Medical Plan Summaries

Download links below for plan comparisons for plan year November 1, 2018, through December 31, 2019 (please note that these are Synod medical plan summaries in tables, for more detailed summaries from carriers, please navigate to the Plan summaries, Enrollment forms and FSA info page.

Sutter Health Plus Plan Options

Kaiser Plan Options

2018-19 Summaries
EFFECTIVE: NOVEMBER 1, 2018 to DECEMBER 31, 2019

DescriptionSutter Health Plus HMOKaiser HMOSutter Health Plus HMO DeductibleKaiser HMO HRA (In Network)
In NetworkIn Network
Lifetime MaximumUnlimitedUnlimitedUnlimitedUnlimited
Annual DeductibleNoneNone$1,000/Member
$2,000/Family
$2,000*/Member; $4,000*/Family

HRA Allocation from Synod is $1,000 mem/$2,000 family
Annual Out-of-Pocket Maximum$1,500/Member
$3,000/Family
$1,500/Member
$3,000/Family
$3,000/Member
$6,000/Family
$4,000/Member
$8,000/Family
Professional
Physician Visit$20 Copay$30 Copay$20 Copay; Ded Waived$20 Copay after Ded
Specialist$20 Copay$30 Copay$20 Copay; Ded Waived$20 Copay after Ded
Physical Therapy$20 Copay$30 Copay$20 Copay$20 Copay after Ded
Home Health CareNo copay; 100 visits per yearNo Copay; 100 visits per yearNo copay; 100 visits per year; Ded waivedNo Copay; 100 visits/year; Ded waived
Hospital Services
Inpatient
$250 per admission
$500/Admit
20% Coinsurance after Ded
20% Coinsurance after Ded
Outpatient$100/visit$250/Procedure20% Coinsurance after Ded20% Coinsurance after Ded
Emergency Room$100 Copay, waived if admitted$150 Copay, waived if admitted20% Coinsurance after Ded20% Coinsurance after Ded
Lab & X-RayNo charge$10 Copay
$20 Lab/$10 X-ray; Ded Waived
$10 Copay after Ded
Durable Medical Equip20% Coinsurance20% Coinsurance20% Coinsurance after Ded20% Coins.; Ded Waived
Preventive Care
AdultNo CopayNo CopayNo Copay; Ded WaivedNo Copay; Ded Waived
ChildrenNo CopayNo CopayNo Copay; Ded WaivedNo Copay; Ded Waived
Maternity
Office VisitsNo CopayNo CopayNo Copay; Ded WaivedNo Copay; Ded Waived
Mental Health / Substance Abuse
Inpatient$250 per admission$500/admit20% Coinsurance after Ded$20% Coinsurance after Ded
Outpatient$20/Visit$30/Visit$20 Copay/Visit; Ded Waived$20 Copay/Visit after Ded
Chiropractic BenefitNone$15 Copay/30 visitsNoneNone
Prescription Drug
Generic$10 Copay$15 Copay$10 Copay; Ded waived$10 Copay; Ded Waived
Brand$30 Copay$35 Copay$30 Copay; Ded waived$30 Copay; Ded Waived
Brand Non-Formulary$60 CopayMust be Formulary$60 Copay; Ded waivedMust be Formulary
Brand Name Deduct.NoneNoneNoneNone
NotesSee Plan for more detailsKaiser NW has lower Co-pays; see Plan See Plan for more details See Plan for more details

This information is meant to be a summary of benefits only. Please refer to the plan document for detailed information. If there is a conflict between this information and the plan document, the plan document will prevail.

* HEALTH REIMBURSEMENT ACCOUNT (HRA) ALLOCATIONS: For the Kaiser HRA Plan, please note that half of the Calendar Year Deductible is allocated into a Health Reimbursement Account for employees that can be used by an employee as first monies towards their covered medical expenses.  Kaiser HRA Enrollees receive their full allocation on November 1st (beginning in 2020, that allocation will be on January 1st as we are moving to a Calendar Year).