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Medical Coverage Level

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Which Coverage Level Is Best?

You get to choose how much coverage you need and how you want to pay for it. It’s up to you! When you choose your coverage level, you get to pick the one with the features you want. Consider what changes you may be facing. Change is constant, so make sure you do your homework before sticking with what you had in the past.

Your coverage level determines how much you pay out of your paycheck (premiums). It also determines how much you pay out of your pocket when you receive care (deductibles, coinsurance, copays).

Make sure to take your total costs (premium + out of pocket = total costs) into consideration when choosing a coverage level.

The coverage levels are designed to give you a variety of levels to choose from so you can determine which may serve your needs best for the coming year.

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Medical Coverage Level Options

You have several coverage levels to choose from. Each coverage level is available from different insurance carriers at different costs.

When you enroll, you’ll find plenty of tools and resources to help you choose a coverage level.

Bronze Bronze Plus Silver Gold Platinum
Option type High-deductible option with HSA High-deductible option with HSA PPO PPO PPO that offers limited benefits for out-of-network care**
Paycheck contributions $ $ $$ $$$ $$$$
Annual Deductible
In-network (individual / family) $3,300 / $6,600 $2,450 / $4,900 $1,000 / $2,000 $800 / $1,600 N/A
Out-of-network (individual / family) $3,300 / $6,600 $2,450 / $4,900 $2,000 / $4,000 $1,600 / $3,200 $5,000 / $10,000
Traditional or true family? Traditional True family Traditional Traditional Traditional
Annual-Out-of-Pocket-Maximum
In-network (individual / family) $6,400 / $12,800 $3,900 / $7,800 $5,300 / $10,600 $3,600 / $7,200 $1,600 / $3,200
Out-of-network (individual / family) $12,800 / $25,600 $11,500 / $23,000 $10,600 / $21,200 $7,200 / $14,400 $11,500 / $23,000
Traditional or true family? Traditional True family Traditional Traditional Traditional
In-Network Benefits
Preventive care Covered 100%, no deductible Covered 100%, no deductible Covered 100%, no deductible Covered 100%, no deductible Covered 100%
Doctor's office visit You pay 25% after deductible You pay 25% after deductible You pay $30 for PCP visit and $50 for specialist visit, no deductible You pay $25 for PCP visit and $40 for specialist visit, no deductible You pay $25 for PCP visit and $40 for specialist visit
Emergency room You pay 25% after deductible You pay 25% after deductible You pay $150, then 30% after deductible You pay 25% after deductible You pay $200
Urgent care You pay 25% after deductible You pay 25% after deductible You pay 30% after deductible You pay 25% after deductible You pay $50
Inpatient care You pay 25% after deductible You pay 25% after deductible You pay 30% after deductible You pay 25% after deductible You pay $350
Outpatient care You pay 25% after deductible You pay 25% after deductible If not an office visit, you pay 30% after deductible If not an office visit, you pay 25% after deductible If not an office visit, covered 100%***
**For some insurance carriers in CA, CO, DC, GA, MD, OR, VA, and WA, the Platinum coverage level is an HMO option that covers in-network care only.
***There is a $100 copay for outpatient surgery at a hospital or free-standing facility.
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Prescription Drug Coverage

Bronze Bronze Plus Silver Gold Platinum
Preventive drugs You pay $0** You pay $0** You pay $0** You pay $0** You pay $0**
30-Day Retail Supply
Tier 1 (generally lowest cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $12 You pay $10 You pay $8
Tier 2 (generally medium cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $50 You pay $40 You pay $30
Tier 3 (generally highest cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $70 You pay $60 You pay $50
90-Day Mail Order Supply
Tier 1 (generally lowest cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $30 You pay $25 You pay $20
Tier 2 (generally medium cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $125 You pay $100 You pay $75
Tier 3 (generally highest cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $175 You pay $150 You pay $125
**Preventive drugs are determined by the insurance carrier or pharmacy benefit manager. You must have a doctor's prescription for the medication—even for products sold over the counter (OTC)—and you must use an in-network retail pharmacy or mail-order service.
These charts may not take into account how each coverage level covers any state-mandated benefits, its plan administration capabilities, or the approval from the state Department of Insurance of the benefits offered by the plan. If you have questions about a specific benefit, contact the insurance carrier for additional information. Individual carriers may offer coverage that differs slightly from the standard coverage reflected here. In the event that there is a discrepancy between this site and the official plan documents, the official plan documents will control.

These charts are a high-level listing of commonly covered benefits across carriers and coverage levels for the Aon Active Health Exchange. They are intended to provide you with a snapshot of benefits provided across coverage levels. In general, carriers have agreed to the majority of standardized plan benefits recommended by the exchange.

For a more detailed look at these and additional coverages, go to Your Total Rewards at http://digital.alight.com/equitable/. It does account for any carrier adjustments to standardized plan benefits. To see summaries when you enroll online, check the boxes next to the options you want to review and click Compare. In order to get the most comprehensive information about any specific coverage, you will need to call the carrier directly.

Note: For additional comparison, you may find Summaries of Benefits and Coverage on Your Total Rewards at http://digital.alight.com/equitable/.


California Residents: Your options will be different, depending on the insurance carrier you choose. See what's different.

Out-of-Area: Your specific options are based on your home zip code. If you live outside the service areas of all the insurance carriers, you can choose an out-of-area option at the Silver coverage level. Aetna will be the insurance carrier.

Choosing a Primary Care Physician: Certain options require you to choose a primary care physician. You may need to designate a primary care physician to coordinate your care if you choose Kaiser Permanente or Health Net as your insurance carrier.

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Do You Take Any Prescription Drugs?

This is really important! Your prescription drug coverage will be provided through your insurance carrier’s pharmacy benefit manager.

While your coverage level will determine your coverage for prescription drugs, each pharmacy benefit manager has its own rules. You need to make sure you’re comfortable with how your and your family's medications will be covered. Get the details.

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Questions?

Also check out the Frequently Asked Questions (PDF) and the Glossary.

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Make It Yours To Go

Download a printable version of the benefits information you need.