2021 Active Plan Comparison

Benefits

 

Kaiser Permanente

Sutter Health Plus

 

 

Blue Shield Preferred 

Service Areas Within the KP footprint Within the SHPlus footprint Any State
Annual Deductible $5,500/11,000 (You pay $0)  $5,500/$11,000
(You pay $0)
 
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)
 
Preventative Health
Annual Routine Exam No Charge  No Charge No Charge
Well Woman Exam No Charge No Charge No Charge
Well Child Preventative Care No Charge  No Charge No Charge
Outpatient Services
Office Visits $20 per visit  $50 per visit 20% per visit 
Labs and X-Rays $10 per encounter  No Charge 20% per visit
Hospital Services 
Inpatient  20% per admit  30% coinsurance after deductible 20% per admit
Outpatient Surgery  20% per procedure  30% coinsurance after deductible 20% per procedure
Outpatient Services 20% per procedure  30% coinsurance after deductible 20% per procedure
CT Scans, MRIs, MRAs, PET Scans 20%per procedure  $100 copay per procedure after deductible $100 per visit + 20%
Skilled Nursing Facility 20% per admit  30% after deductible 20% per admit
Prescription Medications 30 day supply                                                                 
Retail Generic $10  $10 $10 
Retail Formulary Brand $30  $30 $25
Non-Formulary Brand N/A  $60 $40
Specialty Drugs $250 30% coinsurance up to $250 $250
Prescription Medications Mail Order 100-days
Mail Order Generic $20  $20 $20
Mail Order Formulary Brand $50  $60 $50
Mail Order Non-Formulary  N/A $ 120 $80
Emergency Services
ER Visit $100 per visit  $150 per visit $100 per visit
Ambulance Transport $150 per trip  $150 copay per trip after deductible 20% per trip
Short Term Rehab Services 20% per visit  $50 [er visit 20% per visit
Mental Health Services                                       Blue Shield uses MHSA- Magellen Assist
Inpatient Care 20% per admit  $50 per visit 100% per admit + 20%
Outpatient Individual Therapy  $20 per visit  $50 per visit/$20 per telehealth visit 20% per visit
Chemical Dependency Services
Inpatient Detox 20% per admit  30% coinsurance after deductible Not Covered
Outpatient Individual Therapy $20 per visit  $50 per visit/$20 per telehealth visit Not Covered
Chiropractic and Acupuncture
Chiropractic $0 (30 sessions through Landmark Healthplan)  $0 (30 sessions through Landmark Healthplan) 20% per visit
Chiropractic $0 (30 sessions through Landmark Healthplan)  $0 (30 sessions through Landmark Healthplan) 20% per visit

Highlighted cells are not included in the copay exclusion