Regional Medical Options
Last Updated December 13, 2023
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.
2024 Regional Medical Program Options
Kaiser Permanente Options — Atlanta Area
Kaiser HSAMedical | |
Annual Deductible
|
Individual:$4,500 Family:$4,500 Embedded |
Annual Out-of-Pocket Maximum
|
Individual:$6,250 Family:$6,250 Embedded |
Coinsurance |
40% |
Physician Care Office Visits
|
PCP:40% after deductible Specialist: Preventive Care:0% |
General Hospital Services
|
Lab:40% after deductible X-Ray:40% after deductible Diagnostic:40% after deductible |
Hospital Services
|
Inpatient: Outpatient: |
Emergency Services
|
ER:40% after deductible Urgent Care:40% after deductible |
Mental Health/Substance Abuse
|
Inpatient: Office Visit:40% after deductible |
Kaiser HSAMedical |
Annual Deductible |
Individual:$4,500 Family:$4,500 Embedded |
Annual Out-of-Pocket Maximum |
Individual:$6,250 Family: $6,250 Embedded |
Coinsurance |
40% |
Physician Care Office Visits |
PCP: 40% Specialist: Preventive Care: 0% |
General Hospital Services |
Lab:40% X-Ray:40% Diagnostic:40% |
Hospital Services |
Inpatient: Outpatient: |
Emergency Services |
ER:40% Urgent Care:40% |
Mental Health/Substance Abuse |
Inpatient: Office Visit:40% |
Kaiser HSAPrescription Drug | |
Annual Deductible |
Combined Deductible |
Generic
|
Retail: Mail Order: |
Formulary
|
Retail:$35 Mail Order: |
Non-Formulary
|
Retail: Mail Order: |
Specialty |
Retail: Mail Order: |
Kaiser HSAPrescription Drug |
Annual Deductible |
Combined Deductible |
Generic |
Retail: Mail Order: |
Formulary |
Retail:$35 Mail Order: |
Non-Formulary |
Retail: Mail Order: |
Specialty |
Retail:30% up to $200 Mail Order:N/A |
Kaiser Permanente Options — California
Kaiser HSA Medical |
|
Annual Deductible
|
Individual:$4,500 Family:$4,500 Embedded |
Annual Out-of-Pocket Maximum
|
Individual:$6,250 Family:$6,250 Embedded |
Coinsurance |
40% |
Physician Care Office Visits
|
PCP:$40 after deductible Specialist: Preventive Care:0% |
General Hospital Services
|
Lab:40% after deductible X-Ray:40% after deductible Diagnostic:40% after deductible |
Hospital Services
|
Inpatient: Outpatient: |
Emergency Services
|
ER:$250 after deductible Urgent Care:$40 after deductible |
Mental Health/Substance Abuse
|
Inpatient: Office Visit:$40 after deductible |
Kaiser HSA Medical |
Annual Deductible |
Individual:$4,500 Family:$4,500 Embedded |
Annual Out-of-Pocket Maximum |
Individual:$6,250 Family:$6,250 Embedded |
Coinsurance |
40% |
Physician Care Office Visits |
PCP:$40 Specialist: Preventive Care:0% |
General Hospital Services |
Lab:40% X-Ray:40% Diagnostic:40% |
Hospital Services |
Inpatient: Outpatient: |
Emergency Services |
ER:$250 Urgent Care:$40 |
Mental Health/Substance Abuse |
Inpatient: Office Visit:$40 |
Kaiser HSAPrescription Drug | |
Annual Deductible |
Combined Deductible |
Generic
|
Retail:$15 Mail Order: |
Formulary
|
Retail:$35 Mail Order: |
Non-Formulary
|
Retail:$35 Mail Order: |
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: |
Formulary | Formulary |
Retail:$30 Mail Order:$30 |
Retail:$35 Mail Order: |
Non-Formulary | Non-Formulary |
Retail:$30 Mail Order:$30 |
Retail:$35 Mail Order: |
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 — Colorado
Kaiser HSA |
|
Annual Deductible |
Individual: $4,500 Family: $4,500 Embedded |
Annual Out-of-Pocket Maximum |
Individual: $6,250 Family: $6,250 Embedded |
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 HMO Medical |
Kaiser HSA |
Annual Deductible | Annual Deductible |
Individual: $500 Family: $500 Embedded |
Individual: $4,500 Family: $4,500 Embedded |
Annual Out-of-Pocket Maximum | Annual Out-of-Pocket Maximum |
Individual: Family: $3,000 Embedded |
Individual: $6,250 Family: $6,250 Embedded |
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 HSAPrescription Drug | |
Annual Deductible |
Combined Deductible |
Generic
|
Retail:$15 Mail Order: |
Formulary
|
Retail:$35 Mail Order: |
Non-Formulary
|
Retail: Mail Order: |
Specialty |
Retail:40% up to $200 Mail Order:N/A |
Kaiser HSAPrescription Drug |
Annual Deductible |
Combined Deductible |
Generic |
Retail:$15 Mail Order: |
Formulary |
Retail:$35 Mail Order: |
Non-Formulary |
Retail: Mail Order: |
Specialty |
Retail:40% up to $200 Mail Order:N/A |
Kaiser Permanente Options — Mid-Atlantic States
Kaiser HSAMedical | |
Annual Deductible
|
Individual:$4,500 Family:$4,500 Embedded |
Annual Out-of-Pocket Maximum
|
Individual:$6,250 Family:$6,250 Embedded |
Coinsurance |
40% |
Physician Care Office Visits
|
PCP:$50 after deductible Specialist: Preventive Care:0% after deductible |
General Hospital Services
|
Lab:40% after deductible X-Ray:40% after deductible Diagnostic:40% after deductible |
Hospital Services
|
Inpatient: Outpatient: |
Emergency Services
|
ER:$250 after deductible Urgent Care:$50 after deductible |
Mental Health/Substance Abuse
|
Inpatient: Office Visit:$50 after deductible |
Kaiser HSAMedical |
Annual Deductible |
Individual:$4,500 Family:$4,500 Embedded |
Annual Out-of-Pocket Maximum |
Individual:$6,250 Family:$6,250 Embedded |
Coinsurance |
40% |
Physician Care Office Visits |
PCP:$50 Specialist: Preventive Care:0% |
General Hospital Services |
Lab:40% X-Ray:40% Diagnostic:40% |
Hospital Services |
Inpatient: Outpatient: |
Emergency Services |
ER:$250 Urgent Care:$50 |
Mental Health/Substance Abuse |
Inpatient: Office Visit:$50 |
Kaiser HSAPrescription Drug | |
Annual Deductible |
Combined Deductible |
Generic
|
Retail: Mail Order: |
Formulary
|
Retail:$50 Mail Order: |
Non-Formulary
|
Retail: Mail Order: |
Specialty |
Retail:50% up to $150 Mail Order:N/A |
Kaiser HSAPrescription Drug |
Annual Deductible |
Combined Deductible |
Generic |
Retail: Mail Order: |
Formulary |
Retail:$50 Mail Order: |
Non-Formulary |
Retail: Mail Order: |
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 |
Annual Out-of-Pocket Maximum
|
Individual: $6,650 Family: $6,650 Embedded |
Coinsurance |
40% |
Physician Care Office Visits
|
PCP: 40% after deductible Specialist: Preventive Care: 0% after deductible |
General Hospital Services
|
Lab: 40% after deductible X-Ray: 40% after deductible Diagnostic: 40% after deductible |
Hospital Services
|
Inpatient: Outpatient: |
Emergency Services
|
ER: 40% after deductible Urgent Care: 40% after deductible |
Mental Health/Substance Abuse
|
Inpatient: Office Visit: 40% after deductible |
Kaiser HSA Medical |
Annual Deductible |
Individual: $4,000 Family: $4,000 Embedded |
Annual Out-of-Pocket Maximum |
Individual: $6,650 Family: $6,650 Embedded |
Coinsurance |
40% |
Physician Care Office Visits |
PCP: 40% Specialist: Preventive Care: 0% |
General Hospital Services |
Lab: 40% X-Ray: 40% Diagnostic: 40% |
Hospital Services |
Inpatient: Outpatient: |
Emergency Services |
ER: 40% Urgent Care: 40% |
Mental Health/Substance Abuse |
Inpatient: Office Visit: 40% |
Kaiser HSAPrescription Drug | |
Annual Deductible |
Combined Deductible |
Generic
|
Retail:$15 Mail Order: |
Formulary
|
Retail:$30 Mail Order: |
Non-Formulary
|
Retail: Mail Order: |
Specialty |
Retail:50% Mail Order:N/A |
Kaiser HSAPrescription Drug |
Annual Deductible |
Combined Deductible |
Generic |
Retail:$15 Mail Order: |
Formulary |
Retail:$30 Mail Order: |
Non-Formulary |
Retail: Mail Order: |
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: Specialist: Preventive Care:0% |
General Hospital Services
|
Lab:30% after deductible X-Ray:30% after deductible Diagnostic:30% after deductible |
Hospital Services
|
Inpatient: Outpatient: |
Emergency Services
|
ER:$75/visit after deductible Urgent Care:30% after deductible |
Mental Health/Substance Abuse
|
Inpatient: Office Visit:30% after deductible |
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% Specialist: Preventive Care:0% |
General Hospital Services |
Lab:30% X-Ray:30% Diagnostic:30% |
Hospital Services |
Inpatient: Outpatient: |
Emergency Services |
ER:$75/visit Urgent Care:30% |
Mental Health/Substance Abuse |
Inpatient: Office Visit:30% |
Kaiser HSA Prescription Drug |
|
Annual Deductible |
Combined Deductible |
Generic
|
Retail: Mail Order: |
Formulary
|
Retail:$30 Mail Order: |
Non-Formulary
|
Retail: Mail Order: |
Specialty |
Retail: Mail Order:
|
Kaiser HSA Prescription Drug |
Annual Deductible |
Combined Deductible |
Generic |
Retail: Mail Order: |
Formulary |
Retail:$30 Mail Order: |
Non-Formulary |
Retail: Mail Order: |
Specialty |
Retail: Mail Order:
|