Regional Medical Options
Last Updated March 1, 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:
- BCBSIL Blue Advantage HMO
- BCBS McKay Plan
- Dean Health Plan Prevea 360
- Dean Health Plan HMO
- Kaiser HSA Plan (Atlanta)
- Kaiser HSA Plan (California)
- Kaiser HSA Plan (Colorado)
- Kaiser HSA Plan (Mid-Atlantic States)
- Kaiser HSA Plan (Oregon)
- Kaiser HSA Plan (Washington)
- Kaiser HMO Plan (Atlanta)
- Kaiser HMO Plan (California)
- Kaiser HMO Plan (Colorado)
- Kaiser HMO Plan (Mid-Atlantic States)
- Kaiser HMO Plan (Oregon)
- Kaiser HMO Plan (Washington)
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 |
Individual:$4,500 Family:$4,500 Embedded |
Annual Out-of-Pocket Maximum
|
Individual:$3,000 Family:$3,000 Embedded |
Individual:$6,250 Family:$6,250 Embedded |
Coinsurance |
20% |
40% |
Physician Care Office Visits
|
PCP: Specialist: Preventive Care:0% |
PCP:40% Specialist: Preventive Care:0% |
General Hospital Services
|
Lab:$10 X-Ray:$10 Diagnostic:20% |
Lab:40% X-Ray:40% Diagnostic:40% |
Hospital Services
|
Inpatient: Outpatient: |
Inpatient: Outpatient: |
Emergency Services
|
ER:20% Urgent Care:$20 |
ER:40% Urgent Care:40% |
Mental Health/Substance Abuse
|
Inpatient: Office Visit:$20 |
Inpatient: Office Visit:40% |
Kaiser HMOMedical | Kaiser HSAMedical |
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:$3,000 Family:$3,000 Embedded |
Individual:$6,250 Family: $6,250 Embedded |
Coinsurance | Coinsurance |
20% |
40% |
Physician Care Office Visits |
Physician Care Office Visits |
PCP: Specialist: Preventive Care: 0% |
PCP: 40% Specialist: 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: Outpatient: |
Inpatient: Outpatient: |
Emergency Services | Emergency Services |
ER:20% Urgent Care:$20 |
ER:40% Urgent Care:40% |
Mental Health/Substance Abuse | Mental Health/Substance Abuse |
Inpatient: Office Visit:$20 |
Inpatient: Office Visit:40% |
Kaiser HMOPrescription Drug | Kaiser HSAPrescription Drug | |
Annual Deductible |
$100 |
Combined Deductible |
Generic
|
Retail:$10 Mail Order:$20 |
Retail: Mail Order: |
Formulary
|
Retail:$30 Mail Order:$60 |
Retail:$35 Mail Order: |
Non-Formulary
|
Retail:At applicable copay Mail Order:At applicable copay |
Retail:At applicable copay Mail Order: |
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: Mail Order: |
Formulary | Formulary |
Retail:$30 Mail Order:$60 |
Retail:$35 Mail Order: |
Non-Formulary | Non-Formulary |
Retail:At applicable copay Mail Order:At applicable copay |
Retail:At applicable copay Mail Order: |
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 |
Individual:$4,500 Family:$4,500 Embedded |
Annual Out-of-Pocket Maximum
|
Individual:$3,000 Family:$3,000 Embedded |
Individual:$6,250 Family:$6,250 Embedded |
Coinsurance |
20% |
40% |
Physician Care Office Visits
|
PCP: Specialist: Preventive Care:0% |
PCP:$40 Specialist: Preventive Care:0% |
General Hospital Services
|
Lab:$10 X-Ray:$10 Diagnostic:$10 |
Lab:40% X-Ray:40% Diagnostic:40% |
Hospital Services
|
Inpatient: Outpatient: |
Inpatient: Outpatient: |
Emergency Services
|
ER:20% Urgent Care:$20 |
ER:$250 Urgent Care:$40 |
Mental Health/Substance Abuse
|
Inpatient: Office Visit:$20 |
Inpatient: Office Visit:$40 |
Kaiser HMO Medical |
Kaiser HSA Medical |
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:$3,000 Family:$3,000 Embedded |
Individual:$6,250 Family:$6,250 Embedded |
Coinsurance | Coinsurance |
20% |
40% |
Physician Care Office Visits | Physician Care Office Visits |
PCP: Specialist: Preventive Care:0% |
PCP:$40 Specialist: 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: Outpatient: |
Inpatient: Outpatient: |
Emergency Services | Emergency Services |
ER:20% Urgent Care:$20 |
ER:$250 Urgent Care:$40 |
Mental Health/Substance Abuse | Mental Health/Substance Abuse |
Inpatient: Office Visit:$20 |
Inpatient: 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: |
Formulary
|
Retail:$30 Mail Order:$30 |
Retail:$35 Mail Order: |
Non-Formulary
|
Retail:$30 Mail Order:$30 |
Retail:$35 Mail Order: |
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: |
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:30% up to $250 Mail Order:N/A |
Kaiser Permanente Options — Colorado
Kaiser HMO Medical |
Kaiser HSA |
|
Annual Deductible |
Individual: $500 Family: $500 Embedded |
Individual: $4,500 Family: $4,500 Embedded |
Annual Out-of-Pocket Maximum |
Individual: Family: $3,000 Embedded |
Individual: $6,250 Family: $6,250 Embedded |
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 |
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 HMOPrescription Drug | Kaiser HSAPrescription Drug | |
Annual Deductible |
$0 |
Combined Deductible |
Generic
|
Retail:$10 Mail Order:$20 |
Retail:$15 Mail Order: |
Formulary
|
Retail:$30 Mail Order:$60 |
Retail:$35 Mail Order: |
Non-Formulary
|
Retail:At applicable copay Mail Order:At applicable copay |
Retail: Mail Order: |
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: |
Formulary | Formulary |
Retail:$30 Mail Order:$60 |
Retail:$35 Mail Order: |
Non-Formulary | Non-Formulary |
Retail:At applicable copay Mail Order:At applicable copay |
Retail: Mail Order: |
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 |
Individual:$4,500 Family:$4,500 Embedded |
Annual Out-of-Pocket Maximum
|
Individual:$3,000 Family:$3,000 Embedded |
Individual:$6,250 Family:$6,250 Embedded |
Coinsurance |
20% |
40% |
Physician Care Office Visits
|
PCP: Specialist: Preventive Care:0% |
PCP:$50 Specialist: Preventive Care:0% |
General Hospital Services
|
Lab:$20 X-Ray:$20 Diagnostic:20% |
Lab:40% X-Ray:40% Diagnostic:40% |
Hospital Services
|
Inpatient: Outpatient: |
Inpatient: Outpatient: |
Emergency Services
|
ER:$100 Urgent Care:$30 |
ER:$250 Urgent Care:$50 |
Mental Health/Substance Abuse
|
Inpatient: Office Visit:$20 |
Inpatient: Office Visit:$50 |
Kaiser HMOMedical | Kaiser HSAMedical |
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:$3,000 Family:$3,000 Embedded |
Individual:$6,250 Family:$6,250 Embedded |
Coinsurance | Coinsurance |
20% |
40% |
Physician Care Office Visits | Physician Care Office Visits |
PCP: Specialist: Preventive Care:0% |
PCP:$50 Specialist: 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: Outpatient: |
Inpatient: Outpatient: |
Emergency Services | Emergency Services |
ER:$100 Urgent Care:$30 |
ER:$250 Urgent Care:$50 |
Mental Health/Substance Abuse | Mental Health/Substance Abuse |
Inpatient: Office Visit:$20 |
Inpatient: Office Visit:$50 |
Kaiser HMOPrescription Drug | Kaiser HSAPrescription Drug | |
Annual Deductible |
$0 |
Combined Deductible |
Generic
|
Retail:$10 Mail Order:$20 |
Retail: Mail Order: |
Formulary
|
Retail:$30 Mail Order:$60 |
Retail:$50 Mail Order: |
Non-Formulary
|
Retail:$50 Mail Order:$100 |
Retail: Mail Order: |
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: Mail Order: |
Formulary | Formulary |
Retail:$30 Mail Order:$60 |
Retail:$50 Mail Order: |
Non-Formulary | Non-Formulary |
Retail:$50 Mail Order:$100 |
Retail: Mail Order: |
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 |
Individual: $4,000 Family: $4,000 Embedded |
Annual Out-of-Pocket Maximum
|
Individual: $3,000 Family: $3,000 Embedded |
Individual: $6,650 Family: $6,650 Embedded |
Coinsurance |
20% |
40% |
Physician Care Office Visits
|
PCP: Specialist: Preventive Care: 0% |
PCP: 40% Specialist: Preventive Care: 0% |
General Hospital Services
|
Lab: $10 X-Ray: $10 Diagnostic: $10 |
Lab: 40% X-Ray: 40% Diagnostic: 40% |
Hospital Services
|
Inpatient: Outpatient: |
Inpatient: Outpatient: |
Emergency Services
|
ER: 20% Urgent Care: $20 |
ER: 40% Urgent Care: 40% |
Mental Health/Substance Abuse
|
Inpatient: Office Visit: $20 |
Inpatient: Office Visit: $40 |
Kaiser HMO Medical | Kaiser HSA Medical |
Annual Deductible | Annual Deductible |
Individual: $500 Family: $500 Embedded |
Individual: $4,000 Family: $4,000 Embedded |
Annual Out-of-Pocket Maximum | Annual Out-of-Pocket Maximum |
Individual: $3,000 Family: $3,000 Embedded |
Individual: $6,650 Family: $6,650 Embedded |
Coinsurance | Coinsurance |
20% |
40% |
Physician Care Office Visits | Physician Care Office Visits |
PCP: Specialist: Preventive Care: 0% |
PCP: 40% Specialist: 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: Outpatient: |
Inpatient: Outpatient: |
Emergency Services | Emergency Services |
ER: 20% Urgent Care: $20 |
ER: 40% Urgent Care: 40% |
Mental Health/Substance Abuse | Mental Health/Substance Abuse |
Inpatient: Office Visit: $20 |
Inpatient: Office Visit: $40 |
Kaiser HMOPrescription Drug | Kaiser HSAPrescription Drug | |
Annual Deductible |
$0 |
Combined Deductible |
Generic
|
Retail:$10 Mail Order:$20 |
Retail:$15 Mail Order: |
Formulary
|
Retail:$30 Mail Order:$60 |
Retail:$30 Mail Order: |
Non-Formulary
|
Retail:$30 Mail Order:$60 |
Retail: Mail Order: |
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: |
Formulary | Formulary |
Retail:$30 Mail Order:$60 |
Retail:$30 Mail Order: |
Non-Formulary | Non-Formulary |
Retail:$30 Mail Order:$60 |
Retail: Mail Order: |
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 |
Individual:$4,500 Family:$7,350 |
Annual Out-of-Pocket Maximum
|
Individual:$3,000 Family:$3,000 Embedded |
Individual:$6,000 Family:$7,350 |
Coinsurance |
20% |
30% |
Physician Care Office Visits
|
PCP: Specialist: Preventive Care:0% |
PCP:$20/30% Specialist: Preventive Care:0% |
General Hospital Services
|
Lab:20% X-Ray:20% Diagnostic:20% |
Lab:30% X-Ray:30% Diagnostic:30% |
Hospital Services
|
Inpatient: Outpatient: |
Inpatient: Outpatient: |
Emergency Services
|
ER:20% Urgent Care:$20 |
ER:$75/30% Urgent Care:$20/30% |
Mental Health/Substance Abuse
|
Inpatient: Office Visit:$20 |
Inpatient: Office Visit:$20/30% |
Kaiser HMOMedical | Kaiser HSAMedical |
Annual Deductible | Annual Deductible |
Individual:$500 Family:$500 Embedded |
Individual:$4,500 Family:$7,350 |
Annual Out-of-Pocket Maximum | Annual Out-of-Pocket Maximum |
Individual:$3,000 Family:$3,000 Embedded |
Individual:$6,000 Family:$7,350 |
Coinsurance | Coinsurance |
20% |
30% |
Physician Care Office Visits | Physician Care Office Visits |
PCP: Specialist: Preventive Care:0% |
PCP:$20/30% Specialist: 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: Outpatient: |
Inpatient: Outpatient: |
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: Office Visit:$20 |
Inpatient: Office Visit:$20/30% |
Kaiser HMO Prescription Drug |
Kaiser HSA Prescription Drug |
|
Annual Deductible |
$0 |
Combined Deductible |
Generic
|
Retail: Mail Order: |
Retail: Mail Order: |
Formulary
|
Retail: Mail Order: |
Retail:$30 Mail Order: |
Non-Formulary
|
Retail: Mail Order: |
Retail: Mail Order: |
Specialty |
Retail: Mail Order: |
Retail: Mail Order:
|
Kaiser HMO Prescription Drug |
Kaiser HSA Prescription Drug |
Annual Deductible | Annual Deductible |
$0 |
Combined Deductible |
Generic | Generic |
Retail: Mail Order: |
Retail: Mail Order: |
Formulary | Formulary |
Retail: Mail Order: |
Retail:$30 Mail Order: |
Non-Formulary | Non-Formulary |
Retail: Mail Order: |
Retail: Mail Order: |
Specialty | Specialty |
Retail: Mail Order: |
Retail: Mail Order:
|