 5400/60 (shop) | Silver 70 HMO 2300/65 (shop) | Silver 70 HMO 1900/65 (shop) | Gold 80 HMO 1000/40 (shop) |
| Metal | Bronze | Silver | Silver | Gold |
| Network | Kaiser Permanente | Kaiser Permanente | Kaiser Permanente | Kaiser Permanente |
| Deductible | $5400/$10,800 family | $2300/$4600 family | $1900/$3800 family | $1000 ($2000 family) |
| Coinsurance | 50% coverage for most services | 55% coverage for most services | 55% coverage for most services | Fixed copays for most services |
| Out of Pocket Mzx | $8600/17,200 family | $8750/17,500 family | $8750/17,500 family | $7800/15,600 family |
| Ambulance | 50% coverage (after ded) | 55% coverage (after ded) | 55% coverage (after ded) | $350 copayment (after ded) |
| Chiropractor | $15 copay (20 visits ann max) | $15 copay (20 visits ann max) | $15 copay (20 visits ann max) | $15 copay (20 visits ann max) |
| Durable Med Equip | 50% coverage (after ded) | 55% coverage (ded applies) | 55% coverage (after ded) | 80% coverage |
| Emergency Room | 50% coverage (after ded) | 55% coverage (ded applies) | 55% coverage (after ded) | $350 copayment |
| Hospital | 50% coverage (after ded) | 55% coverage (ded applies) | 55% coverage (after ded) | $600 per day 1st 5 days (ded applies) |
| Infertility | Optional | Optional | Optional | Optional |
| Lab & X-Ray | 50% coverage (after ded) | $30 lab/$75 X-ray after ded | $30 lab/$75 X-ray after ded | $30 lab/$60 X-ray |
| Office Visit | $60 copay 1st 3 visits then ded applies | $65 copayment | $65 copayment | $40 copayment |
| Specialist | $80 copay 1st 3 visits then deductible applies | $100 copayment | $100 copayment | $60 copayment |
| Outpatient Surgery | 50% coverage (after ded) | 65% coverage (after ded) | 55% coverage (after ded) | $350 copayment (ded applies) |
| Physical Therapy | $65 copayment | $55 copayment | $65 copayment | $40 copayment |
| Inpatient Psych | 50% coverage (after ded) | 55% coverage (ded applies) | 55% coverage (after ded) | $600 per day 1st 5 days (ded applies) |
| Outpatient Psych | $60 copay 1st 3 visits then ded applies | $65 copayment | $65 copayment | $40 copayment |
| Rx Tier 1 | $20 copay | $20 copay | $20 copay | $20 copayment |
| Rx Tier 2 | 50% coverage to $500 (med ded applies) | $100 copay (after $500 Rx ded) | $100 copayment | $50 copay (after $250 Rx ded) |
| Rx Tier 3 | 50% coverage to $500 (med ded applies) | $100 copay (after $500 Rx ded) | $100 copayment | $50 copay (after $250 Rx ded) |
| Rx Tier 4 | 50% coverage to $500 (med ded applies) | 80% cov $250 max (after $370 Rx ded) | 80% cov $250 max ben (after medical ded) | 80% coverage to $250 (after $250 Rx ded) |
| Links | Brochure Formulary Providers | Brochure Formulary Providers | Brochure Formulary Providers | Brochure Formulary Providers |
| Edward | 395.81 | 464.97 | 474.27 | 548.45 |
| JJ | 452.49 fam 753.13 | 531.56 fam 882.29 | 542.19 fam 899.66 | 626.99 fam 1038.18 |
| Jerry | 604.07 | 709.63 | 723.83 | 837.03 |
| Kevin | 408.76 | 480.19 | 489.79 | 566.4 |
| Total | 1861.13 w deps 2161.77 | 2186.35 w deps 2537.08 | 2230.08 w deps 2587.55 | 2578.87 w deps 2990.06 |