The following charts summarizes the benefits for the medical plans offered to all eligible employees.
Comparing the Options
Before you review your medical plan options, you should understand how they work. Start with these terms:
A set percentage you pay of the cost of the care you receive, for example 20%.
A set dollar amount you pay when you receive health care, for example $35 when you see a specialist.
A set amount you must pay out of your pocket before the plan starts paying part of the cost unless a copay applies.
The most you will pay in a calendar year for provider visits, prescriptions, etc., for covered expenses and includes your deductible, copays, and coinsurance. This “safety net” provides peace of mind for those who have a serious condition or illness
California Only | Traditional HMO (broader network) | Value Network HMO (limited network) |
||
|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Annual Deductible Individual/Family | $0 deductible | Not Covered | $0 deductible | Not Covered |
| Annual Out-of-Pocket Max | ||||
| Max Individual/Family | $2,500/Individual $5,000/Family | Not Covered | $2,500/Individual $5,000/Family | Not Covered |
| Member Co-Insurance | 0% | Not Covered | 0% | Not Covered |
| Physician Services | ||||
| Primary Care | $15 Copay | Not Covered | $15 Copay | Not Covered |
| Specialist Visits | $30 Copay | Not Covered | $30 Copay | Not Covered |
| Preventative Care | No charge | Not Covered | No charge | Not Covered |
| Hospital Services | ||||
| Inpatient Hospitalization | $250 copay per admission | Not Covered | $250 copay per admission | Not Covered |
| Outpatient Surgery | $100 Copay | Not Covered | $100 Copay | Not Covered |
| Diagnostic X-Ray & Lab | ||||
| X-Ray/Lab | No charge | Not Covered | No charge | Not Covered |
| Urgent and Emergency Care | ||||
| Emergency Room (copay waived if admitted) | $150 per visit | $150 per visit | ||
| Urgent Care | $35 Copay | Not Covered | $35 Copay | Not Covered |
| Prescriptions | ||||
| Generic | $10 Copay | Not Covered | $10 Copay | Not Covered |
| Preferred Brand | $30 Copay | Not Covered | $30 Copay | Not Covered |
| Non-Preferred Brand | $50 Copay | Not Covered | $50 Copay | Not Covered |
| Specialty (30 day maximum) | 30% up to $250 | Not Covered | 30% up to $250 | Not Covered |
Traditional PPO | HDHP |
|||
|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network |
|
| Annual Deductible Individual/Family | $500/Individual $1,000/Family | $1,500/Individual $3,000/Family | $3,300/Individual $6,600/Family | $10,000/Individual $20,000/Family |
| Annual Out-of-Pocket Max Individual/Family | $3,500/Individual $7,000/Family | $6,000/Individual $12,000/Family | $6,000/Individual $12,000/Family | $12,000/Individual $40,000/Family |
| Member Co-Insurance | 20% | 40% | 0% | 40% |
| Physician Services | ||||
| Primary Care | $15 Copay* | 40% | No charge (after deductible is met) | 40% |
| Specialist Visits | $30 Copay* | 40% | No charge (after deductible is met) | 40% |
| Preventative Care | $0 Copay* | Not Covered | No Charge* | Not Covered |
| Hospital Services | ||||
| Inpatient Hospitalization | 20% | 40% | No charge (after deductible is met) | 40% |
| Outpatient Surgery | 20% | 40% | No charge (after deductible is met) | 40% |
| Diagnostic X-Ray & Lab | ||||
| Basic X-Ray/Lab | 20% | 40% | No charge (after deductible is met) | 40% |
| Urgent and Emergency Care Visits | ||||
| Emergency Room (copay waived if admitted) | $300 per visit copay + 20%* | $300 per visit copay + 20%* | No Charge* | |
| Urgent Care | $50 Copay* | 40% | No charge (after deductible is met) | 40% |
| Prescriptions | ||||
| Generic | $10 Copay | Not Covered | $10 Copay (after deductible is met) | No charge (after deductible is met) |
| Preferred Brand | $30 Copay | Not Covered | $30 Copay (after deductible is met) | No charge (after deductible is met) |
| Non-Preferred Brand | $50 Copay | Not Covered | $50 Copay (after deductible is met) | No charge (after deductible is met) |
| Specialty (30 day maximum) | 30% up to $250 | Not Covered | 30% up to $250 (after deductible is met) | No charge (after deductible is met) |
If you, or any member of your family, are covered by another medical plan in addition to Waev Inc. Medical Plan, you should advise your medical office so that benefits can be coordinated between the plans. For more information, see the Medical Summary Plan Description (SPD).