Medical
Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Cigna OAP Base
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$8,100/$16,200
Preventive Care
No charge
Primary Care Visit
$25 copay/visit
Specialist Visit
$50 copay/visit
Urgent Care
$25 copay/visit
Emergency Room
$250 copay/visit, plus 30% coinsurance
Retail Rx (Up to 30-Day Supply)
Generic
$15 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$60 copay
Specialty
30% coinsurance but not more than $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$45 copay
Preferred Brand
$120 copay
Non-Preferred Brand
$180 copay
Specialty
30% coinsurance but not more than $250
Out-of-Network
Deductible (Individual/Family)
$1,000/$2,000
Out-of-Pocket Max (Individual/Family)
$16,200/$32,400
Preventive Care
50% coinsurance
Primary Care Visit
50% coinsurance
Specialist Visit
50% coinsurance
Urgent Care
50% coinsurance
Emergency Room
30% coinsurance
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Plan Cost
Employee Only: $113.46
Employee and Spouse: $363.07
Employee and Child(ren): $332.81
Employee and Family: $552.16
Cigna OAP Buy-up
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$4,500/$9,000
Preventive Care
No charge
Primary Care Visit
$10 copay/visit
Specialist Visit
$25 copay/visit
Urgent Care
$10 copay/visit
Emergency Room
$150 copay/visit, plus 10%
coinsurance
Retail Rx (Up to 30-Day Supply)
Generic
$5 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
30% coinsurance but not more than $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$5 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
30% coinsurance but not more than $250
Out-of-Network
Deductible (Individual/Family)
$1,000/$2,000
Out-of-Pocket Max (Individual/Family)
$9,000/$18,000
Preventive Care
40% coinsurance
Primary Care Visit
40% coinsurance
Specialist Visit
40% coinsurance
Urgent Care
40% coinsurance
Emergency Room
$150 copay/visit, plus 10%
coinsurance
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Plan Cost
Employee Only: $260.75
Employee and Spouse: $719.65
Employee and Child(ren): $664.02
Employee and Family: $1,067.29
Cigna OAP HSA
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,100/$4,200
Out-of-Pocket Max (Individual/Family)
$6,900/$8,900
Preventive Care
No charge
Primary Care Visit
25% coinsurance/visit
Specialist Visit
25% coinsurance/visit
Urgent Care
25% coinsurance
Emergency Room
25% coinsurance
Retail Rx (Up to 30-Day Supply)
Generic
$20 copay
Preferred Brand
$65 copay
Non-Preferred Brand
$100 copay
Specialty
30% coinsurance but not more
than $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$65 copay
Non-Preferred Brand
$100 copay
Specialty
30% coinsurance but not more
than $250
Out-of-Network
Deductible (Individual/Family)
$4,200/$8,400
Out-of-Pocket Max (Individual/Family)
$13,800/$27,600
Preventive Care
50% coinsurance
Primary Care Visit
50% coinsurance
Specialist Visit
50% coinsurance
Urgent Care
50% coinsurance
Emergency Room
25% coinsurance
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Plan Cost
Employee Only: $0.00
Employee and Spouse: $76.92
Employee and Child(ren): $67.59
Employee and Family: $135.19
Kaiser California Platinum 90 HMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
No charge
Primary Care Visit
$10 / visit
Specialist Visit
$20 / visit
Urgent Care
$10 / visit
Emergency Room
$200 / visit
Retail Rx (Up to 30-Day Supply)
Generic
$5 copay
Preferred Brand
$15 copay
Non-Preferred Brand
$15 copay
Specialty
10% coinsurance up to $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$30 copay
Specialty
Not covered
Plan Cost
Your cost is determined by your age. Please refer to the rate table on Rippling for details.
Kaiser Hawaii Added Choice Plan 306
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$2,000/$6,000
Preventive Care
No charge
Primary Care Visit
$20/visit
Specialist Visit
$20/visit
Urgent Care
$20/visit
Emergency Room
$100/visit
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$45 copay
Non-Preferred Brand
$45 copay
Specialty
$200 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$90 copay
Non-Preferred Brand
$90 copay
Specialty
Not Covered
Out-of-Network
Deductible (Individual/Family)
$100/$300
Out-of-Pocket Max (Individual/Family)
$2,000/$6,000
Preventive Care
20% coinsurance
Primary Care Visit
20% coinsurance
Specialist Visit
20% coinsurance
Urgent Care
Not Covered
Emergency Room
$100/visit
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Plan Cost
Employee Only: $22.96
Employee and Spouse: $69.13
Employee and Child(ren): $59.89
Employee and Family: $115.30
Kaiser Hawaii Plan 420 HMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$2,500/$7,500
Preventive Care
No charge
Primary Care Visit
$15/visit
Specialist Visit
$15/visit
Urgent Care
$15/visit
Emergency Room
$75/visit
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$45 copay
Non-Preferred Brand
$45 copay
Specialty
$200 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$90 copay
Non-Preferred Brand
$90 copay
Specialty
Not Covered
Plan Cost
Employee Only: $22.17
Employee and Spouse: $66.75
Employee and Child(ren): $57.83
Employee and Family: $111.32