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
2018-19 Summaries
EFFECTIVE: NOVEMBER 1, 2018 to DECEMBER 31, 2019
| Description | Sutter Health Plus HMO | Kaiser HMO | Sutter Health Plus HMO Deductible | Kaiser HMO HRA (In Network) |
| In Network | In Network | |||
| Lifetime Maximum | Unlimited | Unlimited | Unlimited | Unlimited |
| Annual Deductible | None | None | $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 Care | No copay; 100 visits per year | No Copay; 100 visits per year | No copay; 100 visits per year; Ded waived | No 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/Procedure | 20% Coinsurance after Ded | 20% Coinsurance after Ded |
| Emergency Room | $100 Copay, waived if admitted | $150 Copay, waived if admitted | 20% Coinsurance after Ded | 20% Coinsurance after Ded |
| Lab & X-Ray | No charge | $10 Copay | $20 Lab/$10 X-ray; Ded Waived | $10 Copay after Ded |
| Durable Medical Equip | 20% Coinsurance | 20% Coinsurance | 20% Coinsurance after Ded | 20% Coins.; Ded Waived |
| Preventive Care | ||||
| Adult | No Copay | No Copay | No Copay; Ded Waived | No Copay; Ded Waived |
| Children | No Copay | No Copay | No Copay; Ded Waived | No Copay; Ded Waived |
| Maternity | ||||
| Office Visits | No Copay | No Copay | No Copay; Ded Waived | No Copay; Ded Waived |
| Mental Health / Substance Abuse | ||||
| Inpatient | $250 per admission | $500/admit | 20% Coinsurance after Ded | $20% Coinsurance after Ded |
| Outpatient | $20/Visit | $30/Visit | $20 Copay/Visit; Ded Waived | $20 Copay/Visit after Ded |
| Chiropractic Benefit | None | $15 Copay/30 visits | None | None |
| 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 Copay | Must be Formulary | $60 Copay; Ded waived | Must be Formulary |
| Brand Name Deduct. | None | None | None | None |
| Notes | See Plan for more details | Kaiser 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).