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Medical

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Blue Shield Access+ and Net Value HMO
  • No annual deductible
  • $15.00 co-pay per visit
  • Preventive Care: No Charge
  • Diagnostic X-ray/Lab: No Charge
  • Emergency Services $50.00 co pay - waived if admitted to hospital
  • Maximum Calendar Year Co-pay (excluding Pharmacy) $1,500.00 individual, $3,000.00 family
  • Out of network reimbursed at a fee schedule
  • Prescription Drugs (not to exceed 30 day supply):
  • $5 Generic, $20 Brand-name Formulary, $50 Brand-name Non-Formulary

Kaiser HMO
  • No annual deductible
  • $15.00 co-pay per visit
  • Preventive Care: No Charge
  • Diagnostic X-ray/Lab: No Charge
  • Emergency Services $50.00 co pay - waived if admitted to hospital
  • Maximum Calendar Year Co-pay (excluding Pharmacy) $1,500.00 individual, $3,000.00 family
  • Out of network reimbursed at a fee schedule
  • Prescription Drugs (not to exceed 30 day supply):
  • $5 Generic, $20 Brand-name Formulary, $50 Brand-name Non-Formulary

PERS Select, PERS Choice, and PERS Care
  • Preventive Care: No Charge PPO, 40% Non PPO (PERS, Choice, Select)
  • Diagnostic X-ray/Lab: 20% PPO, 40% Non PPO (PERS, Choice, Select)
  • Diagnositc X-ray/Lab: 10% PPO, 40% Non PPO (PERS Care)

Emergency Services:
  • 20% PPO and Non-PPO (PERS Choice, Select)
  • 10% PPO and Non-PPO (PERS Care)

Calendar Year Deductible:
  • $500 per member, $100 for family (PERS Choice, Select, Care)
  • Maximum Calendar Year Co-pay (excluding pharmacy)
  • $3,000 individual, $6,000 family (PERS, Choice, Select)
  • $2,000 individual, $4,000 family (PERS, Choice, Select)
 
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