Medical

Medical Plan Comparison

	BCBS Gold Plan		BCBS Silver Plan		BCBS Bronze Plan		Kaiser Permanente†***
	In-Network	Out-of-Network	In-Network	Out-of-Network	In-Network	Out-of-Network	In-Network Only
	You Pay
Calendar Year Deductible
Individual	$250	$500	$2,000	$4,000	$3,000	$6,000	$250
Family	$750	$1,500	$4,000‡	$8,000‡	$6,000‡	$11,000‡	$500
Calendar Year Out-of-Pocket Maximum (Includes Deductible)
Individual	$5,000	$10,000	$6,000	$11,000	$6,000	$11,000	$5,000
Family	$10,000	$30,000	$11,000	$33,000	$11,000	$33,000	$10,000
Coinsurance / Copays
Preventive Care	$0	50%*	$0	50%*	$0	50%*	$0
Primary Care Physician	$25	50%*	20%*	50%*	30%*	50%*	$20
Specialist	$45	50%*	20%*	50%*	30%*	50%*	$30
Urgent Care	20%*	50%*	20%*	50%*	30%*	50%*	$30
Emergency Room	20%*		20%*		30%*		$200
Inpatient Hospital	20%*	50%*	20%*	50%*	30%*	50%*	20%*
Inpatient and Outpatient Mental Health & Substance Abuse	20%*	50%*	20%*	50%*	30%*	50%*	Inpatient: 10%* Outpatient: $10 copay (group); $20 copay (individual)
Inpatient and Outpatient Mental Health & Substance Abuse	$25 copay for services performed in an office setting		20%*	50%*	30%*	50%*
Retail Rx (up to 30-day supply)
Preventive	N/A		$0		$0		N/A
Generic	$10		$10*		$10*		$10
Preferred Brand	$30		20%: $25 min.*/$50 max.		20%: $25 min.*/$50 max.		$30
Non-Preferred Brand	$50		20%: $50 min.*/$100 max.		20%: $50 min.*/$100 max.		$60
Mail Order Rx (up to 90-day supply)
Preventive	N/A		$0		$0		N/A
Generic	$20		$20*		$20*		$20
Preferred Brand	$60		20%: $65 min.*/$125 max.		20%: $65 min.*/$125 max.		$60
Non-Preferred Brand	$100		20%: $125 min.*/$250 max.		20%: $125 min.*/$250 max.		$120

† Available to employees in the following states only: California, Colorado, Mid-Atlantic, Georgia, Northwest and Washington.

‡ For coverage types other than Employee Only, the deductible will automatically default to the family deductible.

* Copay/cost share applies after plan deductible is met.

If the actual cost of the drug is less than the minimum, you pay the cost of the drug.

* The benefits for Colorado are not the same as what is in this benefits guide. Inpatient Hospital is a $250 copay. Inpatient Mental Health & Substance Abuse is a $250 copay. Outpatient Mental Health & Substance Abuse is a $25 copay.

Medical Plan Glossary

Out-of-Pocket Maximum

The most you’ll pay in a year for covered in-network care and prescriptions.
After you reach this amount, the plan covers 100% of eligible costs.

Copay

A fixed amount you pay for certain services.
Does not count toward your deductible but does count toward your out-of-pocket maximum.

Annual Deductible

What you pay each year for eligible charges before the plan starts paying.

Coinsurance

After meeting your deductible, you share costs with the plan.
Example: You pay 20%, the plan pays 80%, until you reach your out-of-pocket maximum.

Preventive Care

Covered at 100% when you use in-network providers. Like physical exams, flu shots and screenings.

Network Provider

In-network providers offer highest level of benefits and lower out-of-pocket costs.
Out-of-network providers set their own rates and you may be responsible for the difference if fees are above Reasonable and Customary (R&C) limits

Plan Documents

Gold Benefit Summary

Silver Benefit Summary

Bronze Benefit Summary

Kaiser Colorado Benefit Summary

Kaiser Georgia Benefit Summary

Kaiser Mid-Atlantic Benefit Summary

Kaiser Northern CA Benefit Summary

Kaiser Northwest Benefit Summary

Kaiser Southern CA Benefit Summary

Kaiser Washington Benefit Summary

Medical Plan Costs Per Pay Period

Your medical contributions depend upon whether you’re in Group A or Group B.

SECTION A	SECTION B
• Employees covered by a collective bargaining agreement that specifically provides for participation • Hourly/non-exempt Employees (other than hourly employees noted in Group B) • Sales Associates	Hourly/Non-exempt Employees that are bonus-eligible
	• Area Dispatchers • Dispatchers • E&D Scaffold Supervisor • Operations Supervisor — CES Onsite • Government Sales Center Specialist • Inside Sales and Senior Inside Sales Representatives • Key Account Sales Coordinators • Operations Supervisors • Training Specialists • Tools Estimator
	• Salaried/Exempt Employees

2026 Medical Contributions

Healthcare (BCBS) Help

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