Regional Medical Options

Last Updated March 1, 2023

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.

2023 Regional Medical Program Options

Kaiser Permanente Options — Atlanta Area

Kaiser HMOMedical

Kaiser HSAMedical

Annual Deductible

Individual:$500

Family:$500 Embedded i

Individual:$4,500

Family:$4,500 Embedded i

Annual Out-of-Pocket Maximum

Individual:$3,000

Family:$3,000 Embedded i

Individual:$6,250

Family:$6,250 Embedded i

Coinsurance

20%

40%

Physician Care Office Visits

PCP:
$20

Specialist:
$20

Preventive Care:0%

PCP:40%

Specialist:
40%

Preventive Care:0%

General Hospital Services

Lab:$10

X-Ray:$10

Diagnostic:20%

Lab:40%

X-Ray:40%

Diagnostic:40%

Hospital Services

Inpatient:
20%

Outpatient:
20%

Inpatient:
40%

Outpatient:
40%

Emergency Services

ER:20%

Urgent Care:$20

ER:40%

Urgent Care:40%

Mental Health/Substance Abuse

Inpatient:
20%

Office Visit:$20

Inpatient:
40%

Office Visit:40%

Kaiser HMOMedical	Kaiser HSAMedical
Annual Deductible	Annual Deductible
Individual:$500 Family:$500 Embedded i	Individual:$4,500 Family:$4,500 Embedded i
Annual Out-of-Pocket Maximum	Annual Out-of-Pocket Maximum
Individual:$3,000 Family:$3,000 Embedded i	Individual:$6,250 Family: $6,250 Embedded i
Coinsurance	Coinsurance
20%	40%
Physician Care Office Visits	Physician Care Office Visits
PCP: $20 Specialist: $20 Preventive Care: 0%	PCP: 40% Specialist: 40% Preventive Care: 0%
General Hospital Services	General Hospital Services
Lab:$10 X-Ray:$10 Diagnostic:20%	Lab:40% X-Ray:40% Diagnostic:40%
Hospital Services	Hospital Services
Inpatient: 20% Outpatient: 20%	Inpatient: 40% Outpatient: 40%
Emergency Services	Emergency Services
ER:20% Urgent Care:$20	ER:40% Urgent Care:40%
Mental Health/Substance Abuse	Mental Health/Substance Abuse
Inpatient: 20% Office Visit:$20	Inpatient: 40% Office Visit:40%

Kaiser HMOPrescription Drug

Kaiser HSAPrescription Drug

Annual Deductible

$100

Combined Deductible

Generic

Retail:$10

Mail Order:$20

Retail:
$15

Mail Order:
$30

Formulary

Retail:$30

Mail Order:$60

Retail:$35

Mail Order:
$70

Non-Formulary

Retail:At applicable copay

Mail Order:At applicable copay

Retail:At applicable copay

Mail Order:
At applicable copay

Specialty

Retail:20% up to $150

Mail Order:N/A

Retail:30% up to $200

Mail Order:N/A

Kaiser HMOPrescription Drug	Kaiser HSAPrescription Drug
Annual Deductible	Annual Deductible
$100	Combined Deductible
Generic	Generic
Retail:$10 Mail Order:$20	Retail: $15 Mail Order: $30
Formulary	Formulary
Retail:$30 Mail Order:$60	Retail:$35 Mail Order: $70
Non-Formulary	Non-Formulary
Retail:At applicable copay Mail Order:At applicable copay	Retail:At applicable copay Mail Order: At applicable copay
Specialty	Specialty
Retail:20% up to $150 Mail Order:N/A	Retail:30% up to $200 Mail Order:N/A

Kaiser Permanente Options — California

Kaiser HMO
Medical

Kaiser HSA
Medical

Annual Deductible

Individual:$500

Family:$500 Embedded i

Individual:$4,500

Family:$4,500 Embedded i

Annual Out-of-Pocket Maximum

Individual:$3,000

Family:$3,000 Embedded i

Individual:$6,250

Family:$6,250 Embedded i

Coinsurance

20%

40%

Physician Care Office Visits

PCP:
$20

Specialist:
$20

Preventive Care:0%

PCP:$40

Specialist:
$40

Preventive Care:0%

General Hospital Services

Lab:$10

X-Ray:$10

Diagnostic:$10

Lab:40%

X-Ray:40%

Diagnostic:40%

Hospital Services

Inpatient:
20%

Outpatient:
20%

Inpatient:
40%

Outpatient:
40%

Emergency Services

ER:20%

Urgent Care:$20

ER:$250

Urgent Care:$40

Mental Health/Substance Abuse

Inpatient:
20%

Office Visit:$20

Inpatient:
40%

Office Visit:$40

Kaiser HMO Medical	Kaiser HSA Medical
Annual Deductible	Annual Deductible
Individual:$500 Family:$500 Embedded i	Individual:$4,500 Family:$4,500 Embedded i
Annual Out-of-Pocket Maximum	Annual Out-of-Pocket Maximum
Individual:$3,000 Family:$3,000 Embedded i	Individual:$6,250 Family:$6,250 Embedded i
Coinsurance	Coinsurance
20%	40%
Physician Care Office Visits	Physician Care Office Visits
PCP: $20 Specialist: $20 Preventive Care:0%	PCP:$40 Specialist: $40 Preventive Care:0%
General Hospital Services	General Hospital Services
Lab:$10 X-Ray:$10 Diagnostic:$10	Lab:40% X-Ray:40% Diagnostic:40%
Hospital Services	Hospital Services
Inpatient: 20% Outpatient: 20%	Inpatient: 40% Outpatient: 40%
Emergency Services	Emergency Services
ER:20% Urgent Care:$20	ER:$250 Urgent Care:$40
Mental Health/Substance Abuse	Mental Health/Substance Abuse
Inpatient: 20% Office Visit:$20	Inpatient: 40% Office Visit:$40

Kaiser HMOPrescription Drug

Kaiser HSAPrescription Drug

Annual Deductible

$100 for brand and specialty only

Combined Deductible

Generic

Retail:$10

Mail Order:$10

Retail:$15

Mail Order:
$30

Formulary

Retail:$30

Mail Order:$30

Retail:$35

Mail Order:
$70

Non-Formulary

Retail:$30

Mail Order:$30

Retail:$35

Mail Order:
$70

Specialty

Retail:20% up to $150 after drug deductible

Mail Order:N/A

Retail:30% 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:30% up to $250 Mail Order:N/A

Kaiser Permanente Options — Colorado

Kaiser HMO
Medical

Kaiser HSA
Medical

Annual Deductible

Individual: $500

Family: $500 Embedded i

Individual: $4,500

Family: $4,500 Embedded i

Annual Out-of-Pocket Maximum

Individual:
$3,000

Family: $3,000 Embedded i

Individual: $6,250

Family: $6,250 Embedded i

Coinsurance

20%

40%

Physician Care Office Visits

PCP:$20

Specialist:$20

Preventive Care:0%

PCP:$50

Specialist:$50

Preventive Care:0%

General Hospital Services

Lab:0%

X-Ray:20%

Diagnostic:20%

Lab:40%

X-Ray:40%

Diagnostic:40%

Hospital Services

Inpatient:20%

Outpatient:20%

Inpatient:40%

Outpatient:40%

Emergency Services

ER:20%

Urgent Care:$25

ER:$250

Urgent Care:$50

Mental Health/Substance Abuse

Inpatient:20%

Office Visit:$20

Inpatient:40%

Office Visit:$50

Kaiser HMO Medical	Kaiser HSA Medical
Annual Deductible	Annual Deductible
Individual: $500 Family: $500 Embedded i	Individual: $4,500 Family: $4,500 Embedded i
Annual Out-of-Pocket Maximum	Annual Out-of-Pocket Maximum
Individual: $3,000 Family: $3,000 Embedded i	Individual: $6,250 Family: $6,250 Embedded i
Coinsurance	Coinsurance
20%	40%
Physician Care Office Visits	Physician Care Office Visits
PCP:$20 Specialist:$20 Preventive Care:0%	PCP:$50 Specialist:$50 Preventive Care:0%
General Hospital Services	General Hospital Services
Lab:0% X-Ray:20% Diagnostic:20%	Lab:40% X-Ray:40% Diagnostic:40%
Hospital Services	Hospital Services
Inpatient:20% Outpatient:20%	Inpatient:40% Outpatient:40%
Emergency Services	Emergency Services
ER:20% Urgent Care:$25	ER:$250 Urgent Care:$50
Mental Health/Substance Abuse	Mental Health/Substance Abuse
Inpatient:20% Office Visit:$20	Inpatient:40% Office Visit:$50

Kaiser HMOPrescription Drug

Kaiser HSAPrescription Drug

Annual Deductible

Combined Deductible

Generic

Retail:$10

Mail Order:$20

Retail:$15

Mail Order:
$30

Formulary

Retail:$30

Mail Order:$60

Retail:$35

Mail Order:
$70

Non-Formulary

Retail:At applicable copay

Mail Order:At applicable copay

Retail:
$35

Mail Order:
$70

Specialty

Retail:20% up to $250

Mail Order:N/A

Retail:30% up to $200

Mail Order:N/A

Kaiser HMOPrescription Drug	Kaiser HSAPrescription Drug
Annual Deductible	Annual Deductible
$0	Combined Deductible
Generic	Generic
Retail:$10 Mail Order:$20	Retail:$15 Mail Order: $30
Formulary	Formulary
Retail:$30 Mail Order:$60	Retail:$35 Mail Order: $70
Non-Formulary	Non-Formulary
Retail:At applicable copay Mail Order:At applicable copay	Retail: $35 Mail Order: $70
Specialty	Specialty
Retail:20% up to $250 Mail Order:N/A	Retail:30% up to $200 Mail Order:N/A

Kaiser Permanente Options — Mid-Atlantic States

Kaiser HMOMedical

Kaiser HSAMedical

Annual Deductible

Individual:$500

Family:$500 Embedded i

Individual:$4,500

Family:$4,500 Embedded i

Annual Out-of-Pocket Maximum

Individual:$3,000

Family:$3,000 Embedded i

Individual:$6,250

Family:$6,250 Embedded i

Coinsurance

20%

40%

Physician Care Office Visits

PCP:
$20

Specialist:
$30

Preventive Care:0%

PCP:$50

Specialist:
$50

Preventive Care:0%

General Hospital Services

Lab:$20

X-Ray:$20

Diagnostic:20%

Lab:40%

X-Ray:40%

Diagnostic:40%

Hospital Services

Inpatient:
20%

Outpatient:
20%

Inpatient:
40%

Outpatient:
40%

Emergency Services

ER:$100

Urgent Care:$30

ER:$250

Urgent Care:$50

Mental Health/Substance Abuse

Inpatient:
20%

Office Visit:$20

Inpatient:
40%

Office Visit:$50

Kaiser HMOMedical	Kaiser HSAMedical
Annual Deductible	Annual Deductible
Individual:$500 Family:$500 Embedded i	Individual:$4,500 Family:$4,500 Embedded i
Annual Out-of-Pocket Maximum	Annual Out-of-Pocket Maximum
Individual:$3,000 Family:$3,000 Embedded i	Individual:$6,250 Family:$6,250 Embedded i
Coinsurance	Coinsurance
20%	40%
Physician Care Office Visits	Physician Care Office Visits
PCP: $20 Specialist: $30 Preventive Care:0%	PCP:$50 Specialist: $50 Preventive Care:0%
General Hospital Services	General Hospital Services
Lab:$20 X-Ray:$20 Diagnostic:20%	Lab:40% X-Ray:40% Diagnostic:40%
Hospital Services	Hospital Services
Inpatient: 20% Outpatient: 20%	Inpatient: 40% Outpatient: 40%
Emergency Services	Emergency Services
ER:$100 Urgent Care:$30	ER:$250 Urgent Care:$50
Mental Health/Substance Abuse	Mental Health/Substance Abuse
Inpatient: 20% Office Visit:$20	Inpatient: 40% Office Visit:$50

Kaiser HMOPrescription Drug

Kaiser HSAPrescription Drug

Annual Deductible

Combined Deductible

Generic

Retail:$10

Mail Order:$20

Retail:
$20

Mail Order:
$40

Formulary

Retail:$30

Mail Order:$60

Retail:$50

Mail Order:
$100

Non-Formulary

Retail:$50

Mail Order:$100

Retail:
50%

Mail Order:
50%

Specialty

Retail:50% up to $150

Mail Order:N/A

Retail:50% up to $150

Mail Order:N/A

Kaiser HMOPrescription Drug	Kaiser HSAPrescription Drug
Annual Deductible	Annual Deductible
$0	Combined Deductible
Generic	Generic
Retail:$10 Mail Order:$20	Retail: $20 Mail Order: $40
Formulary	Formulary
Retail:$30 Mail Order:$60	Retail:$50 Mail Order: $100
Non-Formulary	Non-Formulary
Retail:$50 Mail Order:$100	Retail: 50% Mail Order: 50%
Specialty	Specialty
Retail:50% up to $150 Mail Order:N/A	Retail:50% up to $150 Mail Order:N/A

Kaiser Permanente Options — Oregon

Kaiser HMO Medical

Kaiser HSA Medical

Annual Deductible

Individual: $500

Family: $500 Embedded i

Individual: $4,000

Family: $4,000 Embedded i

Annual Out-of-Pocket Maximum

Individual: $3,000

Family: $3,000 Embedded i

Individual: $6,650

Family: $6,650 Embedded i

Coinsurance

20%

40%

Physician Care Office Visits

PCP:
$20

Specialist:
$20

Preventive Care: 0%

PCP: 40%

Specialist:
40%

Preventive Care: 0%

General Hospital Services

Lab: $10

X-Ray: $10

Diagnostic: $10

Lab: 40%

X-Ray: 40%

Diagnostic: 40%

Hospital Services

Inpatient:
20%

Outpatient:
20%

Inpatient:
40%

Outpatient:
40%

Emergency Services

ER: 20%

Urgent Care: $20

ER: 40%

Urgent Care: 40%

Mental Health/Substance Abuse

Inpatient:
20%

Office Visit: $20

Inpatient:
40%

Office Visit: $40

Kaiser HMO Medical	Kaiser HSA Medical
Annual Deductible	Annual Deductible
Individual: $500 Family: $500 Embedded i	Individual: $4,000 Family: $4,000 Embedded i
Annual Out-of-Pocket Maximum	Annual Out-of-Pocket Maximum
Individual: $3,000 Family: $3,000 Embedded i	Individual: $6,650 Family: $6,650 Embedded i
Coinsurance	Coinsurance
20%	40%
Physician Care Office Visits	Physician Care Office Visits
PCP: $20 Specialist: $20 Preventive Care: 0%	PCP: 40% Specialist: 40% Preventive Care: 0%
General Hospital Services	General Hospital Services
Lab: $10 X-Ray: $10 Diagnostic: $10	Lab: 40% X-Ray: 40% Diagnostic: 40%
Hospital Services	Hospital Services
Inpatient: 20% Outpatient: 20%	Inpatient: 40% Outpatient: 40%
Emergency Services	Emergency Services
ER: 20% Urgent Care: $20	ER: 40% Urgent Care: 40%
Mental Health/Substance Abuse	Mental Health/Substance Abuse
Inpatient: 20% Office Visit: $20	Inpatient: 40% Office Visit: $40

Kaiser HMOPrescription Drug

Kaiser HSAPrescription Drug

Annual Deductible

Combined Deductible

Generic

Retail:$10

Mail Order:$20

Retail:$15

Mail Order:
$30

Formulary

Retail:$30

Mail Order:$60

Retail:$30

Mail Order:
$60

Non-Formulary

Retail:$30

Mail Order:$60

Retail:
$50

Mail Order:
$100

Specialty

Retail:30% up to $150

Mail Order:N/A

Retail:50%

Mail Order:N/A

Kaiser HMOPrescription Drug	Kaiser HSAPrescription Drug
Annual Deductible	Annual Deductible
$0	Combined Deductible
Generic	Generic
Retail:$10 Mail Order:$20	Retail:$15 Mail Order: $30
Formulary	Formulary
Retail:$30 Mail Order:$60	Retail:$30 Mail Order: $60
Non-Formulary	Non-Formulary
Retail:$30 Mail Order:$60	Retail: $50 Mail Order: $100
Specialty	Specialty
Retail:30% up to $150 Mail Order:N/A	Retail:50% Mail Order:N/A

Kaiser Permanente Options — Washington

Kaiser HMOMedical

Kaiser HSAMedical

Annual Deductible

Individual:$500

Family:$500 Embedded i

Individual:$4,500

Family:$7,350

Annual Out-of-Pocket Maximum

Individual:$3,000

Family:$3,000 Embedded i

Individual:$6,000

Family:$7,350

Coinsurance

20%

30%

Physician Care Office Visits

PCP:
$20

Specialist:
$20

Preventive Care:0%

PCP:$20/30%

Specialist:
$20/30%

Preventive Care:0%

General Hospital Services

Lab:20%

X-Ray:20%

Diagnostic:20%

Lab:30%

X-Ray:30%

Diagnostic:30%

Hospital Services

Inpatient:
20%

Outpatient:
20%

Inpatient:
30%

Outpatient:
$20/30%

Emergency Services

ER:20%

Urgent Care:$20

ER:$75/30%

Urgent Care:$20/30%

Mental Health/Substance Abuse

Inpatient:
20%

Office Visit:$20

Inpatient:
30%

Office Visit:$20/30%

Kaiser HMOMedical	Kaiser HSAMedical
Annual Deductible	Annual Deductible
Individual:$500 Family:$500 Embedded i	Individual:$4,500 Family:$7,350 Embedded i
Annual Out-of-Pocket Maximum	Annual Out-of-Pocket Maximum
Individual:$3,000 Family:$3,000 Embedded i	Individual:$6,000 Family:$7,350 Embedded i
Coinsurance	Coinsurance
20%	30%
Physician Care Office Visits	Physician Care Office Visits
PCP: $20 Specialist: $20 Preventive Care:0%	PCP:$20/30% Specialist: $20/30% Preventive Care:0%
General Hospital Services	General Hospital Services
Lab:20% X-Ray:20% Diagnostic:20%	Lab:30% X-Ray:30% Diagnostic:30%
Hospital Services	Hospital Services
Inpatient: 20% Outpatient: 20%	Inpatient: 30% Outpatient: $20/30%
Emergency Services	Emergency Services
ER:20% Urgent Care:$20	ER:$75/30% Urgent Care:$20/30%
Mental Health/Substance Abuse	Mental Health/Substance Abuse
Inpatient: 20% Office Visit:$20	Inpatient: 30% Office Visit:$20/30%

Kaiser HMO
Prescription Drug

Kaiser HSA
Prescription Drug

Annual Deductible

Combined Deductible

Generic

Retail:
$10

Mail Order:
$20

Retail:
$15

Mail Order:
$45

Formulary

Retail:
$20

Mail Order:
$40

Retail:$30

Mail Order:
$90

Non-Formulary

Retail:
At applicable copay

Mail Order:
At applicable copay

Retail:
At applicable copay

Mail Order:
At applicable copay

Specialty

Retail:
50% up to $150

Mail Order:
N/A

Retail:
At applicable copay

Mail Order:
N/A

Kaiser HMO Prescription Drug	Kaiser HSA Prescription Drug
Annual Deductible	Annual Deductible
$0	Combined Deductible
Generic	Generic
Retail: $10 Mail Order: $20	Retail: $15 Mail Order: $45
Formulary	Formulary
Retail: $20 Mail Order: $40	Retail:$30 Mail Order: $90
Non-Formulary	Non-Formulary
Retail: At applicable copay Mail Order: At applicable copay	Retail: At applicable copay Mail Order: At applicable copay
Specialty	Specialty
Retail: 50% up to $150 Mail Order: N/A	Retail: At applicable copay Mail Order: N/A

Contact Information

BCBSIL

Network Names

Network Name: Blue Advantage HMO
1-800-892-2803
BCBSIL app

Dean Health
1-800-279-1301

Kaiser Permanente California
1-800-464-4000

Kaiser Permanente Colorado
1-800-632-9700

Kaiser Permanente Georgia
1-888-865-5813

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