2025 FEHB Plan Comparison Details

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. traditional coverage begins.

Costs & Network

Disclaimer: In some cases, the enrollee share of premiums for the Self Plus One enrollment type will be higher than for the Self and Family enrollment type. Enrollees who wish to cover one eligible family member are free to elect either the Self and Family or Self Plus One enrollment type. Check premiums on our website at www.opm.gov/fehbpremiums.

Self

Self Plus One

Self & Family

Plan Selection Comparison Tool

Plans	Aetna Open Access (High)	Health Net of California (High)	Kaiser Permanente - Southern California (High)	Panama Canal Area Benefit Plan (High)
Plan Links	[Website] Brochure Link [Summary of Benefits] [Provider Directory] [RX Pricing Tool]	[Website] Brochure Link [Summary of Benefits] [Provider Directory] [RX Pricing Tool]	[Website] Brochure Link [Summary of Benefits] [Provider Directory] [RX Pricing Tool]	[Website] Brochure Link [Summary of Benefits] [Provider Directory] [RX Pricing Tool]
General Information - State	California	California	California	California
General Information - Enrollment Code - Self	2X1	LP1	621	431
General Information - Enrollment Code - Self & Family	2X2	LP2	622	432
General Information - Enrollment Code - Self Plus One	2X3	LP3	623	433
General Information - Carrier Code	2X	LP	62	43
General Information - Telephone Number	877-459-6604	800-522-0088	800-464-4000	800-424-8196
Biweekly Premium	$334.41	$388.25	$128.56	$127.83
Biweekly Premium	$805.76	$859.90	$336.07	$214.50
Biweekly Premium	$770.62	$932.94	$271.84	$224.34

Plans - Networks	Aetna Open Access (High) - In-Network 1	Aetna Open Access (High) - Out-of-Network	Health Net of California (High) - In-Network 1	Health Net of California (High) - In-Network 2	Health Net of California (High) - Out-of-Network	Kaiser Permanente - Southern California (High) - In-Network 1	Kaiser Permanente - Southern California (High) - In-Network 2	Kaiser Permanente - Southern California (High) - Out-of-Network	Panama Canal Area Benefit Plan (High) - In-Network 1	Panama Canal Area Benefit Plan (High) - In-Network 2	Panama Canal Area Benefit Plan (High) - 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	None	None	None	None	None	None	None	None	None	None
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
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
Type of Account	None	None	None	None	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	N/A	N/A	N/A	N/A
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	N/A	N/A	N/A	N/A
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	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	None	None	None	None	None	None	None	None	None	None
Net Deductible A net deductible is the sum of your deductible minus any medical account fund.	None	None	None	None	None	None	None	None	None	None	None
Net Deductible A net deductible is the sum of your deductible minus any medical account fund.	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	None	$1,500.00	None	None	$2,000.00	None	None	$8,200.00	None	$8,200.00
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.	$10,000.00	None	$3,000.00	None	None	$4,000.00	None	None	$12,000.00	None	$12,000.00
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.	$10,000.00	None	$4,500.00	None	None	$4,000.00	None	None	$12,000.00	None	$12,000.00
Member Cost with Medicare A & B Primary - Deductible Waiver with Parts A & B Member Cost with Medicare A & B Primary - 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	N/A	N/A	N/A	N/A
Member Cost with Medicare A & B Primary - Out-of-Pocket Maximum with Parts A & B Member Cost with Medicare A & B Primary - 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	N/A	$2000	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare A & B Primary - Primary Care Physician Office Visit with Medicare A & B Primary Member Cost 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 Copayment	N/A	$20	Member Pays All Charges	Member Pays All Charges	$15	N/A	N/A	N/A	N/A	Copayment Waived
Member Cost with Medicare A & B Primary - Specialty Office Physician Visit with Parts A & B Member Cost with Medicare A & B Primary - 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 Copayment	N/A	$30	Member Pays All Charges	Member Pays All Charges	$25	N/A	N/A	N/A	N/A	Copayment Waived
Member Cost with Medicare A & B Primary - Inpatient Hospital Services with Parts A & B Member Cost with Medicare A & B Primary - 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	Member Pays All Charges	Member Pays All Charges	$250	Member Pays All Charges	Member Pays All Charges	N/A	N/A	Coinsurance Waived Copayment Waived
Member Cost with Medicare A & B Primary - Outpatient Hospital Services with Parts A & B Member Cost with Medicare A & B Primary - 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	Member Pays All Charges	Member Pays All Charges	$50	N/A	N/A	N/A	N/A	Copayment Waived Copayment Waived
Member Cost with Medicare A & B Primary - Part B Premium Reimbursement with Parts A & B Member Cost with Medicare A & B Primary - If a plan reimburses you for your Part B premiums, this displays the maximum amount that you will be annually reimbursed. A ‘No” means that the premium will not be reimbursed.	No	N/A	No	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Advantage (Part C) Primary - Deductible Waiver with Part C Member Cost with Medicare Advantage (Part C) Primary - This field will indicate either the amount of your annual deductible or that the deductible has been waived (forgiven) when Medicare C is the primary coverage.	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Advantage (Part C) Primary - Out-of-Pocket Maximum with Part C Member Cost with Medicare Advantage (Part C) Primary - 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 C is your primary coverage.	N/A	N/A	$3400	N/A	N/A	$2000	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Advantage (Part C) Primary - Primary Care Physician Office Visit with Medicare Advantage (Part C) Primary Member Cost with Medicare Advantage (Part C) Primary - This is the amount you pay for a primary care visit. When you have Medicare C, some plans will waive the copay.	$20 Copayment	N/A	$5 Copayment	Member Pays All Charges	Member Pays All Charges	$10 Copayment	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Advantage (Part C) Primary - Specialty Physician Office Visit with Part C Member Cost with Medicare Advantage (Part C) Primary - This is the amount you pay for a Specialty care visit. When you have Medicare C, some plans will waive the copay.	$35 Copayment	N/A	$5 Copayment	Member Pays All Charges	Member Pays All Charges	$10 Copayment	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Advantage (Part C) Primary - Inpatient Hospital Services with Part C Member Cost with Medicare Advantage (Part C) Primary - This is the amount you pay for an inpatient hospital stay. When you have Medicare C, some plans waive this amount.	$250 Per Day Up To $1000 Per Admission	N/A	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	$250 Copayment	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Advantage (Part C) Primary - Outpatient Hospital Services with Part C Member Cost with Medicare Advantage (Part C) Primary - This is the amount you pay for an outpatient hospital visit when you have Medicare Parts C as your primary coverage.What is the amount a member with Medicare C pays for an outpatient hospital visit?	$175 Copayment	N/A	Member Pays Nothing	Member Pays Nothing	Member Pays All Charges	$50 Copayment	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Advantage (Part C) Primary - Part B Premium Reimbursement with Part C Member Cost with Medicare Advantage (Part C) Primary - If a plan reimburses you for your Part B premiums, this displays the maximum amount that you will be annually reimbursed. A ‘No” means that the premium will not be reimbursed.	N/A	N/A	No	N/A	N/A	$3000 Max	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Part D EGWP - Prescription Drug Deductible Member Cost with Medicare Part D EGWP - Is the deductible waived for prescription drugs with Medicare Part D EGWP?	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Part D EGWP - Out-of-Pocket Maximum Member Cost with Medicare Part D EGWP - What is the maximum a member with Medicare Part D pays out-of-pocket for covered prescriptions?	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Part D EGWP - EGWP Tier 0 Member Cost with Medicare Part D EGWP - What is the member cost of Tier 0 prescriptions with Medicare Part D EGWP?	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Part D EGWP - EGWP Tier 1 Member Cost with Medicare Part D EGWP - What is the member cost of Tier 1 prescriptions with Medicare Pard D EGWP?	N/A	N/A	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	N/A	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Part D EGWP - EGWP Tier 2 Member Cost with Medicare Part D EGWP - What is the member cost of Tier 0 prescriptions with Medicare Part D EGWP?	N/A	N/A	$5 Copayment	Member Pays All Charges	Member Pays All Charges	N/A	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Part D EGWP - EGWP Tier 3 Member Cost with Medicare Part D EGWP - What is the member cost of Tier 3 prescriptions with Medicare Part D EGWP?	N/A	N/A	$7.50 Copayment	Member Pays All Charges	Member Pays All Charges	N/A	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Part D EGWP - EGWP Tier 4 Member Cost with Medicare Part D EGWP - What is the member cost of Tier 4 prescriptions with Medicare Pard D EGWP?	N/A	N/A	$7.50 Copayment	Member Pays All Charges	Member Pays All Charges	N/A	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Part D EGWP - EGWP Tier 5 Member Cost with Medicare Part D EGWP - What is the member cost of Tier 5 prescriptions with Medicare Part D EGWP?	N/A	N/A	$7.50 Copayment	Member Pays All Charges	Member Pays All Charges	N/A	N/A	N/A	N/A	N/A	N/A
Member Cost with Medicare Part D EGWP - EGWP Tier 6 Member Cost with Medicare Part D EGWP - What is the member cost of Tier 6 prescriptions with Medicare Part D EGWP?	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Primary/Specialty Care - Preventive Care Primary/Specialty 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?	Member Pays Nothing	N/A	Member Pays Nothing	N/A	N/A	Member Pays Nothing	N/A	N/A	Member Pays Nothing	N/A	Member Pays Nothing
Primary/Specialty Care - Primary Care Office Visit Primary/Specialty Care - 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 Copayment	N/A	$20 Copayment	N/A	N/A	$15 Copayment	N/A	N/A	$5 Copayment	N/A	50% + Difference Between Plan Allowance and Billed Amount
Primary/Specialty Care - Specialist Office Visit Primary/Specialty Care - 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 Copayment	N/A	$30 Copayment	N/A	N/A	$25 Copayment	N/A	N/A	$5 Copayment	N/A	50% + Difference Between Plan Allowance and Billed Amount
Primary/Specialty Care - Plan Requires Referral to See Certain Specialists Primary/Specialty Care - 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	N/A	Yes	N/A	N/A	Yes	N/A	No
Emergency & Urgent Care - Emergency Care Emergency & Urgent Care - What is the member cost share for Emergency Care?	$125 Copayment	$125 Copayment	$100 Copayment	N/A	$100	$100 Copayment	N/A	N/A	$5 Copayment	N/A	50% + Difference Between Plan Allowance and Billed Amount
Emergency & Urgent Care - Urgent Care Emergency & Urgent Care - What is the member cost share for Urgent Care?	$50 Copayment	N/A	$20 Copayment	N/A	$20	$15 Copayment	N/A	N/A	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Emergency & Urgent Care - Out-of-Pocket Waived Emergency & Urgent Care - 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	N/A	Yes	Yes	N/A	N/A	No	N/A	No
Surgery & Hospital Charges - Doctor Costs Inpatient Surgery Surgery & Hospital Charges - The amount you will pay for a doctor to perform inpatient surgery.	Member Pays Nothing	N/A	Member Pays Nothing	N/A	N/A	Member Pays Nothing	N/A	N/A	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Surgery & Hospital Charges - Hospital Inpatient Cost Per Admission Surgery & Hospital Charges - This is the amount you pay before the Plan pays benefits when you are admitted as an inpatient to a hospital.	$250 Per Day Up To $1000 Per Admission	N/A	$150 Per Day Up To $750 Per Admission	N/A	N/A	$250 Copayment	N/A	N/A	$25 Copayment	N/A	$100 Copayment 50% + Difference Between Plan Allowance and Billed Amount
Surgery & Hospital Charges - Room & Board Charges Surgery & Hospital Charges - This is the amount you pay for covered Room & Board charges while an inpatient in a hospital.	Member Pays Nothing	N/A	$150 Per Day Up To $750 Per Admission	N/A	N/A	Member Pays Nothing	N/A	N/A	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Surgery & Hospital Charges - Other Inpatient Costs Surgery & Hospital Charges - This is the amount you pay for other costs associated with inpatient surgery.	Member Pays Nothing	N/A	Member Pays Nothing	N/A	N/A	Member Pays Nothing	N/A	N/A	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Surgery & Hospital Charges - Doctor Costs Outpatient Surgery Surgery & Hospital Charges - This is the amount you pay for a doctor to perform surgery in an outpatient hospital setting or ambulatory surgery center.	Member Pays Nothing	N/A	Member Pays Nothing	N/A	N/A	$50 Copayment	N/A	N/A	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Surgery & Hospital Charges - Other Outpatient Costs Surgery & Hospital Charges - This is the amount you pay for other outpatient care at a hospital (not surgery or emergency room services).	$175 Copayment	N/A	$200 Copayment	N/A	N/A	Member Pays Nothing	N/A	N/A	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Lab, X-Ray & Other Diagnostic Tests - Simple Diagnostic Tests/Procedures Lab, X-Ray & Other Diagnostic Tests - What is the member cost share for Simple Diagnostic Tests/Procedures (e.g., blood tests, urinalysis, ultrasounds)?	$20 Min $35 Max	N/A	Member Pays Nothing	N/A	N/A	Member Pays Nothing	N/A	N/A	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Lab, X-Ray & Other Diagnostic Tests - Complex Diagnostic Tests/Procedures Lab, X-Ray & Other Diagnostic Tests - 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 Copayment	N/A	N/A	Member Pays Nothing	N/A	N/A	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Lab, X-Ray & Other Diagnostic Tests - Enhanced Lab Network Lab, X-Ray & Other Diagnostic Tests - What is the member cost share for Enhanced lab Network?	$20 Min $75 Max	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	50% + Difference Between Plan Allowance and Billed Amount
Prescription Drugs - Mail Service Pharmacy Benefit Prescription Drugs - 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	N/A	Yes	N/A	N/A	No	N/A	No
Prescription Drugs - Mail Order Pharmacy Restriction Prescription Drugs - Mail order drug dispensing may be restricted to a specific mail order pharmacy. For more details, refer to the medication pricing tool.	Yes	N/A	Yes	N/A	N/A	Yes	N/A	N/A	N/A	N/A	N/A
Prescription Drugs - Specialty Pharmacy Restriction Prescription Drugs - Specialty drug dispensing may be restricted to a specific specialty pharmacy. For more details, refer to the medication pricing tool.	Yes	N/A	Yes	N/A	N/A	N/A	N/A	N/A	No	No	No
Prescription Drugs - Hormone Therapy Prescription Drugs - Does the plan cover Hormone Therapy for the treatment of gender dysphoria?	Covered	N/A	Covered	Not Covered	Not Covered	Covered	Not Covered	Not Covered	N/A	N/A	Covered
Prescription Drugs - Tier 0 Prescription Prescription Drugs - Specifies formulary tier description and cost sharing for Tier 0	Member Pays Nothing	N/A	N/A	N/A	N/A	Member Pays Nothing	N/A	N/A	N/A	N/A	N/A
Prescription Drugs - Tier 1 Prescriptions Prescription Drugs - Specifies formulary tier description and cost sharing for Tier 1	$10 Copayment	N/A	$10	N/A	N/A	$10 Copayment	N/A	N/A	N/A	N/A	N/A
Prescription Drugs - Tier 2 Prescriptions Prescription Drugs - Specifies formulary tier description and cost sharing for Tier 2	$35 Copayment	N/A	$35	N/A	N/A	$40 Copayment	N/A	N/A	N/A	N/A	N/A
Prescription Drugs - Tier 3 Prescriptions Prescription Drugs - Specifies formulary tier description and cost sharing for Tier 3	$100 Copayment	N/A	$60	N/A	N/A	$40 Copayment	N/A	N/A	N/A	N/A	N/A
Prescription Drugs - Tier 4 Prescriptions Prescription Drugs - Specifies formulary tier description and cost sharing for Tier 4	50% $350 Max	N/A	20% $200	N/A	N/A	$100 Copayment	N/A	N/A	N/A	N/A	N/A
Prescription Drugs - Tier 5 Prescriptions Prescription Drugs - Specifies formulary tier description and cost sharing for Tier 5	50% $700 Max	N/A	20% $200	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Prescription Drugs - Tier 6 Prescriptions Prescription Drugs - Specifies formulary tier description and cost sharing for Tier 6	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Treatment, Devices, and Services - Applied Behavioral Analysis (ABA) Treatment, Devices, and Services - This is the amount you pay for Applied Behavior Analysis (ABA) coverage.	$35 Copayment	N/A	Member Pays Nothing	N/A	N/A	Member Pays Nothing	N/A	N/A	N/A	N/A	N/A
Treatment, Devices, and Services - Chiropractic Treatment, Devices, and Services - Your cost share for chiropractic care.	$35 Copayment	N/A	$10 Copayment 20 Combined Visits	N/A	N/A	$15 Copayment	N/A	N/A	$10 Copayment	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Occupational Therapy Treatment, Devices, and Services - Your cost share for occupational therapy.	$35 Copayment	N/A	Member Pays Nothing	N/A	N/A	$15 Copayment	N/A	N/A	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Physical Therapy Treatment, Devices, and Services - Your cost share for physical therapy.	$35 Copayment	N/A	Member Pays Nothing	N/A	N/A	$15 Copayment	N/A	N/A	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Speech Therapy Treatment, Devices, and Services - Your cost share for speech therapy.	$35 Copayment	N/A	Member Pays Nothing	N/A	N/A	$15 Copayment	N/A	N/A	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Professional Services (Mental Health and Substance Use Disorder) Treatment, Devices, and Services - This is the member copayment for Professional Services Mental Health and Substance Use Disorder treatment	$35 Copayment	N/A	$20 Copayment	Member Pays All Charges	Member Pays All Charges	$15 Copayment	Member Pays All Charges	Member Pays All Charges	$5 Copayment	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Inpatient Hospital (Mental Health and Substance Use Disorder Services) Treatment, Devices, and Services - This is the member copayment for Inpatient Hospital Mental Health and Substance Use Disorder Services	$250 Per Day $1000 Max	N/A	$150 Copayment $750 Copayment	Member Pays All Charges	Member Pays All Charges	$250 Copayment	Member Pays All Charges	Member Pays All Charges	$25 Copayment	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Outpatient Hospital (Mental Health and Substance Use Disorder Services) Treatment, Devices, and Services - This is the member copayment for Outpatient Hospital Mental Health and Substance Use Disorder Services	$35 Copayment	N/A	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	$15 Copayment	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Infertility Services Treatment, Devices, and Services - Member cost for Diagnosis and Treatment Infertility Services	50%	N/A	50%	Member Pays All Charges	Member Pays All Charges	50%	Member Pays All Charges	Member Pays All Charges	$5 Copayment	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Fertility Preservation Procedures (e.g., iatrogenic infertility) (Infertility Services) Treatment, Devices, and Services - Member Cost of Fertility Preservation Procedures (e.g., iatrogenic infertility) (Infertility Services)	50%	N/A	50%	Member Pays All Charges	Member Pays All Charges	$25 Copayment	Member Pays All Charges	Member Pays All Charges	$5 Copayment	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Artificial Insemination Services (e.g. ICI, IVI, IUI) Treatment, Devices, and Services - Specifies what coverage Carrier provides for artificial insemination procedures and services	50%	N/A	50%	Member Pays All Charges	Member Pays All Charges	Member Pays All Charges	Member Pays All Charges	Member Pays All Charges	$5 Copayment	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Assisted Reproductive Technology (ART) (e.g., IVF, GIFT, ZIFT) (Infertility Services) Treatment, Devices, and Services - Specifies what portion of the ART medical and pharmacy services the plan pays vs what portion of the medical services the member pays	Member Pays All Charges	N/A	Member Pays All Charges	Member Pays All Charges	Member Pays All Charges	Member Pays All Charges	Member Pays All Charges	Member Pays All Charges	Member Pays All Charges	N/A	Member Pays All Charges
Treatment, Devices, and Services - Surgical Procedures Treatment, Devices, and Services - Member cost associated with Surgical Procedures	$35 Copayment	N/A	$150 Copayment $750 Copayment	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Reconstructive Surgery Treatment, Devices, and Services - Member cost associated with Reconstructive Surgery	$35 Copayment	N/A	$150 Copayment $750 Copayment	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Gender Affirming Surgery Treatment, Devices, and Services - Member cost associated with Gender Affirming Surgery	$35 Copayment	N/A	$150 Copayment $750 Copayment	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	N/A	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Hearing Services Treatment, Devices, and Services - Member cost Associated with Hearing Services	$35 Copayment	N/A	$30 Copayment	Member Pays All Charges	Member Pays All Charges	$15 Copayment	Member Pays All Charges	Member Pays All Charges	$10 Copayment	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Hearing Aids (External) Treatment, Devices, and Services - Member cost Associated with Hearing Aids (External)	Not Covered	N/A	Covered	Not Covered	Not Covered	Covered	Not Covered	Not Covered	$10	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Maternity Care Treatment, Devices, and Services - Member cost associated with Prenatal Care, Screening for Gestational Diabetes, Delivery, and Postpartum Care (Maternity Care)	Member Pays Nothing	N/A	$30 Copayment	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	N/A	Member Pays Nothing + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Maternity Care - Hospital Stay Treatment, Devices, and Services - Member cost Associated with Hospital Stay--Vaginal Birth, Cesarean Birth (Maternity Care)	$250 Copayment $1000 Max	N/A	$150 Copayment $750 Copayment	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	N/A	Member Pays Nothing + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Hospice Care Treatment, Devices, and Services - Member cost Associated with Hospice Care	$5 Copayment	N/A	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Home Health Services (Skilled Nursing Care) Treatment, Devices, and Services - Member Cost Associated with Home Health Services (Skilled Nursing Care)	$90 Copayment	N/A	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Durable Medical Equipment Treatment, Devices, and Services - Member cost Associated with Durable medical Equipment	30%	N/A	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	20%	Member Pays All Charges	Member Pays All Charges	30% + Difference Between Plan Allowance and Billed Amount	N/A	30% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Outpatient Rehabilitation (Skilled Nursing Care Facility) Treatment, Devices, and Services - Member Cost Associated with Outpatient Rehabilitation (Skilled Nursing Care Facility)	30%	N/A	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	N/A	50% + Difference Between Plan Allowance and Billed Amount
Treatment, Devices, and Services - Diabetes Education Treatment, Devices, and Services - Member Cost Associated with Diabetes Education	Member Pays Nothing	N/A	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	N/A	N/A
Treatment, Devices, and Services - Nutritional Counseling Treatment, Devices, and Services - Member Cost Associated with Nutritional Counseling	Member Pays Nothing	N/A	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	Member Pays All Charges	Member Pays All Charges	Member Pays Nothing	N/A	Member Pays Nothing
Dental - Routine Dental Exams and Cleaning for Adults Dental - Does the plan cover Preventive Dental for Adults?	Yes	Yes	No	N/A	N/A	No	N/A	No	Yes	N/A	Yes
Dental - Routine Dental Exams and Cleaning for Children Dental - Does the plan cover Preventive Dental for Children?	Yes	Yes	No	N/A	N/A	No	N/A	No	Yes	N/A	Yes
Dental - Minor Restorative for Adults Dental - Does the plan cover Minor Restorative for Adults (e.g., fillings, local anesthesia)?	Yes	Yes	No	N/A	N/A	No	N/A	N/A	No	N/A	No
Dental - Minor Restorative for Children Dental - Does the plan cover Minor Restorative for Children (e.g., fillings, local anesthesia)?	Yes	Yes	No	N/A	N/A	No	N/A	N/A	No	N/A	No
Dental - Major Restorative for Adults Dental - Does the plan cover Major Restorative for Adults (e.g., endodontics, crowns, prosthodontics)?	No	No	No	N/A	N/A	No	N/A	N/A	No	N/A	No
Dental - Major Restorative for Children Dental - Does the plan cover Major Restorative for Children (e.g., endodontics, crowns, prosthodontics)?	No	No	No	N/A	N/A	No	N/A	N/A	No	N/A	No
Dental - Orthodontic Dental - Does the plan cover Orthodontics?	No	No	No	N/A	N/A	No	N/A	N/A	No	N/A	No
Vision - Routine Eye Exams Vision - Does the plan cover Routine Eye Exams?	Yes	N/A	Yes	N/A	N/A	Yes	N/A	N/A	No	N/A	No
Vision - Eye Exams for Medical Condition or Non-Surgical Treatment Vision - Does the plan cover Eye Exams for Medical Condition or Non-Surgical Treatment?	Yes	N/A	Yes	N/A	N/A	Yes	N/A	N/A	No	N/A	No
Vision - Eyeglass Frames & Lenses Vision - Does the plan cover Eyeglass Frames and Lenses?	Yes	Yes	No	N/A	N/A	No	N/A	N/A	No	N/A	No
Vision - Contacts Vision - Does the plan cover Contacts?	Yes	Yes	No	N/A	N/A	No	N/A	N/A	No	N/A	No
Alternative Care - Alternative Care 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	N/A	Yes	N/A	N/A	Yes	N/A	Yes
Alternative Care - Chronic Disease Management: Asthma Alternative Care - Is Chronic Disease Management of Asthma covered?	Covered	N/A	Covered	Not Covered	Not Covered	Covered	Not Covered	Not Covered	Not Covered	N/A	Not Covered
Alternative Care - Chronic Disease Management: Heart Disease Alternative Care - Is Chronic Disease Management of Heart Disease covered?	Covered	N/A	Covered	Not Covered	Not Covered	Covered	Not Covered	Not Covered	Not Covered	N/A	Not Covered
Alternative Care - Chronic Disease Management: Hypertension Alternative Care - Is Chronic Disease Management of Hypertension covered?	Covered	N/A	Covered	Not Covered	Not Covered	Covered	Not Covered	Not Covered	Not Covered	N/A	Not Covered
Alternative Care - Chronic Disease Management: Obesity Alternative Care - Is Chronic Disease Management of Obesity covered?	Covered	N/A	Covered	Not Covered	Not Covered	Covered	Not Covered	Not Covered	Not Covered	N/A	Not Covered

Key:

Outstanding

Excellent

Good

Fair

Poor NA (NA is displayed if a plan did not report or is unable to report a result in this coverage area.)

Plans	Aetna Open Access (High)	Health Net of California (High)	Kaiser Permanente - Southern California (High)	Panama Canal Area Benefit Plan (High)
Quality - Controlling High Blood Pressure People with high blood pressure receive effective treatment.
Quality - Hemoglobin A1c Control for Patients with Diabetes Do people with diabetes have their condition under control?
Quality - Timeliness of Prenatal Care Pregnant women receive care in the first trimester.				NA
Quality - Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis Ages 18 to 64 Appropriate use of antibiotics for acute bronchitis.				NA
Quality - Asthma Medication Ratio Appropriate ratio of controller medications to total asthma medications.				NA
Quality - Breast Cancer Screening Do women who need screening mammograms get them?
Quality - Follow Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence 30 day Follow-up appointment within 30 days of discharge.				NA
Quality - Follow Up After Emergency Department Visit for Mental Illness 30 day Follow-up appointment within 30 days of discharge.				NA
Quality - Childhood Immunization Status—Combination 10 Recommended well-child visits completed.				NA
Quality - Use of Imaging Studies for Low Back Pain Appropriate treatment of lower back pain.
CustomerService - Overall Plan Satisfaction How pleased are customers with the plan overall?
CustomerService - Claims Processing How quickly do customers say the plan handles claims?	NA	NA	NA
CustomerService - Getting Needed Care Members report getting the care they need.
CustomerService - Coordination of Care Members say that their doctors know about care from other providers.	NA