2021 Active Plan Comparison

Benefits

 

Kaiser Permanente
with HRA

Sutter Health Plus with HRA

 

 

Blue Shield Preferred 

In Network

 

 

Blue Shield Preferred 

Out of Network

Service Areas Within the KP footprint Within the SHPlus footprint Any State

Any State

Annual Deductible $5,500/11,000 (You pay $0)  $5,500/$11,000
(You pay $0)
$2500/$5,000 $2500/$5,000
/Max Copay $6550/$13,100
(You only pay the final $1,050/$2,100)
 $6,500/13,000
(You only pay the final $1,000/$2,000)
$6850/$13,700 $10,500/$21,000
$10,500/$21,000Preventative Health  
Annual Routine Exam No Charge  No Charge No Charge Not Covered
Well Woman Exam No Charge No Charge No Charge Not Covered
Well Child Preventative Care No Charge  No Charge 20% 50%
Outpatient Services  
Office Visits $20 per visit  $50 per visit $25 per visit 50%
Labs and X-Rays $10 per encounter  No Charge $25 per visit 50%
Hospital Services   
Inpatient  20% per admit  30% coinsurance after deductible 20% per admit 50% of up to $600/day plus 100% of additional charges
Outpatient Surgery  20% per procedure  30% coinsurance after deductible

Ambulatory Center:10%

Outpatient Dept of Hospital: 25%

50% of up to $350/day plus 100% of additional charges

Outpatient Services 20% per procedure  30% coinsurance after deductible 20% per procedure 50% of up to $350/day plus 100% of additional charges
CT Scans, MRIs, MRAs, PET Scans 20%per procedure  $100 copay per procedure after deductible $100 per visit + 20% 50% of up to $350/day plus 100% of additional charges
Skilled Nursing Facility 20% per admit  30% after deductible 20% per admit 50%
Prescription Medications 30 day supply                                                                   
Retail Generic $10  $10 $15 25% plus $15 per Rx
Retail Formulary Brand $30  $30 $30 25% plus $30 per Rx
Non-Formulary Brand N/A  $60 $45 25% plus $45 per Rx
Specialty Drugs $250 30% coinsurance up to $250 25% plus $15 per Rx 25% plus $15 per Rx plus 25% of purchase price
Prescription Medications Mail Order 100-days  
Mail Order Generic $20  $20 $20 Not Covered
Mail Order Formulary Brand $50  $60 $50 Not Covered
Mail Order Non-Formulary  N/A $ 120 $80 Not Covered
Emergency Services  
ER Visit $100 per visit  $150 per visit $150 per visit plus 20% $150 per visit plus 20%
Ambulance Transport $150 per trip  $150 copay per trip after deductible 20% per trip 20%
Short Term Rehab Services 20% per visit  $50 [er visit 20% 25%
Mental Health Services                                       Blue Shield uses MHSA- Magellen Assist  
Inpatient Care 20% per admit  $50 per visit $25 per visit 50%
Outpatient Individual Therapy  $20 per visit  $50 per visit/$20 per telehealth visit $25 per visit 50%
Chemical Dependency Services  
Inpatient Detox 20% per admit  30% coinsurance after deductible 0-20% 50%
Outpatient Individual Therapy $20 per visit  $50 per visit/$20 per telehealth visit $0 - $25 per visit 50%
Chiropractic and Acupuncture  
Chiropractic $0 (30 sessions through Landmark Healthplan)  $0 (30 sessions through Landmark Healthplan) $25 per visit 50%
Chiropractic $0 (30 sessions through Landmark Healthplan)  $0 (30 sessions through Landmark Healthplan) $25 per visit 50%

Highlighted cells are not included in the copay exclusion