Live in California?

Your options will be different, depending on the insurance carrier you choose.

For starters, each insurance carrier in California can elect to offer each coverage level either as an option that offers in- and out-of-network benefits (e.g., a PPO) or an option that offers in-network benefits only (e.g., an HMO).

Also, insurance carriers can choose to offer either the standard Gold option or a Gold II option—not both. The Gold II option offers only in-network benefits.

Review the table below to see which insurance carriers offer out-of-network benefits for the coverage levels you're considering.

	Bronze	Bronze Plus	Bronze Plus	Silver	Silver	Gold	Platinum
Aetna	In- and out-of-network	In- and out-of-network	In- and out-of-network	In- and out-of-network	In- and out-of-network	In- and out-of-network	In- and out-of-network
Anthem Blue Cross	In-network only	In-network only	In-network only	In-network only	In-network only	In-network only	In-network only
Cigna	In- and out-of-network	In- and out-of-network	In- and out-of-network	In- and out-of-network	In- and out-of-network	In- and out-of-network	In- and out-of-network
Health Net	In- and out-of-network	In- and out-of-network	In- and out-of-network	In- and out-of-network	In- and out-of-network	N/A	In- and out-of-network
Kaiser Permanente	In-network only	In-network only	In-network only	In-network only	In-network only	N/A	In-network only
United Healthcare	In- and out-of-network	In- and out-of-network	In- and out-of-network	In- and out-of-network	In- and out-of-network	In- and out-of-network	In- and out-of-network

Medical Coverage Level

	Bronze	Bronze Plus	Bronze Plus	Silver	Silver	Gold	Platinum

Option type	High-deductible option with HSA	High-deductible option with HSA	High-deductible option with HSA	High-deductible option with HSA	High-deductible option with HSA	PPO	PPO
Paycheck contributions	$	$	$	$$	$$	$$$	$$$$

2027 Annual Deductible
In-network (individual / family)	$3,500/$7,000	$2,500 / $5,000^†	$3,500/$7,000^†	$1,750 / $3,500^†	$2,750/$5,500	$800 / $1,600	$250 / $500
Out-of-network (individual / family)	$3,500/$7,000	$2,500 / $5,000^†	$3,500/$7,000^†	$1,750/$3,500^†	$2,750/$5,500	$1,600 / $3,200	$5,000 / $10,000
Traditional or true family?	Traditional	True family	True family	True family	True family	Traditional	Traditional

2027 Annual Out-of-Pocket Maximum
In-network (individual / family)	$6,400 / $12,800	$4,500 / $9,000^†	$4,500 / $9,000^†	$4,250 / $8,500^†	$4,250/$8,500	$3,600 / $7,200	$2,300 / $4,600
Out-of-network (individual / family)	$12,800 / $25,600	$9,000/$18,000^†	$9,000/$18,000^†	$8,500 / $17,000^†	$8,500 / $17,000	$7,200 / $14,400	$11,500 / $23,000
Traditional or true family?	Traditional	True family	True family	True family	True family	Traditional	Traditional

2027 In-Network Benefits
Preventive care	Covered 100%, no deductible	Covered 100%, no deductible	Covered 100%, no deductible	Covered 100%, no deductible	Covered 100%, no deductible	Covered 100%, no deductible	Covered 100%, no deductible
Doctor's office visit	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay $25 for PCP visit and $40 for specialist visit, no deductible	You pay $25 for PCP visit and $40 for specialist visit, no deductible
Emergency room	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay $150, then 20% after deductible	You pay $150, then 15% after deductible
Urgent care	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay $40	You pay $25
Inpatient care	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 20% after deductible	You pay 15% after deductible
Outpatient care	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	If not an office visit, you pay 20% after deductible	If not an office visit, you pay 15% after deductible

Prescription Drug Coverage

	Bronze	Bronze Plus	Bronze Plus	Silver	Silver	Gold	Platinum

Preventive drugs

You pay $0^**

30-Day Retail Supply
Tier 1 (generally lowest cost options)	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $10	You pay $8
Tier 2 (generally medium cost options)	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $40	You pay $30
Tier 3 (generally highest cost options)	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $60	You pay $50

90-Day Mail Order Supply
Tier 1 (generally lowest cost options)	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $25	You pay $20
Tier 2 (generally medium cost options)	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $100	You pay $75
Tier 3 (generally highest cost options)	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $150	You pay $125

These charts may not take into account how each coverage level covers any state-mandated benefits, its plan administration capabilities, or the approval from the state Department of Insurance of the benefits offered by the plan. If you have questions about a specific benefit, contact the insurance carrier for additional information. Individual carriers may offer coverage that differs slightly from the standard coverage reflected here. In the event that there is a discrepancy between this site and the official plan documents, the official plan documents will control.

These charts are a high-level listing of commonly covered benefits across carriers and coverage levels. They are intended to provide you with a snapshot of benefits provided across coverage levels. In general, carriers have agreed to the majority of standardized plan benefits.

For a more detailed look at these and additional coverages, go to the Premier Company Benefits website at premiercompany.benefitsnow.com. It does account for any carrier adjustments to standardized plan benefits. To see summaries when you enroll online, check the boxes next to the options you want to review and click Compare. In order to get the most comprehensive information about any specific coverage, you will need to call the carrier directly.

Note: For additional comparison, you may find Summaries of Benefits and Coverage on the Premier Company Benefits website at premiercompany.benefitsnow.com.

Out-of-Area: Your specific options are based on your home zip code. If you live outside the service areas of all the insurance carriers, you can choose an out-of-area option at the Silver coverage level. Aetna will be the insurance carrier. Important:The Silver option available to out-of-area individuals is different from the Silver option described in this guide. Refer to premiercompany.benefitsnow.com for details.)

Choosing a Primary Care Physician: Certain options require you to choose a primary care physician. You may need to designate a primary care physician to coordinate your care if you choose Kaiser Permanente or Health Net as your insurance carrier.

Do You Take Any Prescription Drugs?

Your prescription drug coverage will be provided through your pharmacy benefit manager. The pharmacy benefit manager could be a separate prescription drug company. Employees who enroll under Aetna, Anthem Blue Cross, Cigna, or UnitedHealthcare will have their pharmacy benefits managed by CVS Caremark. All other carriers will manage their own prescription drug coverage.

While your coverage level will determine your coverage for prescription drugs, each pharmacy benefit manager has its own rules. You need to make sure you’re comfortable with how your family's medications will be covered. Get the details.

Questions?

Check out the Frequently Asked Questions (PDF) and the Glossary.


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California Medical Coverage Level

Live in California?

Medical Coverage Level

Prescription Drug Coverage

Do You Take Any Prescription Drugs?

Questions?