Regional Medical Options

Last Updated December 21, 2021

Based on where you live, you might be eligible to enroll in a regional medical option.

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.

2022 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

$0

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

$0

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

$0

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

$0

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