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Healthcare Compare 2020 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
$170.63
Self
$431.28
Self Plus One
$407.64
Self & Family
$248.09
Self
$560.37
Self Plus One
$614.79
Self & Family
$103.65
Self
$280.34
Self Plus One
$237.99
Self & Family
$72.52
Self
$144.75
Self Plus One
$151.38
Self & Family
In-Network 1 Out-of-Network In-Network 1 Out-of-Network In-Network 1 In-Network 1 Out-of-Network
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
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 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
N/A
N/A
Net Deductible
A net deductible is the sum of your deductible minus any medical account fund.
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
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
$10,000.00
Self Plus One
$10,000.00
Self & Family
None
Self
None
Self Plus One
None
Self & Family
$1,500.00
Self
$3,000.00
Self Plus One
$4,500.00
Self & Family
None
Self
None
Self Plus One
None
Self & Family
$2,000.00
Self
$4,000.00
Self Plus One
$4,000.00
Self & Family
None
Self
None
Self Plus One
None
Self & Family
$2,500.00
Self
$2,500.00
Self Plus One
$2,500.00
Self & Family
Medicare Coordination
 Services & Benefits
In-Network 1 Out-of-Network In-Network 1 Out-of-Network In-Network 1 In-Network 1 Out-of-Network
  Member Cost with Medicare A & B Primary
This is your cost share.
Deductible Waiver
This field will indicate either the amount of your annual deductible or that the deductible has been waived (forgiven) when Medicare A and B is the primary coverage.
N/A N/A N/A N/A N/A N/A N/A
Out-of-Pocket Maximum
This is the most you have to pay annually in cost-sharing (deductibles, copayments and coinsurance) for covered, in-network services in your FEHB plan when Medicare A and B is your primary coverage.
$5000 N/A $1500 $3000 $4500 N/A $2000 $5000 $5000 $2500
Primary Care Office Visit with Medicare A & B Primary
This is the amount you pay for a primary care visit. When you have Medicare A and B, some plans will waive the copay.
$20 N/A $20 N/A $10 $5 Coinsurance Waived Copayment Waived
Specialty Office Visit
This is the amount you pay for a Specialty care visit. When you have Medicare A and B, some plans will waive the copay.
$35 N/A $30 N/A $10 $5 Coinsurance Waived Copayment Waived
Inpatient Hospital
This is the amount you pay for an inpatient hospital stay. When you have Medicare A and B, some plans waive this amount.
$250 Per Day Up To $1000 Per Admission N/A $150 Per Day Up To $750 Per Admission N/A $250 $25 Coinsurance Waived Copayment Waived
Outpatient Hospital
This is the amount you pay for an outpatient hospital visit when you have Medicare Parts A & B as your primary coverage.What is the amount a member with Medicare A and B pays for an outpatient hospital visit?
$175 N/A $200 N/A $50 $25 Coinsurance Waived Copayment Waived
Part B Premium Reimbursement
If a plan reimburses you for your Part B premiums, this displays the maximum amount that you will be reimbursed. A ‘No” means that the premium will not be reimbursed.
No N/A N/A N/A $1500 Max N/A N/A
  Primary/Specialty Care
This is your cost share.
Preventive Care
What is the member cost share for Preventive Care, as defined by the U.S. Preventive Services Task Force with a rating of A or B?
You pay nothing N/A You pay nothing N/A Member Pays Nothing You pay nothing Member Pays Nothing
Primary Care Office Visit
The amount you pay for a visit to a primary care practitioner (typically an M.D. or D.O., but can include other licensed providers).
$20 N/A $20 N/A $15 $5 50% +
Specialist Office Visit
The amount you pay for a visit to a provider focusing on a specific area of medicine. Some plans require a referral from your primary care provider for you to see a specialist. You must get a referral, if required, or your plan may not pay for the services.
$35 N/A $30 N/A $25 $5 50% +
Plan Requires Referral to See Certain Specialists
A written order from your primary care provider for you to see a specialist or get certain health care services. Some plans may require you need to get a referral before you can get health care services from anyone other than your primary care provider. In those plans, if you don’t get a referral first, the plan may not pay for the services
No N/A Yes N/A Yes Yes No
  Emergency & Urgent Care
This is your cost share.
Emergency Care
What is the member cost share for Emergency Care?
$125 $125 $100 $100 $100 $5 50% +
Urgent Care
What is the member cost share for Urgent Care?
$50 N/A $20 $20 $15 Member Pays Nothing 50% +
Out-of-Pocket Waived
Is a member's Out-of-Pocket cost waived when the member is admitted to the hospital following ER treatment? Select "NA" if a member pays nothing for any medical emergency.
Yes N/A Yes Yes Yes No No
  Surgery & Hospital Charges
This is your cost share.
Doctor Costs Inpatient Surgery
The amount you will pay for a doctor to perform inpatient surgery.
You pay nothing N/A You pay nothing N/A Member Pays Nothing You pay nothing 50% +
Hospital Inpatient Cost Per Admission
This is the amount you pay before the Plan pays benefits when you are admitted as an inpatient to a hospital.
$250/day up to $1000/admit N/A $150/day up to $750/admit N/A $250 $25 $100 +
Room & Board Charges
This is the amount you pay for covered Room & Board charges while an inpatient in a hospital.
You pay nothing N/A You pay nothing N/A Member Pays Nothing You pay nothing 50% +
Other Inpatient Costs
This is the amount you pay for other costs associated with inpatient surgery.
You pay nothing N/A You pay nothing N/A Member Pays Nothing You pay nothing 50% +
Doctor Costs Outpatient Surgery
This is the amount you pay for a doctor to perform surgery in an outpatient hospital setting or ambulatory surgery center.
You pay nothing N/A You pay nothing N/A $50 You pay nothing 50% +
Other Outpatients Costs
This is the amount you pay for other outpatient care at a hospital (not surgery or emergency room services).
$175 N/A $200 N/A Member Pays Nothing You pay nothing 50% +
  Lab, X-Ray & Other Diagnostic Tests
This is your cost share.
Simple Diagnostic Tests/Procedures
What is the member cost share for Simple Diagnostic Tests/Procedures (e.g., blood tests, urinalysis, ultrasounds)?
$20 min $35 max N/A You pay nothing N/A Member Pays Nothing You pay nothing 50% +
Complex Diagnostic Tests/Procedures
What is the member cost share for Complex Diagnostic Tests/Procedures (e.g., CT scans, MRIs, PET scans, sleep labs)?
$20 min $75 max N/A $250 N/A Member Pays Nothing You pay nothing 50% +
Enhanced Lab Network
What is the member cost share for Enhanced lab Network?
$20 min $75 max N/A N/A N/A N/A You pay nothing 50% +
  Prescription Drugs
(Plans may not have drugs on the same tier. For more information on a specific drug, refer to each plan's RX Pricing tool below.)
This is your cost share.
Separate Annual Out-of-Pocket Maximum None None 2900 None None 5000 5000
Separate Annual Deductible
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
None
Self
None
Self Plus One
None
Self & Family
None
Self
None
Self Plus One
None
Self & Family
Retail Generic
The amount you will pay to fill a prescription for retail generic drugs.
Tier 1: $10 Tier 3: $100 N/A Tier 1: $10 N/A $10 20% 20%
Retail Brand
The amount you will pay to fill a prescription for retail brand name drugs.
Tier 1: $35 Tier 3: $100 N/A Tier 2: $35 Tier 3: $60 N/A $40 20% 20%
Specialty
Your cost share for specialty prescription drugs. Specialty prescription drugs are high cost, complex drugs placed on a specialty tier of the formulary and/or dispensed from a designated specialty pharmacy.
Tier 4: 50% $350 max Tier 5: 50% $700 max N/A Tier 4: 20% $200 max N/A $100 20% 20%
Mail Service Pharmacy Benefit
This is the amount you pay for a mail order prescription. These are medications sent via mail for maintenance prescriptions, typically greater than a 30-day supply.
Yes N/A Yes N/A 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.
Applied Behavioral Analysis (ABA)
This is the amount you pay for Applied Behavior Analysis (ABA) coverage.
$35 N/A You pay nothing N/A $15/day No No
Chiropractic
Your cost share for chiropractic care.
$35 N/A $10 N/A $15 $10 50% +
Occupational Therapy
Your cost share for occupational therapy.
$35 N/A You pay nothing N/A $15 You pay nothing 50% +
Physical Therapy
Your cost share for physical therapy.
$35 N/A You pay nothing N/A $15 Member Pays Nothing 50% +
Speech Therapy
Your cost share for speech therapy.
$35 N/A You pay nothing N/A $15 You pay nothing 50% +
  Dental
This is your cost share.
Preventive Dental for Adults
Does the plan cover Preventive Dental for Adults?
Yes Yes No N/A No Yes Yes
Preventive for Children
Does the plan cover Preventive Dental for Children?
Yes Yes No N/A No Yes Yes
Minor Restorative for Adults
Does the plan cover Minor Restorative for Adults (e.g., fillings, local anesthesia)?
Yes Yes No N/A No No No
Minor Restorative for Children
Does the plan cover Minor Restorative for Children (e.g., fillings, local anesthesia)?
Yes Yes No N/A No No No
Major Restorative for Adults
Does the plan cover Major Restorative for Adults (e.g., endodontics, crowns, prosthodontics)?
No No No N/A No No No
Major Restorative for Children
Does the plan cover Major Restorative for Children (e.g., endodontics, crowns, prosthodontics)?
No No No N/A No No No
Orthodontic
Does the plan cover Orthodontics?
No No No N/A No No No
  Vision
This is your cost share.
Routine Eye Exams
Does the plan cover Routine Eye Exams?
Yes N/A Yes N/A Yes No No
Eye Exams for Medical Condition or Non-Surgical Treatment
Does the plan cover Eye Exams for Medical Condition or Non-Surgical Treatment?
Yes N/A Yes N/A Yes No No
Eyeglass Frames & Lenses
Does the plan cover Eyeglass Frames and Lenses?
Yes Yes No N/A No No No
Contacts
Does the plan cover Contacts?
Yes Yes No N/A No No No
  Alternative Care
This is your cost share.
Alternative Care
Your plan may cover some type of alternative care such as: acupuncture, massage therapy, hypnotherapy, holistic medicine, Yoga, herbal treatments, or naturopathic services. Please consult the plan brochure for more information.
Yes N/A Yes N/A 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?
Avoidance of Antibiotics in Adults with Acute Bronchitis
Appropriate use of antibiotics for accute bronchitis
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.
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 Plan Satisfaction
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