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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
Self Plus One
Self Plus One
Self & Family
Self & Family
Aetna Open Access (High) Health Net of California (High) Kaiser Foundation Health Plan of California (High) Panama Canal Area Benefit Plan (High)
 General Information
State California California California California
Enrollment Code - Self 2X1 Self LP1 Self 621 Self 431 Self
Enrollment Code - Self & Family 2X2 Self & Family LP2 Self & Family 622 Self & Family 432 Self & Family
Enrollment Code - Self Plus One 2X3 Self Plus One LP3 Self Plus One 623 Self Plus One 433 Self Plus One
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
Self
$319.24
Self Plus One
$302.42
Self & Family
$228.15
Self
$516.06
Self Plus One
$574.68
Self & Family
$86.99
Self
$240.77
Self Plus One
$207.72
Self & Family
$69.40
Self
$138.51
Self Plus One
$144.87
Self & Family
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
Self
None
Self Plus One
None
Self & Family
None
Self
None
Self Plus One
None
Self & Family
None
Self
None
Self Plus One
None
Self & Family
None
Self
None
Self Plus One
None
Self & Family
None
Self
None
Self Plus One
None
Self & Family
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
Self
None
Self Plus One
None
Self & Family
None
Self
None
Self Plus One
None
Self & Family
None
Self
None
Self Plus One
None
Self & Family
None
Self
None
Self Plus One
None
Self & Family
None
Self
None
Self Plus One
None
Self & Family
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
Self
$7,900.00
Self Plus One
$7,900.00
Self & Family
$1,500.00
Self
$3,000.00
Self Plus One
$4,500.00
Self & Family
$2,000.00
Self
$4,000.00
Self Plus One
$4,000.00
Self & Family
$2,500.00
Self
$2,500.00
Self Plus One
$2,500.00
Self & Family
None
Self
None
Self Plus One
None
Self & Family
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
Control Panel