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.
Aetna HDHP
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,300/$6,400
Out-of-Pocket Max (Individual/Family)
$5,600/$11,200
Preventive Care
$0
Primary Care Visit
10% after deductible
Specialist Visit
10% after deductible
Urgent Care
10% after deductible
Emergency Room
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay after deductible
Preferred Brand
$30 copay after deductible
Non-Preferred Brand
$50 copay after deductible
Specialty
30% to $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay after deductible
Preferred Brand
$60 copay after deductible
Non-Preferred Brand
$100 copay after deductible
Specialty
N/A
Out-of-Network
Deductible (Individual/Family)
$5,000/$10,000
Out-of-Pocket Max (Individual/Family)
$8,000/$16,000
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
Specialty
Not Covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
Specialty
Not Covered
Plan Cost
Keker, Van Nest & Peters pays the majority of the cost of employee’s medical, dental and vision coverage and you pay a greater portion of dependent insurance premiums. Keker, Van Nest & Peters pays the full cost of your Life, AD&D, and LTD coverage. You pay for benefit premiums on a pretax basis. Since your healthcare contributions are subtracted from your gross pay before federal, state, and Social Security taxes are withheld, you pay less in taxes. Because this tax advantage reduces your reported taxable wages, your Social Security benefits could be slightly reduced when you become eligible to receive them.
Domestic partner contributions are regulated by the IRS. Contributions you make for domestic partner coverage must be made on a post-tax basis.
Employees and Associates wishing to decline medical coverage will receive $200 a month opt-out credit with proof of other medical coverage. This credit is considered taxable compensation.
Aetna PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,000
Out-of-Pocket Max (Individual/Family)
$2,500/$5,000
Preventive Care
$0
Primary Care Visit
$15 copay
Specialist Visit
$25 copay
Urgent Care
$35 copay deductible waived
Emergency Room
$250 copay + 10% coinsurance (copay waived if admitted)
Retail Rx
(Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
30% to $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$100 copay
Specialty
N/A
Out-of-Network
Deductible (Individual/Family)
$1,000/$2,000
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
250 copay + 10% coinsurance (copay waived if admitted)
Retail Rx
(Up to 30-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
Specialty
Not Covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
Specialty
Not Covered
Plan Cost
Keker, Van Nest & Peters pays the majority of the cost of employee’s medical, dental and vision coverage and you pay a greater portion of dependent insurance premiums. Keker, Van Nest & Peters pays the full cost of your Life, AD&D, and LTD coverage. You pay for benefit premiums on a pretax basis. Since your healthcare contributions are subtracted from your gross pay before federal, state, and Social Security taxes are withheld, you pay less in taxes. Because this tax advantage reduces your reported taxable wages, your Social Security benefits could be slightly reduced when you become eligible to receive them.
Domestic partner contributions are regulated by the IRS. Contributions you make for domestic partner coverage must be made on a post-tax basis.
Employees and Associates wishing to decline medical coverage will receive $200 a month opt-out credit with proof of other medical coverage. This credit is considered taxable compensation.
Aetna HMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
None
Out-of-Pocket Max (Individual/Family)
$2,500 / $5,000
Preventive Care
$0
Primary Care Visit
$25 copay
Specialist Visit
$50 copay
Urgent Care
$50 copay
Emergency Room
$150 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
30% to $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$100 copay
Specialty
N/A
Plan Cost
Keker, Van Nest & Peters pays the majority of the cost of employee’s medical, dental and vision coverage and you pay a greater portion of dependent insurance premiums. Keker, Van Nest & Peters pays the full cost of your Life, AD&D, and LTD coverage. You pay for benefit premiums on a pretax basis. Since your healthcare contributions are subtracted from your gross pay before federal, state, and Social Security taxes are withheld, you pay less in taxes. Because this tax advantage reduces your reported taxable wages, your Social Security benefits could be slightly reduced when you become eligible to receive them.
Domestic partner contributions are regulated by the IRS. Contributions you make for domestic partner coverage must be made on a post-tax basis.
Employees and Associates wishing to decline medical coverage will receive $200 a month opt-out credit with proof of other medical coverage. This credit is considered taxable compensation.
Kaiser HDHP
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$3,300 / $6,600
Out-of-Pocket Max (Individual/Family)
$3,300 / $6,600
Preventive Care
$0
Primary Care Visit
$0
Specialist Visit
$0
Urgent Care
$0
Emergency Room
$0
Retail Rx (Up to 30-Day Supply)
Generic
$0
Preferred Brand
$0
Non-Preferred Brand
$0
Specialty
$0
Mail-Order Rx (Up to 100-Day Supply)
Generic
$0
Preferred Brand
$0
Non-Preferred Brand
$0
Specialty
$0
Plan Cost
Keker, Van Nest & Peters pays the majority of the cost of employee’s medical, dental and vision coverage and you pay a greater portion of dependent insurance premiums. Keker, Van Nest & Peters pays the full cost of your Life, AD&D, and LTD coverage. You pay for benefit premiums on a pretax basis. Since your healthcare contributions are subtracted from your gross pay before federal, state, and Social Security taxes are withheld, you pay less in taxes. Because this tax advantage reduces your reported taxable wages, your Social Security benefits could be slightly reduced when you become eligible to receive them.
Domestic partner contributions are regulated by the IRS. Contributions you make for domestic partner coverage must be made on a post-tax basis.
Employees and Associates wishing to decline medical coverage will receive $200 a month opt-out credit with proof of other medical coverage. This credit is considered taxable compensation.
Kaiser HMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
None
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 per visit
Emergency Room
$100 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$15 copay
Preferred Brand
$35 copay
Non-Preferred Brand
$35 copay (prior authorization required)
Specialty
$35 copay
Mail-Order Rx (Up to 100-Day Supply)
Generic
$30 copay
Preferred Brand
$70 copay
Non-Preferred Brand
$70 copay (prior authorization required)
Specialty
N/A
Plan Cost
Keker, Van Nest & Peters pays the majority of the cost of employee’s medical, dental and vision coverage and you pay a greater portion of dependent insurance premiums. Keker, Van Nest & Peters pays the full cost of your Life, AD&D, and LTD coverage. You pay for benefit premiums on a pretax basis. Since your healthcare contributions are subtracted from your gross pay before federal, state, and Social Security taxes are withheld, you pay less in taxes. Because this tax advantage reduces your reported taxable wages, your Social Security benefits could be slightly reduced when you become eligible to receive them.
Domestic partner contributions are regulated by the IRS. Contributions you make for domestic partner coverage must be made on a post-tax basis.
Employees and Associates wishing to decline medical coverage will receive $200 a month opt-out credit with proof of other medical coverage. This credit is considered taxable compensation.