Medical Plan Summaries

Download links below for plan comparisons for plan year November 1, 2018, through December 31, 2019 (please note that these are Synod medical plan summaries in tables, for more detailed summaries from carriers, click on Benefits then "Plan Summaries and Enrollment Forms" from the dropdown menu).

Sutter Health Plus Plan Options
Kaiser Plan Options

2018-19 Summaries
EFFECTIVE: NOVEMBER 1, 2018 to DECEMBER 31, 2019

Description

Sutter Health Plus HMO

Kaiser HMO

 Sutter Health Plus HMO Deductible

Kaiser HMO HRA (In Network)

 

 

 

In Network

In Network

Lifetime Maximum

Unlimited

Unlimited

Unlimited

Unlimited

Annual Deductible

None

None

$1,000/Member

$2,000/Family

$2,000*/Member; $4,000*/Family

HRA Allocation from Synod is $1,000 mem/$2,000 family

Annual Out-of-Pocket Maximum

$1,500/Member

$3,000/Family

$1,500/Member

$3,000/Family

$3,000/Member

$6,000/Family

$4,000/Member

$8,000/Family

Professional

 

 

 

Physician Visit

$20 Copay

$30 Copay

$20 Copay; Ded Waived

$20 Copay after Ded

Specialist

$20 Copay

$30 Copay

$20 Copay; Ded Waived

$20 Copay after Ded

Physical Therapy

$20 Copay

$30 Copay

$20 Copay

$20 Copay after Ded

Home Health Care

No copay; 100 visits per year

No Copay; 100 visits per year

No copay; 100 visits per year; Ded waived

No Copay; 100 visits/year; Ded waived

Hospital Services

 

 

 

Inpatient

$250 per admission

$500/Admit

20% Coinsurance after Ded

20% Coinsurance after Ded

Outpatient

$100/visit

$250/Procedure

20% Coinsurance after Ded

20% Coinsurance after Ded

Emergency Room

$100 Copay, waived if admitted

$150 Copay, waived if admitted

20% Coinsurance after Ded

20% Coinsurance after Ded

Lab & X-Ray

No charge

$10 Copay

$20 Lab/$10 X-ray; Ded Waived

$10 Copay after Ded

Durable Medical Equip

20% Coinsurance

20% Coinsurance

20% Coinsurance after Ded

20% Coins.; Ded Waived

Preventive Care

 

 

 

Adult

No Copay

No Copay

No Copay; Ded Waived

No Copay; Ded Waived

Children

No Copay

No Copay

No Copay; Ded Waived

No Copay; Ded Waived

Maternity

 

 

 

Office Visits

No Copay

No Copay

No Copay; Ded Waived

No Copay; Ded Waived

Mental Health / Substance Abuse

 

 

 

Inpatient

$250 per admission

$500/admit

20% Coinsurance after Ded

$20% Coinsurance after Ded

Outpatient

$20/Visit

$30/Visit

$20 Copay/Visit; Ded Waived

$20 Copay/Visit after Ded

Chiropractic Benefit

None

$15 Copay/30 visits

None

None

Prescription Drug

 

 

 

 

Generic

$10 Copay

$15 Copay

$10 Copay; Ded waived

$10 Copay; Ded Waived

Brand

$30 Copay

$35 Copay

$30 Copay; Ded waived

$30 Copay; Ded Waived

Brand Non-Formulary

$60 Copay

Must be Formulary

$60 Copay; Ded waived

Must be Formulary

Brand Name Deduct.

None

None

None

None

Notes

See Plan for more details

Kaiser NW has lower Co-pays; see Plan

See Plan for more details

See Plan for more details

This information is meant to be a summary of benefits only. Please refer to the plan document for detailed information. If there is a conflict between this information and the plan document, the plan document will prevail.

 

* HEALTH REIMBURSEMENT ACCOUNT (HRA) ALLOCATIONS: For the Kaiser HRA Plan, please note that half of the Calendar Year Deductible is allocated into a Health Reimbursement Account for employees that can be used by an employee as first monies towards their covered medical expenses.  Kaiser HRA Enrollees receive their full allocation on November 1st (beginning in 2020, that allocation will be on January 1st as we are moving to a Calendar Year).