Healthcare Compare 2019 Plans

The information contained in this comparison tool is not the official statement of benefits. Before making your final enrollment decision, always refer to the individual FEHB brochure which is the official statement of benefits. The amounts shown below indicate what you will pay for each class of service. When you see a plus sign (+), it means you must pay the stated coinsurance AND any difference between your Plan’s allowance and the provider’s billed amount. When a “yes” appears indicating that there is coverage for a specific service, you must check the plan brochure for your cost share. NOTE: HDHP plans require that the combined medical and pharmacy deductible be met before traditional coverage begins.

Self

Self Plus One

Self & Family

	Aetna Open Access (High)	Health Net of California (High)	Kaiser Foundation Health Plan of California (High)	Panama Canal Area Benefit Plan (High)
Plan Links
	Website Brochure Summary of Benefits Provider Directory RX Pricing Tool	Website Brochure Summary of Benefits Provider Directory RX Pricing Tool	Website Brochure Summary of Benefits Provider Directory RX Pricing Tool	Website Brochure Summary of Benefits Provider Directory RX Pricing Tool
General Information
State	California	California	California	California
Enrollment Code - Self	2X1	LP1	621	431
Enrollment Code - Self & Family	2X2	LP2	622	432
Enrollment Code - Self Plus One	2X3	LP3	623	433
Carrier Code	2X	LP	62	43
Plan Type	HMO	HMO	HMO	FFS
Telephone Number	877-459-6604	800-522-0088	800-464-4000	800-424-8196
Costs & Network
Biweekly Premium	$122.40 $319.24 $302.42	$228.15 $516.06 $574.68	$86.99 $240.77 $207.72	$69.40 $138.51 $144.87
	HMO	HMO	HMO	Non-PPO	PPO
Annual Deductible Annual Deductible: The amount you may have to pay for covered health care services before the plan begins to pay. Some plans have both an overall deductible for all or most covered items/services, but some also have separate deductibles for specific types of services (e.g. prescription services).	None None None	None None None	None None None	None None None	None None None
Type of Account	None	None	None	None	None
Medical Account Contribution The amount of funds available to you for paying your out-of-pocket qualified medical expenses through a premium pass-through contribution or a virtual account.	N/A	N/A	N/A	N/A	N/A
Net Deductible After you use your Medical Account, this is the sum of money you owe before your insurer pays your claims.	None None None	None None None	None None None	None None None	None None None
Annual Out-of-Pocket Maximum Annual Maximum Out of Pocket: Yearly amount the Federal government sets as the most each individual or family is required to pay in cost sharing (e.g. copayments, deductibles and coinsurance) during the plan year for covered, in-network services. This amount may be higher than the out of pocket limits the plan sets.	$5,000.00 $7,900.00 $7,900.00	$1,500.00 $3,000.00 $4,500.00	$2,000.00 $4,000.00 $4,000.00	$2,500.00 $2,500.00 $2,500.00	None None None
Medicare Coordination
Deductible Waiver If a member has Medicare A & B , does your plan waive its deductible	No	N/A	No	No	No
Copay Waiver If a member has Medicare A & B, does your plan waive its copayment requirements	No	No	No	No	No
Coinsurance Waiver If a member has Medicare A & B, does your plan waive its coinsurance requirements	No	No	No	No	No
Services & Benefits
	HMO	HMO	HMO	Non-PPO	PPO
Primary/Specialty Care This is your cost share.
Preventive care Preventive Care: Routine health care (including screenings, check-ups and patient counseling) to prevent or discover illness, disease or other health problems covered at no cost to members. FEHB plans follow guidance from the U.S. Preventive Services Task Force and cover all services with a rating of A or B. See http://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/	You pay nothing	You pay nothing	You pay nothing	You pay nothing	You pay nothing
Primary Care Office Visit Primary Care Physician: An M.D. (Medical Doctor) or D.O. (Doctor of Osteopathic Medicine) who provides or coordinates a range of health care services for you.	$20	$20	$15	50% +	$5
Specialist Office Visit Specialist: A provider focusing on a specific area of medicine. Some plans, including many HMOs, require a referral from your primary care provider for you to see a specalist. When plans require a referral, you must get it or the plan may not pay for the services.	$35	$30	$25	50% +	$5
Requires referral to see certain specialists Must a member get a referral to see a specialist	Yes	Yes	Yes	No	Yes
Emergency & Urgent Care This is your cost share.
Emergency Care Medical emergency: An illness, injury or symptom (including pain) severe enough to risk serious danger to your health if you do not get immediate medical attention. If you do not get medical attention immediately, you could reasonably expect your health to be in serious danger, serious problems with your bodily functions or serious damage to any part of your body.	$125	$100	$100	50% +	$5
Urgent Care Urgent Care: Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but no so severe as to require emergency room care. Urgent Care Center: freestanding walk in facility other than a hospital providing immediate medical care	$50	$20	$15	50% +	$5
Surgery & Hospital Charges This is your cost share.
Doctor Costs Inpatient Surgery How much will a member pay for a doctor to perform inpatient surgery	You pay nothing	You pay nothing	You pay nothing	50% +	You pay nothing
Hospital Inpatient Cost Per Admission This is the amount a member pays before the Plan pays benefits when the member is admitted as an inpatient at a hospital.	$250/day up to $1,000/admit	$150/day up to $750/admit	$250	$100	$25
Room & Board Charges This is the amount a member pays for covered Room & Board charges while an inpatient in a hospital.	You pay nothing	You pay nothing	You pay nothing	50% +	You pay nothing
Other inpatient costs How much will a member pay for other costs for inpatient surgery	You pay nothing	You pay nothing	You pay nothing	50% +	You pay nothing
Doctor Costs Outpatient Surgery How much will a member pay for a doctor to perform surgery in an outpatient hospital or ambulatory surgery center	You pay nothing	You pay nothing	$50	50% +	You pay nothing
Other Outpatients Costs This is the amount a member pays for other outpatient care at a hospital (not surgery or emergency room services).	$175	$200	You pay nothing	50% +	You pay nothing
Lab, Xray & other diagnostic tests This is your cost share.
Simple diagnostic tests/procedures Simple diagnostic tests/procedures: Examples include blood tests, urinalysis, Xrays, ultrasounds and EEG. Plans cover some lab tests at no cost as preventive care, such as routine blood tests and urinalysis when provided in connection with a preventive health exam.	$20 min $35 max	You pay nothing	You pay nothing	50% +	You pay nothing
Complex diagnostic tests/procedures Complex diagnostic tests/procedures: Examples include CT scans, MRIs, PET scans and sleep labs. Some plans require preauthorization for these procedures so check the plan brochure.	$20 min $75 max	$250	You pay nothing	50% +	You pay nothing
Enhanced Lab Network Some plans offer an enhanced lab network. Under this benefit, the plan pays the full cost of outpatient lab testing when tests are ordered by the physician and approved by the health plan. If you choose not to use the enhanced lab network, the normal cost sharing and/or coinsurance will apply. Please check the plan brochure for specific information.	$20 min $75 max	You pay nothing	N/A	50% +	You pay nothing
Prescription Drugs (For more information visit the plans Medication Pricing Tool) This is your cost share.
Separate Annual Out-of-Pocket Maximum	None	2900	None	None	None
Separate Annual Deductible	None	None	None	None	None
Retail Generic What is the member cost share for retail generic prescription drugs	$10 / $100	$10	$10	20%	20%
Retail Brand What is the member cost share for retail brand prescription drugs	$35 / $100	$35 - $60	$40	20%	20%
Specialty What is the member cost share for specialty prescription drugs	50% $350 max / 50% $700 max	20% - 20% $200 max	$100	20%	20%
Mail Service Pharmacy Benefit Do you offer a mail service pharmacy benefit	Yes	$20 - $120	Yes	No	No
Medication Pricing Tool	Go To RX Pricing Tool	Go To RX Pricing Tool	Go To RX Pricing Tool	Go To RX Pricing Tool
Treatment Therapies This is your cost share.
ABA What is the member cost share for ABA coverage	$35	You pay nothing	$15/day	No	No
Chiropractic What is the member cost share for chiropractic care	$35	$10	$15	50% +	$10
Occupational therapy What is the member cost share for occupational therapy	$35	You pay nothing	$15	50% +	You pay nothing
Physical therapy What is the member cost share for physical therapy	$35	You pay nothing	$15	50% +	You pay nothing
Speech therapy What is the member cost share for speech therapy	$35	You pay nothing	$15	50% +	You pay nothing
Dental This is your cost share.
Preventive Dental for Adults Preventive dental care includes routine check ups to prevent or discover possible oral health disease.	Yes	No	No	Yes	Yes
Minor Restorative for Adults Minor restorative dental care includes such services as fillings (amalgam/silver), composite and pin restoration, local anesthesia, and emergency treatment (palliative).	Yes	No	No	No	No
Minor Restorative for Children Minor restorative dental care includes such services as fillings (amalgam/silver), composite and pin restoration, local anesthesia, and emergency treatment (palliative).	Yes	No	No	No	No
Major Restorative for Adults Major restorative includes such services as endodontics, periodontics, crowns, partial and complete dentures and prosthodontics.	No	No	No	No	No
Major Restorative for Children Major restorative includes such services as endodontics, periodontics, crowns, partial and complete dentures and prosthodontics.	No	No	No	No	No
Preventive for Children "Yes" indicates that the Plan covers preventive dental care AND limits the coverage to children. Preventive care includes such services as oral exams, cleaning and bite wing X-rays.	Yes	No	No	Yes	Yes
Orthodontic Orthodontics includes braces and retainers used to correct the positioning of teeth.	No	No	No	No	No
Vision This is your cost share.
Routine Eye Exams Does your plan cover routine eye examinations that result in a prescription for eyeglasses or contact lenses	Yes	$30	Yes	No	No
Eye Exams for Medical Condition or Non-Surgical Tr Does your plan cover eye examinations related to a specific medical condition and non-surgical eye treatments	Yes	$30	Yes	No	No
Eyeglass Frames & Lenses Does your plan cover eyeglass frames or lenses	Yes	No	No	No	No
Contacts Does your plan cover contact lenses	Yes	You pay all charges	No	No	No
Alternative Care This is your cost share.
Alternative Care Alternative Care Description	Yes	Yes	Yes	Yes	Yes
Quality The measures below show how well a plan provides or coordinates care for its enrollees.
Key: Outstanding Excellent Good Fair Poor NA is displayed if a plan did not report or is unable to report a result in this coverage area.
Breast Cancer Screening Do women who need screening mammograms get them?
Comprehensive Diabetes Care - HbA1c Control (<8%) Do people with diabetes have their condition under control?
Avoidance of Antibiotics in Adults with Acute Bronchitis Appropriate use of antibiotics for accute bronchitis
Follow-up After Hospital for Mental Illness (30-day)* Follow-up appointment within 30 days of discharge.
Controlling High Blood Pressure People with high blood pressure receive effective treatment.
Timeliness of Prenatal Care Pregnant women receive care in the first trimester.
Use of Imaging Studies for Low Back Pain Appropriate treatment of lower back pain.
Well Child Visits in the first 15 Months of Life Recommended well-child visits completed.
Asthma Medication Ratio Appropriate ratio of controller medications to total asthma medications
Plan All Cause Readmissions Reduced likelihood of readmission following inpatient hospital stay.
Customer Service The measures below show what people think about their plan.
Overall Health Plan Rating How pleased are customers with the plan overall?
Claims Processing How quickly do customers say the plan handles claims?
Customer Service How satisfied are customers with the plan's customer service?
Getting Needed Care Members report getting the care they need.
Coordination of Care Members say that their doctors know about care from other providers