Sequoia Union High School District
Medical
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, HealthNet SmartCare, and Western Health Advantage
- 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, PERS Select)
- Diagnostic X-ray/Lab: 20% PPO, 40% Non PPO (PERS Choice, PERS Select)
- Diagnostic X-ray/Lab: 10% PPO, 40% Non PPO (PERS Care)
Emergency Services:
- 20% PPO and Non-PPO (PERS Choice, PERS Select)
- 10% PPO and Non-PPO (PERS Care)
Calendar Year Deductible:
- $500 per member, $100 for family (PERS Choice, PERS Select, PERS Care)
- Maximum Calendar Year Co-pay (excluding pharmacy)
- $3,000 individual, $6,000 family (PERS Choice, PERS Select)
- $2,000 individual, $4,000 family (PERS Care)
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