| 2009 Medical Plan Comparisons |
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| Plans for Full-time Employees (also available to Part-time) |
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View as a PDF
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2009 PEBB Full-time Medical Plans Comparison
This is a summary, only. Any error or omission here is unintentional and will be resolved in favor of plan documents as required in PEBB contracts, or applicable federal or state law or rule.
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Kaiser
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Kaiser Added Choice
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ProvidenceChoice
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Regence BCBSO
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Provider Type
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HMO
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HMO
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Network
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OON*
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Network
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OON*
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Network
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OON*
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Ind. OOP** max
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$600
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$600
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$1,500
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$2,500
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$1,000
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$2,000
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$1,000
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$2,000
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Family OOP max
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$1,200
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$1,200
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$4,500
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$7,500
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$3,000
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$6,000
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$3,000
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$6,000
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Ind. lifetime max
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No limit
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No limit
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$2 million
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$2 million
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$2 million
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$2 million
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$2 million
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$2 million
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Type of Service
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You
pay
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You
pay
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You
pay
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You
pay
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You
pay
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You
pay
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You
pay
|
You
pay
|
General office
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$5
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$10
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$20
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30%
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$5
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30%
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15%
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30%
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Specialist office
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$5
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$10
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15%
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30%
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$5
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30%
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15%
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30%
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X-ray and lab
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$0
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$0
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15%
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30%
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$0
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30%
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15%
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30%
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Preventive Care1
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Health appraisal
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$0
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$0
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$0
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30%
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$0
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30%
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$0
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30%
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Immunizations
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$0
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$0
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$0
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$0
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$0
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$0
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$0
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$0
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Hearing exams
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$5
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$10
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$20
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30%
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$5
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30%
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15%
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30%
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Cancer screens
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$0
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$0
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15%
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30%
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$0
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30%
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$0
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30%
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Hospital2
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Ambulance
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$75
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$75
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30%
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30%
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$75
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$75
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15%
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15%
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Inpatient/day max
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$50
($250/admit)
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$100 ($500/y)
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15%
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30%
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$50
($250/admit)
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30%
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15%
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30%
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Outpatient
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$5
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$10
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15%
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30%
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$5
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30%
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15%
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30%
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Emergency dept
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$75
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$75
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$75
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$75
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$75
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50%
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15%
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30%
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Surgery2
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Inpatient/day
max
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$50
($250/admit)
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$100
($500/y)
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15%
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30%
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$50
($250/admit)
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30%
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15%
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30%
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Outpatient office
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$5
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$10
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15%
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30%
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$5
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30%
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15%
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30%
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Maternity Care
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Prenatal, delivery, postpartum
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$0
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$0
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15%
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30%
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$0
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30%
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15%
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30%
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Mental Health, Chemical Dependency2
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Inpatient & resident/day max
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$50
($250/admit)
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$100
($500/y)
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15%
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30%
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$50
($250/admit)
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30%
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15%
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30%
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Outpatient
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$5
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$10
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15%
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30%
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$5
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30%
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15%
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30%
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Other Medical3
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Hearing aids
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10%
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10%
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10%, Rx & Aid only thru HMO
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10%
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10%
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10%
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10%
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Diabetic supplies, insulin
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$0
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$0
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$0
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$0
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$0
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$0
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$0
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$0
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Durable medical equipment
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$0
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$0
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Access thru Kaiser HMO
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15%
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30%
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15%
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30%
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Alternative Care
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$10
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$15
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$15
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$15
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$10
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$10
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30%
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30%
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Physical Therapy
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$5
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$10
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15%
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30%
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$5
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30%
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15%
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30%
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Routine Vision
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Exam
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$5
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$10
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15%
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30%
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VSP provider $10: Non-VSP provider $10 plus amount above $424
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Eyewear
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Kaiser facilities only: Amount above $200
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Amount above $2004
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* OON = Out of Network
1 Plans cover preventive services on recommended schedules
2 Plans may require prior authorization
3 Plans may place limits on type, number, frequency, source or maximum coverage of services or devices
4 Benefits provided every 12 months
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| Plans Available to Part-time Employees Only |
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View as a PDF
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2009 PEBB Part-time & Retiree Medical Plans Comparison
This is a summary, only. Any error or omission here is unintentional and will be resolved in favor of plan documents as required in PEBB contracts, or applicable federal or state law or rule.
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Kaiser
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Kaiser Added Choice
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ProvidenceChoice
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Regence BCBSO
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Provider Typ
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HMO
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HMO
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Network
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OON*
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Network
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OON*
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Network
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OON*
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Deductible
(Individual; Family)
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$0
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($250; $750)
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($750;
$2,250)
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($1,000; $3,000)
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$0
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$0
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50% of $1,000 then 20%
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50% of $1,000 then 50%
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Ind. OOP** max
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$1,500
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$2,000
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$3,000
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$4,500
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$2,000
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$4,000
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$2,000
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$4,000
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Family OOP max
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$3,000
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$6,000
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$9,000
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$13,500
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$6,000
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$12,000
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$6,000
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$12,000
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Ind. lifetime max
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No limit
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No limit
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$2 million
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$2 million
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$2 million
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$2 million
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$2 million
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$2 million
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Type of Service
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You
pay
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You pay
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You
pay
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You pay
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You
pay
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You pay
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You
pay
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You pay
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General office
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$30
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$30
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30%
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50%
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$30
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50%
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20%
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50%
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Specialist office
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$30
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$30
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30%
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50%
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$30
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50%
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20%
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50%
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X-ray and lab
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$10
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20%
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30%
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50%
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20%
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50%
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20%
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50%
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Preventive Care1
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Health appraisal
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$0
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$30
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30%
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50%
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$0
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50%
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$0
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50%
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Immunizations
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$0
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$0
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30%
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50%
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$0
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50%
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$0
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50%
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Hearing exams
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$30
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$30
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30%
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50%
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$30
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50%
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20%
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50%
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Cancer screens
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$10
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20%
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30%
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50%
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$0
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50%
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$0
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50%
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Hospital2
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Ambulance
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$75
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20%
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50%
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50%
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$75
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$75
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20%
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20%
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Inpatient
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$500/admit
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20%
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30%
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50%
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$500/admit
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50%
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20%
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50%
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Outpatient
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$30
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$30
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30%
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50%
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$30
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50%
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20%
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50%
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Emergency dept
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$100
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20%
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20%
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20%
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$100
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50%
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20%
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50%
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Surgery2
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Inpatient
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$0
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20%
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30%
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50%
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$30
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50%
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20%
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50%
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Outpatient office
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$30
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20%
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30%
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50%
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$30
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50%
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20%
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50%
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Maternity Care
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Prenatal, delivery, postpartum
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$0
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$30
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30%
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50%
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$0
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50%
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20%
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50%
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Mental Health, Chemical Dependency2
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Inpatient
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$500/admit
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20%
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30%
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50%
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$500/admit
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50%
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20%
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50%
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Residential
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$50/day, $250/admit
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20%
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30%
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50%
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$500/admit
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50%
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20%
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50%
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Outpatient
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$30
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$30
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30%
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50%
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$30
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50%
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20%
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50%
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Other3
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Routine vision
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$30 - exam only
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Not Covered
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Hearing aids
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10%
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10%
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10%, Rx & Aid only thru HMO
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10%
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10%
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10%
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10%
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Diabetic supplies, insulin
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Covered as durable medical equipment & prescription drugs
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$0
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$0
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$0
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$0
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Durable medical equipment
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50%
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50%
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Access thru Kaiser HMO
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50%
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50%
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20%
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50%
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Alternative Care
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Not Covered
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50%
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50%
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Physical Therap
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$30
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$30
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30%
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50%
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$30
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50%
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20%
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50%
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* OON = Out of Network
1 Plans cover preventive services on recommended schedules
2 Plans may require prior authorization, precertification or a treatment plan
3 Plans may place limits on type, number, frequency, source or maximum coverage of services or devices
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| Prescription Drug Coverage |
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View as a PDF
2009 Full-time/Part-time & Retiree Prescription Drug Comparison
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Coverage
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Kaiser
(FT/PT&R)
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Kaiser Added Choice
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Providence
(FT/PT&R)
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Regence
(FT/PT&R)
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HMO
(FT/PT&R)
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Network
(FT/PT&R)
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OON
(FT/PT&R)
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Retail supply
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30-day
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30-day
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30-day
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30-day
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30-day
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34-day
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Pharmacies
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Kaiser Only
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Kaiser Only
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MedImpact1
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MedImpact1
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Participating
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Generic
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$1 / $10
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$5 / $10
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$20 / $30
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$20 / $30
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$5 / $10
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$5 / $10
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Brand
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$15 / $25
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$15 / $25
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$202 / $302
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$202 / $302
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$15 / $25
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$15 / 20%
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Non Formulary
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Not Covered (NC)
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$202 / NC
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$202 / NC
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>$50 or 50%3
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>$50 or 50%3
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90-day Mail Supply4
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Generic
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$1 / $20
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$10 / $20
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$10 / $20
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$10 / $20
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$5 / $25
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$12.50 / $25
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Brand
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$15 / $50
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$30 / $50
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$302 / $502
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$302 / $502
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$37.50 / $62.50
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$37.50 / $62.50
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Non Formulary
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Not Covered
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>$125 or 50%3
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>$125 or 50%3
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1 May use Kaiser mail-order if drug is in stock and in formulary
2 Plus the difference between generic and formulary brand
3 Plus the difference between generic and brand for brands not on the formulary
4 Only “Maintenance drugs” in Kaiser
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