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    Regional Medical Options

    Last Updated December 13, 2024

    Jump to: Overview Regional Medical Program Options
    Based on where you live, you might be eligible to enroll in a regional medical option.

    Overview

    These regional medical options are available in certain areas of the country. If any of these options are available to you, you will see them listed when you log in to the enrollment website:

    Prescription Drug Coverage

    If you elect a regional medical option, prescription drug coverage is provided through the medical vendor — not CVS Caremark. If you have questions about prescription drug coverage, please contact the applicable medical vendor.

    2025 Regional Medical Program Options

    Kaiser Permanente Options — California 

    Kaiser HSA
    Medical

    Annual Deductible

     

    Individual:$4,500

    Family:$4,500 Embedded i

    Annual Out-of-Pocket Maximum

     

    Individual:$6,250

    Family:$6,250 Embedded i

    Coinsurance

    40%

    Physician Care Office Visits

     

     

    PCP:$40 after deductible

    Specialist:
    $50 after deductible

    Preventive Care:0%

    General Hospital Services

     

     

    Lab:40% after deductible

    X-Ray:40% after deductible

    Diagnostic:40% after deductible

    Hospital Services

     

    Inpatient:
     40% after deductible

    Outpatient:
     40% after deductible

    Emergency Services 

     

    ER:$250 after deductible

    Urgent Care:$40 after deductible

    Mental Health/Substance Abuse 

     

    Inpatient:
     40% after deductible

    Office Visit:$40 after deductible
    Kaiser HSA
    Medical
    Annual Deductible 

    Individual:$4,500

    Family:$4,500 Embedded i

    Annual Out-of-Pocket Maximum 

    Individual:$6,250

    Family:$6,250 Embedded i

    Coinsurance

    40%
    Physician Care Office Visits

    PCP:$40
    after deductible

    Specialist:
    $50
    after deductible

    Preventive Care:0%
    after deductible
    General Hospital Services

    Lab:40%
    after deductible

    X-Ray:40%
    after deductible

    Diagnostic:40%
    after deductible
    Hospital Services

    Inpatient:
     40%
    after deductible

    Outpatient:
     40%
    after deductible
    Emergency Services  

    ER:$250
    after deductible

    Urgent Care:$40
    after deductible
    Mental Health/Substance Abuse  

    Inpatient:
     40%|
    after deductible

    Office Visit:$40
    after deductible
    Kaiser HSAPrescription Drug
    Annual Deductible

    Combined Deductible

    Generic

     

    Retail:$15

    Mail Order:
    $30

    Formulary

     

    Retail:$35

    Mail Order:
    $70

    Non-Formulary

     

    Retail:$35

    Mail Order:
    $70
    Specialty

    Retail:40% up to $250

    Mail Order:N/A
    Kaiser HMOPrescription Drug Kaiser HSAPrescription Drug
    Annual Deductible Annual Deductible

    $100 for brand and specialty only

    Combined Deductible
    Generic Generic

    Retail:$10

    Mail Order:$10

    Retail:$15

    Mail Order:
    $30
    Formulary Formulary

    Retail:$30

    Mail Order:$30

    Retail:$35

    Mail Order:
    $70
    Non-Formulary   Non-Formulary  

    Retail:$30

    Mail Order:$30

    Retail:$35

    Mail Order:
    $70
    Specialty Specialty

    Retail:20% up to $150 after drug deductible

    Mail Order:N/A

    Retail:40% up to $250

    Mail Order:N/A

    Kaiser Permanente Options — Mid-Atlantic States

    Kaiser HSAMedical

    Annual Deductible

     

    Individual:$4,500

    Family:$4,500 Embedded i

    Annual Out-of-Pocket Maximum

     

    Individual:$6,250

    Family:$6,250 Embedded i

    Coinsurance

    40%

    Physician Care Office Visits

     

     

    PCP:$50 after deductible

    Specialist:
    $50 after deductible

    Preventive Care:0% after deductible

    General Hospital Services

     

     

    Lab:40% after deductible

    X-Ray:40% after deductible

    Diagnostic:40% after deductible

    Hospital Services

     

    Inpatient:
     40% after deductible

    Outpatient:
     40% after deductible

    Emergency Services 

     

    ER:$250 after deductible

    Urgent Care:$50 after deductible

    Mental Health/Substance Abuse 

     

    Inpatient:
     40% after deductible

    Office Visit:$50 after deductible
    Kaiser HSAMedical
    Annual Deductible

    Individual:$4,500

    Family:$4,500 Embedded i

    Annual Out-of-Pocket Maximum 

    Individual:$6,250

    Family:$6,250 Embedded i

    Coinsurance

    40%
    Physician Care Office Visits

    PCP:$50
    after deductible

    Specialist:
    $50
    after deductible

    Preventive Care:0%
    after deductible
    General Hospital Services

    Lab:40%
    after deductible

    X-Ray:40%
    after deductible

    Diagnostic:40%
    after deductible
    Hospital Services 

    Inpatient:
     40%
    after deductible

    Outpatient:
     40%
    after deductible
    Emergency Services 

    ER:$250
    after deductible

    Urgent Care:$50
    after deductible
    Mental Health/Substance Abuse  

    Inpatient:
     40%
    after deductible

    Office Visit:$50
    after deductible
     

    Kaiser HSAPrescription Drug
    Annual Deductible

    Combined Deductible
    Generic

     

    Retail:
    $20

    Mail Order:
    $40
    Formulary

     

    Retail:$50

    Mail Order:
    $100
    Non-Formulary

     

    Retail:
    50%

    Mail Order:
    50%
    Specialty

    Retail:50% up to $150

    Mail Order:N/A
    Kaiser HSAPrescription Drug
    Annual Deductible

    Combined Deductible
    Generic

    Retail:
    $20

    Mail Order:
    $40
    Formulary

    Retail:$50

    Mail Order:
    $100
    Non-Formulary

    Retail:
    50%

    Mail Order:
    50%
    Specialty

    Retail:50% up to $150

    Mail Order:N/A

    Kaiser Permanente Options — Oregon

    Kaiser HSA Medical

    Annual Deductible

     

    Individual: $4,000

    Family: $4,000 Embedded i

    Annual Out-of-Pocket Maximum

     

    Individual: $6,650

    Family: $6,650 Embedded i

    Coinsurance

    40%

    Physician Care Office Visits

     

     

    PCP: 40% after deductible

    Specialist:
    40% after deductible

    Preventive Care: 0% after deductible

    General Hospital Services

     

     

    Lab: 40% after deductible

    X-Ray: 40% after deductible

    Diagnostic: 40% after deductible

    Hospital Services

     

    Inpatient:
     40% after deductible

    Outpatient:
     40% after deductible

    Emergency Services 

     

    ER: 40% after deductible

    Urgent Care: 40% after deductible

    Mental Health/Substance Abuse 

     

    Inpatient:
     40% after deductible

    Office Visit: 40% after deductible
    Kaiser HSA Medical
    Annual Deductible  

    Individual: $4,000

    Family: $4,000 Embedded i

    Annual Out-of-Pocket Maximum

    Individual: $6,650

    Family: $6,650 Embedded i

    Coinsurance

    40%
    Physician Care Office Visits

    PCP: 40%
    after deductible

    Specialist:
    40%
    after deductible

    Preventive Care: 0%
    after deductible
    General Hospital Services

    Lab: 40%
    after deductible

    X-Ray: 40%
    after deductible

    Diagnostic: 40%
    after deductible
    Hospital Services

    Inpatient:
     40%
    after deductible

    Outpatient:
     40%
    after deductible
    Emergency Services

    ER: 40%
    after deductible

    Urgent Care: 40%
    after deductible
    Mental Health/Substance Abuse

    Inpatient:
     40%
    after deductible

    Office Visit: 40%
    after deductible
    Kaiser HSAPrescription Drug
    Annual Deductible

    Combined Deductible

    Generic

     

    Retail:$15

    Mail Order:
    $30

    Formulary

     

    Retail:$30

    Mail Order:
    $60

    Non-Formulary

     

    Retail:
    $50

    Mail Order:
    $100
    Specialty

    Retail:50%

    Mail Order:N/A
    Kaiser HSAPrescription Drug
    Annual Deductible

    Combined Deductible
    Generic

    Retail:$15

    Mail Order:
    $30
    Formulary

    Retail:$30

    Mail Order:
    $60
    Non-Formulary

    Retail:
    $50

    Mail Order:
    $100
    Specialty

    Retail:50%

    Mail Order:N/A

    Kaiser Permanente Options — Washington

    Kaiser HSAMedical

    Annual Deductible

     

    Individual:$4,500

    Family:$7,350

    Annual Out-of-Pocket Maximum

     

    Individual:$6,000

    Family:$7,350
    Coinsurance

    30%

    Physician Care Office Visits

     

     

    PCP:
    30% after deductible

    Specialist:
    30% after deductible

    Preventive Care:0%

    General Hospital Services

     

     

    Lab:30% after deductible

    X-Ray:30% after deductible

    Diagnostic:30% after deductible

    Hospital Services

     

    Inpatient:
     30% after deductible

    Outpatient:
    30% after deductible

    Emergency Services 

     

    ER:$75/visit after deductible

    Urgent Care:30% after deductible

    Mental Health/Substance Abuse 

     

    Inpatient:
     30% after deductible

    Office Visit:30% after deductible
    Kaiser HSAMedical
    Annual Deductible

    Individual:$4,500

    Family:$7,350
    Embedded i

    Annual Out-of-Pocket Maximum

    Individual:$6,000

    Family:$7,350
    Embedded i

    Coinsurance

    30%
    Physician Care Office Visits

    PCP:30%
    after deductible

    Specialist:
    30%
    after deductible

    Preventive Care:0%
    General Hospital Services

    Lab:30%
    after deductible

    X-Ray:30%
    after deductible

    Diagnostic:30%
    after deductible
    Hospital Services

    Inpatient:
     30%

    Outpatient:
    30%
    after deductible
    Emergency Services

    ER:$75/visit
    after deductible

    Urgent Care:30%
    after deductible
    Mental Health/Substance Abuse

    Inpatient:
     30%
    after deductible

    Office Visit:30%
    after deductible
    Kaiser HSA
    Prescription Drug
    Annual Deductible

    Combined Deductible

    Generic

     

    Retail:
    $15

    Mail Order:
    $45

    Formulary

     

    Retail:$30

    Mail Order:
    $90

    Non-Formulary

     

    Retail:
    N/A

    Mail Order:
    N/A
    Specialty

    Retail:
    Contact Kaiser

    Mail Order:
    N/A
    Kaiser HSA
    Prescription Drug
    Annual Deductible

    Combined Deductible
    Generic

    Retail:
    $15

    Mail Order:
    $45
    Formulary

    Retail:$30

    Mail Order:
    $90
    Non-Formulary 

    Retail:
    N/A

    Mail Order:
    N/A
    Specialty

    Retail:
    Contact Kaiser

    Mail Order:
    N/A
    Related Information

    2025 Regional Medical Options Enrollment Guide

    Guía de Opciones Médicas Regionales de 2025

    Summaries of Benefits and Coverage

    Summary Plan Descriptions

    Contact Information

    BCBSIL

    Network Name: 

    Dean Health
    1-800-279-1301

    Kaiser Permanente California
    1-800-464-4000

    Kaiser Permanente Mid-Atlantic States
    DC Metro: 301-468-6000
    Outside DC Metro: 1-800-777-7902

    Kaiser Permanente Northwest
    1-800-813-2000

    Kaiser Permanente Washington
    1-888-901-4636

    Coverage Transparency

    The federal Transparency in Coverage rule requires our group health plan to publicly share detailed price and cost-sharing information starting July 1, 2022. The Rule requires health plans to post machine readable files (MRFs) that show the negotiated rates for in-network providers and the allowed amounts for out-of-network providers, for certain services covered by the group health plan. Each of our health plan insurers and third-party administrators will publish the MRFs online and update them each month at the following links:

    Note that MRFs are formatted to allow third parties, such as researchers, regulators and app developers, to more easily access and analyze data about health care costs and may be difficult for others to review.