Live in California?

Your options will be different, depending on the insurance carrier you choose.

For starters, each insurance carrier in California has the option to offer each coverage level either as an option that offers in- and out-of-network benefits (e.g., a PPO) or an option that offers in-network benefits only (e.g., an HMO).

Also, insurance carriers can choose to offer either the standard Gold option or a Gold II option—not both. The Gold II option offers only in-network benefits.

Review the table below to see which insurance carriers offer out-of-network benefits for the coverage levels you're considering.

Medical Coverage Level

	Bronze	Bronze	Bronze Plus	Bronze Plus	Bronze Plus	Silver	Silver	Silver	Silver	Gold	Gold II	Platinum	Platinum
Option type	High-deductible option with HSA	High-deductible option with HSA	High-deductible option with HSA	PPO	High-deductible option with HSA	High-deductible option with HSA	PPO	PPO	PPO	PPO	HMO	PPO that offers limited benefits for out-of-network care**	PPO that offers limited benefits for out-of-network care**
Paycheck contributions	$	$	$	$$	$	$$	$$	$$	$$	$$$	$$$	$$$$	$$$$

Annual Deductible
In-network (individual / family)	$3,300 / $6,600	$4,900 / $9,800	$2,450 / $4,900^†^◆	$2,300 / $4,600	$3,000 / $6,000	$1,500 / $3,000^†	$1,000 / $2,000	$1,000 / $2,000	$1,500 / $3,000	$800 / $1,600	N / A	N / A	$250 / $500
Out-of-network (individual / family)	$3,300 / $6,600	$4,900 / $9,800	$2,450 / $4,900^†^◆	$4,600 / $9,200	$3,000 / $6,000	$1,500 / $3,000^†	$2,000 / $4,000	$2,000 / $4,000	$1,500 / $3,000	$1,600 / $3,200	N / A	$5,000 / $10,000	$5,000 / $10,000
Traditional or true family?	Traditional	Traditional	True family	Traditional	Traditional	True family	Traditional	Traditional	Traditional	Traditional	N / A	Traditional	Traditional

Annual Out-of-Pocket Maximum
In-network (individual / family)	$6,400 / $12,800	$6,400 / $12,800	$3,900 / $7,800^‡	$6,700 / $13,400	$4,300 / $8,600	$3,800 / $7,600^‡	$5,300 / $10,600	$5,300 / $10,600	$3,800 / $7,600	$3,600 / $7,200	$5,400 / $10,800	$1,600 / $3,200	$2,300 / $4,600
Out-of-network (individual / family)	$12,800 / $25,600	$12,800 / $25,600	$11,500 / $23,000^‡	$13,400 / $26,800	$11,500 / $23,000	$8,000 / $16,000^‡	$10,600 / $21,200	$10,600 / $21,200	$8,000 / $16,000	$7,200 / $14,400	N / A	$11,500 / $23,000	$11,500 / $23,000
Traditional or true family?	Traditional	Traditional	True family	Traditional	Traditional	True family	Traditional	Traditional	Traditional	Traditional	Traditional	Traditional	Traditional

In-Network Benefits
Preventive care	Covered 100%, no deductible	Covered 100%, no deductible	Covered 100%, no deductible	Covered 100%, no deductible	Covered 100%, no deductible	Covered 100%, no deductible	Covered 100%, no deductible	Covered 100%, no deductible	Covered 100%, no deductible	Covered 100%, no deductible	Covered 100%	Covered 100%	Covered 100%, no deductible
Doctor's office visit	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay $30 for PCP visit and $50 for specialist visit, no deductible	You pay 25% after deductible	You pay 25% after deductible	You pay $30 for PCP visit and $50 for specialist visit, no deductible	You pay 30% after deductible	You pay 25% after deductible	You pay $25 for PCP visit and $40 for specialist visit, no deductible	You pay $25 for PCP visit and $40 for specialist visit	You pay $25 for PCP visit and $40 for specialist visit	You pay $25 for PCP visit and $40 for specialist visit, no deductible
Emergency room	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay $150, then 30% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay $150, then 30% after deductible	You pay $150, then 30% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 30%	You pay $200	You pay 15% after deductible
Urgent care	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 30% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 30% after deductible	You pay 30% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 30%	You pay $50	You pay 15% after deductible
Inpatient care	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 30% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 30% after deductible	You pay 30% after deductible	You pay 25% after deductible	You pay 25% after deductible	You pay 30%	You pay $350	You pay 15% after deductible
Outpatient care	You pay 25% after deductible	You pay 25% after deductible	You pay 25% after deductible	If not an office visit, you pay 30% after deductible	You pay 25% after deductible	You pay 25% after deductible	If not an office visit, you pay 30% after deductible	You pay 30% after deductible	You pay 25% after deductible	If not an office visit, you pay 25% after deductible	If not an office visit, you pay 30%	If not an office visit, covered 100%***	You pay 15% after deductible

Prescription Drug Coverage

	Bronze	Bronze	Bronze Plus	Bronze Plus	Bronze Plus	Silver	Silver	Silver	Silver	Gold	Gold II	Platinum	Platinum
Preventive drugs	You pay $0^**	You pay $0^**	You pay $0^**	You pay $0^**	You pay $0^**	You pay $0^**	You pay $0^**	You pay $0^**	You pay $0^**	You pay $0^**	You pay $0^**	You pay $0^**	You pay $0^**

30-Day Retail Supply
Tier 1 (generally lowest cost options)	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $12	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $12	You pay $12	You pay 100% until you've met the deductible, then you pay 25%	You pay $10	You pay $10	You pay $8	You pay $8
Tier 2 (generally medium cost options)	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $60	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $50	You pay $50	You pay 100% until you've met the deductible, then you pay 25%	You pay $40	You pay $40	You pay $30	You pay $30
Tier 3 (generally highest cost options)	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $80	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $70	You pay $70	You pay 100% until you've met the deductible, then you pay 25%	You pay $60	You pay $60	You pay $50	You pay $50

90-Day Mail Order Supply
Tier 1 (generally lowest cost options)	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $30	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $30	You pay $30	You pay 100% until you've met the deductible, then you pay 25%	You pay $25	You pay $25	You pay $20	You pay $20
Tier 2 (generally medium cost options)	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $150	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $125	You pay $125	You pay 100% until you've met the deductible, then you pay 25%	You pay $100	You pay $100	You pay $75	You pay $75
Tier 3 (generally highest cost options)	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $200	You pay 100% until you've met the deductible, then you pay 25%	You pay 100% until you've met the deductible, then you pay 25%	You pay $175	You pay $175	You pay 100% until you've met the deductible, then you pay 25%	You pay $150	You pay $150	You pay $125	You pay $125

These charts may not take into account how each coverage level covers any state-mandated benefits, its plan administration capabilities, or the approval from the state Department of Insurance of the benefits offered by the plan. If you have questions about a specific benefit, contact the insurance carrier for additional information. Individual carriers may offer coverage that differs slightly from the standard coverage reflected here. In the event that there is a discrepancy between this site and the official plan documents, the official plan documents will control.

These charts are a high-level listing of commonly covered benefits across carriers and coverage levels for the Aon Active Health Exchange. They are intended to provide you with a snapshot of benefits provided across coverage levels. In general, carriers have agreed to the majority of standardized plan benefits recommended by the exchange.

For a more detailed look at these and additional coverages, go to enrollment site at . It does account for any carrier adjustments to standardized plan benefits. To see summaries when you enroll online, check the boxes next to the options you want to review and click Compare. In order to get the most comprehensive information about any specific coverage, you will need to call the carrier directly.

Note: For additional comparison, you may find Summaries of Benefits and Coverage on enrollment site at .

Out-of-Area: Your specific options are based on your home zip code. If you live outside the service areas of all the insurance carriers, you can choose an out-of-area option at the Silver coverage level. Aetna will be the insurance carrier. (Note: The Silver option available to out-of-area individuals is different than the Silver option on this site. Refer to for details.)

Choosing a Primary Care Physician: Certain options require you to choose a primary care physician. You may need to designate a primary care physician to coordinate your care if you choose Kaiser Permanente or Health Net as your insurance carrier.

Do You Take Any Prescription Drugs?

This is really important! Your prescription drug coverage will be provided through your insurance carrier’s pharmacy benefit manager.

While your coverage level will determine your coverage for prescription drugs, each pharmacy benefit manager has its own rules. You need to make sure you’re comfortable with how you and your family's medications will be covered. Get the details.

Questions?

It’s easy to find answers! Check out the Frequently Asked Questions (PDF) and the Glossary.

California Medical Coverage Level

Live in California?

Medical Coverage Level

Prescription Drug Coverage

Do You Take Any Prescription Drugs?

Questions?