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Medical
Medical coverage provides you with benefits that help keep you healthy like preventive care screenings and
access to urgent care. It also provides important financial protection if you have a serious medical condition.
Aetna Medical HMO Plan
Kaiser Medical HMO Plan
In-Network
In-Network
Annual Deductible
$0 per individual
$0 family limit
$0 per individual
$0 family limit
Annual Out-of-Pocket Max
$2,500 per individual
$5,000 family limit
$1,500 per individual
$3,000 family limit
Lifetime Max
Unlimited
Unlimited
Office Visit
Primary Provider
$25 copay then plan pays 100%
$15 copay then plan pays 100%
Specialist
$50 copay then plan pays 100%
$30 copay then plan pays 100%
Preventive Services
Plan pays 100%
Plan pays 100%
Chiropractic Care
$15 copay then plan pays 100%
(up to 20 visits per year)
Not covered
Lab and X-ray
Complex imaging: $150 copay
then plan pays 100%; all other:
plan pays 100%
Complex imaging: $50 copay
then plan pays 100%; all other:
$10 copay then plan pays 100%
Inpatient Hospitalization
$750 copay then plan pays
100%
$250 admission copay then plan
pays 100%
Outpatient Surgery
$200 copay then plan pays
100%
$125 copay then plan pays
100%
Urgent Care
$35 copay then plan pays 100%
$15 copay then plan pays 100%
Emergency Room
$150 copay then plan pays
100% (copay waived if
admitted)
$100 copay then plan pays
100% (copay waived if
admitted)