Medical
CENTURY 21 Affiliated provides group health insurance through CaliforniaChoice Health Plan with five (5) HMO options and one (1) PPO option. Under the HMO plan, you must see a provider within network for coverage. Under the PPO plan, participants are encouraged to see In- Network providers; however, some Out-of-Network providers and services may be covered. For more information on the health insurance and to find in-network providers, visit https://www.calchoice.com/ then select “Provider Search”.
OPTION
HMO
HMO
HMO
Bronze HMO A
Silver HMO A
Platinum HMO A
Plan Name
Network Name
Kaiser Permanente
Kaiser Permanente
Kaiser Permanente
Benefits
In-Network
Non-Network
In-Network
Non-Network
In-Network
Non-Network
Deductible Ind/Family
$5,800 / $11,600
N/A
$2,300 / $4,600
N/A
$0 / $0
N/A
$20 / (Tier’s 2-4) 40% up to $500
$20 / $100 / $100 / 20% up to $250
$5 / $15 / $15 / 10% up to $250
RX Benefit
Not Covered
Not Covered
Not Covered
PCP Office Visits
$60 Copayment
Not Covered
$65 Copayment
Not Covered
$10 Copayment
Not Covered
Specialty Office Visits
$95 Copayment
Not Covered
$100 Copayment
Not Covered
$20 Copayment
Not Covered
Chiropractic Services
$15 Copay – Max 20/yr
Not Covered
Not Covered
Not Covered
$15 Copay – Max 20/yr
Not Covered
Preventive Exams
$0 Copayment
Not covered
$0 Copayment
Not Covered
$0 Copayment
Not Covered
Urgent Care
$60 Copayment
Not Covered
$65 Copayment
Not Covered
$10 Copayment
Not Covered
Emergency Room
40% after deductible
45% after deductible
$200 Copayment
40% after deductible
Hospital Services
Not Covered
45% after deductible
Not Covered
$500 / Admit
Not Covered
Out-of-Pocket Maximum
$9,800 / $19,600
N/A
$9,100 / $18,200
N/A
$3,000 / $6,000
N/A
Employee Monthly Premiums
Age Based Plans
Rates will vary by participant age. Please contact Human Resources for more information.
Out-of-Pocket Maximum includes Deductible, Rx, Office, Urgent Care & Emergency Room Copays
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