Medical
Medical coverage offers healthcare protection for you and your family. You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.
Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers. The key difference between the plans is the amount of money you’ll pay each pay period and when you need 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.
Opting Out of Benefits
If you choose to not take MEDICAL coverage with Five Keys, you can receive a medical reimbursement stipend. This is offered as taxable income. Before payments begin, proof of medical insurance for each member must be provided via email to HR@fivekeys.org. Payments will not be made retroactively. Part-time employees are not eligible.
- Employee Only: $250/month
- Employee & Spouse: $300/month
- Employee & Children: $350/month
- Employee & Family: $400/month
Allied (Anthem) $500 Deductible PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,000
Out-of-Pocket Max (Individual/Family)
$2,000/$4,000
Preventive Care
No charge; deductible waived
Primary Care Visit
$20 copay (deductible does not apply)
Specialist Visit
$40 copay (deductible does not apply)
Urgent Care
$20 copay per visit (deductible does not apply)
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay (deductible waived)
Preferred Brand
$35 copay (deductible waived)
Non-Preferred Brand
$50 copay (deductible waived)
Specialty
20% up to $250 (deductible waived)
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay (deductible waived)
Preferred Brand
$70 copay (deductible waived)
Non-Preferred Brand
$100 copay (deductible waived)
Specialty
20% up to $250 for up to a 30-day supply (deductible waived)
Out-of-Network
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$8,000/$16,000
Preventive Care
Not covered
Primary Care Visit
50% after deductible
Specialist Visit
50% after deductible
Urgent Care
50% after deductible
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay + 50% coinsurance (deductible waived)
Preferred Brand
$35 copay + 50% coinsurance (deductible waived)
Non-Preferred Brand
$50 copay + 50% coinsurance (deductible waived)
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
Semi-Monthly Plan Cost
Employee Only: $129.00
Employee and Spouse/DP: $340.00
Employee and Child(ren): $232.00
Employee and Family: $340.00
Allied (Anthem) $1,500 Deductible PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,500 /$3,000
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
No charge; deductible waived
Primary Care Visit
$40 copay per visit (deductible does not apply)
Specialist Visit
$50 copay per visit (deductible does not apply
Urgent Care
$40 copay per visit (deductible does not apply)
Emergency Room
30% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$15 copay (deductible waived)
Preferred Brand
$35 copay (deductible waived)
Non-Preferred Brand
$70 copay (deductible waived)
Specialty
20% up to $250 (deductible waived)
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay (deductible waived)
Preferred Brand
$70 copay (deductible waived)
Non-Preferred Brand
$140 copay (deductible waived)
Specialty
20% up to $250 for up to a 30-day supply (deductible waived)
Out-of-Network
Deductible (Individual/Family)
$3,000/$6,000
Out-of-Pocket Max (Individual/Family)
$8,000/$16,000
Preventive Care
Not covered
Primary Care Visit
50% after deductible
Specialist Visit
50% after deductible
Urgent Care
50% after deductible
Emergency Room
30% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$15 copay (deductible waived)
Preferred Brand
$35 copay (deductible waived)
Non-Preferred Brand
$70 copay (deductible waived)
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
Semi-Monthly Plan Cost
Employee Only: $80.00
Employee and Spouse/DP: $266.50
Employee and Child(ren): $145.50
Employee and Family: $266.50
Kaiser DHMO w/HRA (CA Only)
Kaiser HMO is an in-network only plan, and you must seek services with a Kaiser provider.
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
HRA coverage up to deductible, any costs over deductible are member responsibility.
$2,000 per individual
$4,000 per family
Preventive Care
$0
Primary Care Visit
$20 copay per visit after deductible (HRA covers up to deductible)
Specialist Visit
$20 copay per visit after deductible (HRA covers up to deductible)
Urgent Care
$20 copay after deductible (HRA covers up to deductible)
Emergency Room
20% after deductible (HRA covers up to deductible)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay (deductible waived)
Preferred Brand
$30 copay (deductible waived)
Non-Preferred Brand
$30 copay (deductible waived)
Specialty
20% coinsurance up to $250 (deductible waived)
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay (deductible waived)
Preferred Brand
$60 copay (deductible waived)
Non-Preferred Brand
$60 copay (deductible waived)
Specialty
20% coinsurance (not to exceed $250) for up to a 30-day supply (ded waived)
Semi-Monthly Plan Cost
(Hourly Employees)
Employee Only: $0.00
Employee and Spouse/DP: $188.50
Employee and Child(ren): $92.50
Employee and Family: $248.00
——
(Salaried Employees)
Employee Only: $0.00
Employee and Spouse/DP: $226.00
Employee and Child(ren): $139.00
Employee and Family: $297.50