2019 Active Health Plan Comparison

Benefits

 

Kaiser Permanente

 

 

Blue Shield Preferred 

Blue Shield (Non-Preferred)
Out of Network

Service Areas Many, but not all areas of California Any State
Annual Deductible $3,000/$6,000 (You pay $0) $4,000/$8,000 (You pay $0)  $5,500/$11,000
Max Copay $5,000/$10,000 $6,350/$12,700 $10,000/$20,000
Preventative Health
Annual Routine Exam No Charge No Charge Not Covered
Well Woman Exam No Charge No Charge Not Covered
Well Child Preventative Care No Charge  No Charge Not Covered
Outpatient Services
Office Visits $20 per visit 20% per visit  50% per visit
Labs and X-Rays $10 per encounter 20% per visit 50% per visit
Hospital Services   
Inpatient  20% per admit 20% per admit 50% per admit
Outpatient Surgery  20% per procedure 20% per procedure 50% per procedure
Outpatient Services 20% per procedure 20% per procedure 50% per procedure
CT Scans, MRIs, MRAs, PET Scans 20%per procedure $100 per visit + 20% 50% per visit
Skilled Nursing Facility 20% per admit 20% per admit 20% per admit
Prescription Medications Retail: 30-day supply
Retail Generic $10 $10  25% + $10
Retail Formulary Brand $30 $25 25% + $25
Non-Formulary Brand N/A $40 25% +$40
Specialty Drugs $150 $150
Prescription Medications Mail Order 100-days
Mail Order Generic $20 $20 Not Covered
Mail Order Formulary Brand $50 $50 Not Covered
Mail Order Non-Formulary  N/A $80 Non Covered
Emergency Services
ER Visit $100 per visit $100 per visit $100 per visit + 20%
Ambulance Transport $150 per trip 20% per trip 20% per trip
Short Term Rehab Services 20% per visit 20% per visit 50% per visit
Mental Health Services                                                                  MHSA- Magellen Assist
Inpatient Care 20% per admit 100% per admit + 20% 50% per admit
Outpatient Individual Therapy  $20 per visit 20% per visit 50% per visit
Chemical Dependency Services
Inpatient Detox 20% per admit Not Covered Not Covered
Outpatient Individual Therapy $20 per visit Not Covered Not Covered
Chiropractic and Acupuncture
Chiropractic Not Covered 20% per visit 50% per visit
Accupuncture $20 per visit 20% per visit 50% per visit

Highlighted cells are not included in the copay exclusion