Medical
Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Click here to learn more about UMass Global’s medical benefits:
Kaiser HMO (CA Only)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,500/$3,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$20 copay
Urgent Care
$20 copay
Emergency Room
$200 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Specialty
20% up to $250 copay
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
Not covered
Specialty
Not covered
Bi-Weekly Plan Cost
Employee Only: $24.97
Employee and Spouse: $201.48
Employee and Child(ren): $197.54
Employee and Family: $296.31
Kaiser HMO (OR & WA)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/ $0
Out-of-Pocket Max (Individual/Family)
$600/$1,200
Preventive Care
$0
Primary Care Visit
$15 copay
Specialist Visit
$25 copay
Urgent Care
$35 copay
Emergency Room
$250 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$20 copay
Specialty
30% max of $150
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$80 copay
Specialty
$40 copay (30-day supply)
Bi-Weekly Plan Cost
Employee Only: $15.33
Employee and Spouse: $123.73
Employee and Child(ren): $121.31
Employee and Family: $181.96
Blue Shield Trio HMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,500/$3,000
Preventive Care
$0 copay
Primary Care Visit
$20 copay
Specialist Visit
$20 copay
Urgent Care
$20 copay
Emergency Room
$100 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$20 copay
Non-Preferred Brand
$35 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$70 copay
Bi-Weekly Plan Cost
Employee Only: $12.01
Employee and Spouse: $173.58
Employee and Child(ren): $169.96
Employee and Family: $260.37
Blue Shield Access+ HMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,500/$3,000
Preventive Care
$0 copay
Primary Care Visit
$20 copay
Specialist Visit
$35 copay
Urgent Care
$20 copay
Emergency Room
$100 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$20 copay
Non-Preferred Brand
$35 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$70 copay
Bi-Weekly Plan Cost
Employee Only: $51.46
Employee and Spouse: $299.12
Employee and Child(ren): $283.68
Employee and Family: $432.36
Blue Shield Full EPO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$500/$1,500
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0 copay
Primary Care Visit
$20 copay
Specialist Visit
$25 copay
Urgent Care
$20 copay
Emergency Room
$150 copay + 20%
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$100 copay
Bi-Weekly Plan Cost
Employee Only: $170.99
Employee and Spouse: $584.43
Employee and Child(ren): $504.75
Employee and Family: $836.29
Blue Shield Full PPO Savings with HSA
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,700/$3,400
Out-of-Pocket Max (Individual/Family)
$3,500/$7,000
Preventive Care
$0
Primary Care Visit
10% after deductible
Specialist Visit
10% after deductible
Urgent Care
10% after deductible
Emergency Room
$150 copay + 10%
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$25 copay
Non-Preferred Brand
$40 copay
Specialty
30% up to $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$50 copay
Non-Preferred Brand
$80 copay
Specialty
30% up to $500
Out-of-Network
Deductible (Individual/Family)
$1,700/$3,400
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
Not covered
Primary Care Visit
40% after deductible
Specialist Visit
40% after deductible
Urgent Care
40% after deductible
Emergency Room
$150 copay + 10%
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay + 25%
Preferred Brand
$25 copay + 25%
Non-Preferred Brand
$40 copay + 25%
Specialty
30% up to $250 + 25%
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Bi-Weekly Plan Cost
Employee Only: $23.11
Employee and Spouse: $252.98
Employee and Child(ren): $218.47
Employee and Family: $337.62