Medical Coverage
The following chart summarizes the benefits for the medical plans offered to all eligible employees. In-network only plans (EPO plans) offer In-Network coverage ONLY, except for prescription medications and Emergency only cases.
| Benefit | Bronze Plan | Ranch Plan | California Plan | Liberty Plan | Liberty Plan |
|---|---|---|---|---|---|
| Annual Deductible (Ind./Fam.) | $2,000 / Individual | $1,000 / Individual $2,000 / Family | None | None | None |
| Annual Out-of-Pocket Max (Ind./Fam.) | $6,350 / $12,700 | $2,000 / $4,000 | $1,500 / $3,000 | $1,500 / $3,000 | $15,000 / Unlimited |
| Member Coinsurance | 40% | N/A | N/A | 10% | 30% |
| Primary Care | $50 Copay* | $40 Copay* | $25 Copay | $30 Copay | $65 Copay |
| Specialist Visit | $100 Copay* | $40 Copay* | $25 Copay | $30 Copay | $65 Copay |
| Preventive Care | No Copay* | No Copay* | No Copay | No Copay | 30% |
| Inpatient Hospital | 40% | $500/Admit* | No Charge | No Charge | 30% |
| Outpatient Surgery | 40% | No Charge | No Charge | No Charge | 30% |
| X-Ray/Lab | 40%* | No Charge* | No Charge | No Charge | 30% |
| Emergency Room | $500 Copay + 40% | $250 Copay* | $250 Copay | 10% | 10% |
| Urgent Care | $50 Copay* | $25 Copay* | $25 Copay | 10% | 30% |
| Deductible | None | None | None | None | None |
| Tier 1 (Generic) | $10 Copay | $10 Copay | $10 Copay | $10 Copay | $10 Copay + Balance Bill |
| Tier 2 (Preferred Brand) | $75 Copay | $45 Copay | $35 Copay | $35 Copay | $35 Copay + Balance Bill |
| Tier 3 (Non-Preferred Brand) | $125 Copay | $60 Copay | $45 Copay | $45 Copay | $45 Copay + Balance Bill |
| Tier 4 (Specialty) | 50% (30-day supply) | $10/$45/$60 Copay | $10/$35/$45 Copay | $10/$35/$45 Copay | 30% (30-day supply) |
| Tier 4 (Specialty) | 50% (30-day supply) | $10/$45/$60 Copay | $10/$35/$45 Copay | $10/$35/$45 Copay | 30% (30-day supply) |
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