Your medical benefit: to most, it’s the most important benefit we have available, but many of us don’t use our plan to the fullest. Medical benefits are not just for when you are sick… For example, if you use preventive benefits when you are well, you might actually be able to avoid getting sick!

To learn more about some of the key plan details that are important to understand, like deductible and coinsurance, click here.

  • Deductible

    The amount of covered expenses you must pay before the Plan starts paying benefits.

    In-network:

    Individual: $3,000
    Family: $6,000

    Out-of-network:

    Not covered

  • Coinsurance

    Cost-sharing between you and the company. This is applied after you meet your deductible.

    In-network:

    You pay 20% (after deductible)
    Plan pays 80%

    Out-of-network:

    Not covered

  • Out-of-Pocket Maximum

    The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.

    In-network:

    Individual: $6,000
    Family: $12,000

    Out-of-network:

    Not covered

  • Doctor’s Office Visit

    In-network:

    You pay 20% (after deductible)
    Plan pays 80%

    Out-of-network:

    Not covered

  • Specialist Office Visit

    Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).

    In-network:

    You pay 20% (after deductible)
    Plan pays 80%

    Out-of-network:

    Not covered

  • Preventive/Well Child Care

    Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.

    In-network:

    You pay $0
    Plan pays 100%

    Out-of-network:

    Not covered

  • Emergency Room

    Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital.

    In-network:

    You pay 20% (after deductible)
    Plan pays 80%

    Out-of-network:

    You pay 20% (after deductible)
    Plan pays 80%

  • Urgent Care

    Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.

    In-network:

    You pay 20% (after deductible)
    Plan pays 80%

    Out-of-network:

    Not covered

  • Hospitalization

    In-network: Inpatient

    You pay 20% (after deductible)
    Plan pays 80%

    Out-of-network: Inpatient

    Not covered

    Outpatient:

    You pay 20% (after deductible)
    Plan pays 80%

    Outpatient:

    Not covered

  • Are you required to use network providers?

    No (but your costs will be lower when you do)

  • Do you need a referral to a specialist?

    No.

  • Can I use a Health Savings Account (HSA)?

    A feature of high-deductible or consumer-driven medical plans, this is a tax-advantaged savings account you can use for medical expenses now or save for later.

    Yes.

  • Can I use a Health Care Flexible Spending Account (FSA)?

    An account you contribute to before taxes, then use the money for qualified health-related expenses.

    No, employees enrolled in a HDHP can only participate in a Limited Purpose FSA. A Limited Purpose FSA can only be used for dental and vision expenses.

  • HSA Funding

    Wedgewood will fund $840 annually to each HSA. The HSA’s will be funded $70 per month. Employees enrolled under a HDHP plan can make pre-tax payroll contributions of up to $4,400 for individual coverage or up to $8,750 for family coverage.

Meritain HDHP Base Plan

Provider: Quantum Health Care Coordinators

Phone: 866-871-0630

Website: https://quantum-health.com/

Prescription

Provider: US-Rxcare

Website: https://usrxcare.com

US-Rx Prescription Documents:

  1. ACA zero copay list
  2. 2024 Formulary List
  3. Expanded Preventative List
  4. US-Rx Care Benefit Guide

Quantum Care Coordinator Support
Phone #: 866-871-0630
Website: Wedgewood.Quantum-Health.com
Hours of Operation:
M – FR 8:30AM – 10PM EST

Meritain HDHP Base Plan Meritain Low EPO Plan Meritain High POS Plan Kaiser HDHP Base Plan (CA employees only) Kaiser HMO Low Option (CA employees only) Kaiser HMO High Option (CA employees only)

Deductible

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Not covered

Deductible

In-network: Individual: $750
Family: $1,500

Employer Funding

N/A
Out-of-network: Not covered

Deductible

In-network: Individual: $0
Family: $0

Employer Funding

N/A
Out-of-network: Individual: $2,500

Family: $5,000

Deductible

In-network: Individual: $3,500
Family: $7,000
Out-of-network: Not covered

Deductible

In-network: Individual: $750
Family: $1,500

Deductible

N/A

Coinsurance

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Coinsurance

In-network: 20% (after deductible)
Out-of-network: Not covered

Coinsurance

N/A

Coinsurance

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Coinsurance

In-network: You pay 20% (after deductible)
Plan pays 80%

Coinsurance

In-network: You pay 20%
Plan pays 80%
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $6,000
Family: $12,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $4,000
Family: $8,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Individual: $6,000

Family: $12,000

Out-of-Pocket Maximum

In-network: Individual: $6,000
Family: $12,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $1,500
Family: $3,000
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Doctor’s Office Visit

N/A

Doctor’s Office Visit

N/A

Doctor’s Office Visit

In-network: You pay $10 copay after deductible
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay $25 copay (after deductible)
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay $15 copay
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $40 copay (after deductible)
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $40 copay
Out-of-network: 40% after deductible

Specialist Office Visit

In-network: You pay $30 copay after deductible
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $25 copay (after deductible)
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $15 copay
Out-of-network: Not covered

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: Not covered

Preventive/Well Child Care

N/A

Preventive/Well Child Care

N/A

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: Not covered

Preventive/Well Child Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Preventive/Well Child Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Emergency Room

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: You pay 20% (after deductible)
Plan pays 80%

Emergency Room

In-network: You pay $100 copay after deductible (copay waived if admitted)
Out-of-network: Not Covered

Emergency Room

In-network: You pay $100 copay (waived if admitted)
Out-of-network: 40% after deductible

Emergency Room

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Emergency Room

In-network: You pay 20% Coinsurance
Out-of-network: You pay 20% Coinsurance

Emergency Room

In-network: You pay $100 per Visit
Out-of-network: You pay $100 per Visit

Urgent Care

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Urgent Care

In-network: You pay $40 copay with no deductible
Out-of-network: Not covered

Urgent Care

N/A

Urgent Care

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Urgent Care

In-network: You pay $25 copay with no deductible
Out-of-network: Not covered

Urgent Care

In-network: You pay $15 copay per Visit
Out-of-network: You pay $15 copay per Visit

Hospitalization

In-network: Inpatient You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Inpatient Not covered
Outpatient: You pay 20% (after deductible)
Plan pays 80%
Outpatient: Not covered

Hospitalization

In-network: Inpatient 20% (after deductible)
Out-of-network Not covered
Outpatient: 20% (after deductible)

Hospitalization

In-network: Inpatient $150/Per Day 5 Day Max
Out-of-network 40% after deductible
Outpatient Surgical Procedures: You pay $200 copay

Hospitalization

In-network: Inpatient You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Inpatient Not covered
Outpatient: You pay 30% (after deductible)
Plan pays 70%
Outpatient Not covered

Hospitalization

In-network: Inpatient You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered
Outpatient: You pay 20% (after deductible)
Plan pays 80%

Hospitalization

In-network: Inpatient You pay $250 / procedure
Out-of-network: Not covered
Outpatient: You pay $15 / procedure

Are you required to use network providers?

No (but your costs will be lower when you do)

Are you required to use network providers?

Yes.

Are you required to use network providers?

It is not required but recommended to avoid any balance bills or higher out of pocket costs.

Are you required to use network providers?

Yes.

Are you required to use network providers?

Yes.

Are you required to use network providers?

Yes.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

Yes.

Do you need a referral to a specialist?

Yes.

Do you need a referral to a specialist?

Yes.

Can I use a Health Savings Account (HSA)?

Yes.

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Care Flexible Spending Account (FSA)?

No, employees enrolled in a HDHP can only participate in a Limited Purpose FSA. A Limited Purpose FSA can only be used for dental and vision expenses.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

No, employees enrolled in a HDHP can only participate in a Limited Purpose FSA. A Limited Purpose FSA can only be used for dental and vision expenses.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

HSA Funding

Wedgewood will fund $840 annually to each HSA. The HSA’s will be funded $70 per month. Employees enrolled under a HDHP plan can make pre-tax payroll contributions of up to $4,400 for individual coverage or up to $8,750 for family coverage.

HSA Funding

N/A

HSA Funding

N/A

HSA Funding

Wedgewood will fund $840 annually to each HSA. The HSA’s will be funded $70 per month. Employees enrolled under a HDHP plan can make pre-tax payroll contributions of up to $4,400 for individual coverage or up to $8,750 for family coverage.

HSA Funding

N/A

HSA Funding

N/A

Preventive Care

N/A

Preventive Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Preventive Care

In-network: Plan pays 100%
Out-of-network: 40% after deductible

Preventive Care

N/A

Preventive Care

N/A

Preventive Care

N/A

Primary Care Office Visit

N/A

Primary Care Office Visit

In-network: You pay $20 copay (after deductible)
Out-of-network: Not covered

Primary Care Office Visit

In-network: You pay $20 copay
Out-of-network: 40% after deductible

Primary Care Office Visit

N/A

Primary Care Office Visit

N/A

Primary Care Office Visit

N/A

Routine radiology

N/A

Routine radiology

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network Not covered

Routine radiology

In-network $50 Copay
Out-of-network 40% after deductible

Routine radiology

N/A

Routine radiology

N/A

Routine radiology

N/A

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network Not covered

Complex imaging (MRI/PET/CT)

In-network $100 Copay
Out-of-network 40% after deductible

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

N/A

N/A

N/A

N/A

N/A

N/A

Member Coinsurance

N/A

Member Coinsurance

N/A

Member Coinsurance

In-network: None
Out-of-network: 40% after deductible

Member Coinsurance

N/A

Member Coinsurance

N/A

Member Coinsurance

N/A

Urgent Care Center

N/A

Urgent Care Center

N/A

Urgent Care Center

In-network: $40 copay
Out-of-network: 40% after deductible

Urgent Care Center

N/A

Urgent Care Center

N/A

Urgent Care Center

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

Yes.

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

  • Deductible

    The amount of covered expenses you must pay before the Plan starts paying benefits.

    In-network:

    Individual: $750
    Family: $1,500

    Employer Funding

    N/A

    Out-of-network:

    Not covered

  • Coinsurance

    Cost-sharing between you and the company. This is applied after you meet your deductible (if applicable).

    In-network:

    20% (after deductible)

    Out-of-network:

    Not covered

  • Out-of-Pocket Maximum

    The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.

    In-network:

    Individual: $4,000
    Family: $8,000

    Out-of-network:

    Not covered

  • Preventive Care

    Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.

    In-network:

    Plan pays 100% with no deductible

    Out-of-network:

    Not covered

  • Primary Care Office Visit

    In-network:

    You pay $20 copay (after deductible)

    Out-of-network:

    Not covered

  • Specialist Office Visit

    Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).

    In-network:

    You pay $40 copay (after deductible)

    Out-of-network:

    Not covered

  • Hospitalization

    In-network: Inpatient

    20% (after deductible)

    Out-of-network

    Not covered

    Outpatient:

    20% (after deductible)

  • Routine radiology

    In-network:

    You pay 20% (after deductible)
    Plan pays 80%

    Out-of-network

    Not covered

  • Complex imaging (MRI/PET/CT)

    In-network:

    You pay 20% (after deductible)
    Plan pays 80%

    Out-of-network

    Not covered

  • Urgent Care

    Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.

    In-network:

    You pay $40 copay with no deductible

    Out-of-network:

    Not covered

  • Emergency Room

    Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital. If you are at an out-of-network hospital, you will need to be transferred to a network facility.

    In-network:

    You pay $100 copay after deductible (copay waived if admitted)

    Out-of-network:

    Not Covered

  • Are you required to use network providers?

    Yes.

  • Do you need a referral to a specialist?

    No.

  • Can I use a Health Care Flexible Spending Account (FSA)?

    An account you contribute to before taxes, then use the money for qualified health-related expenses.

    Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Meritain HRA Low Plan

Provider: Quantum Health Care Coordinators

Phone: 866-871-0630

Website: https://quantum-health.com/

Prescription

Provider: US-Rxcare

Website: https://usrxcare.com

US-Rx Prescription Documents:

  1. ACA zero copay list
  2. 2024 Formulary List
  3. Expanded Preventative List
  4. US-Rx Care Benefit Guide

Quantum Care Coordinator Support
Phone #: 866-871-0630
Website: Wedgewood.Quantum-Health.com
Hours of Operation:
M – FR 8:30AM – 10PM EST

Meritain Low EPO Plan Meritain HDHP Base Plan Meritain High POS Plan Kaiser HDHP Base Plan (CA employees only) Kaiser HMO Low Option (CA employees only) Kaiser HMO High Option (CA employees only)

Deductible

In-network: Individual: $750
Family: $1,500

Employer Funding

N/A
Out-of-network: Not covered

Deductible

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Not covered

Deductible

In-network: Individual: $0
Family: $0

Employer Funding

N/A
Out-of-network: Individual: $2,500

Family: $5,000

Deductible

In-network: Individual: $3,500
Family: $7,000
Out-of-network: Not covered

Deductible

In-network: Individual: $750
Family: $1,500

Deductible

N/A

Coinsurance

In-network: 20% (after deductible)
Out-of-network: Not covered

Coinsurance

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Coinsurance

N/A

Coinsurance

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Coinsurance

In-network: You pay 20% (after deductible)
Plan pays 80%

Coinsurance

In-network: You pay 20%
Plan pays 80%
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $4,000
Family: $8,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $6,000
Family: $12,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Individual: $6,000

Family: $12,000

Out-of-Pocket Maximum

In-network: Individual: $6,000
Family: $12,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $1,500
Family: $3,000
Out-of-network: Not covered

Doctor’s Office Visit

N/A

Doctor’s Office Visit

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Doctor’s Office Visit

N/A

Doctor’s Office Visit

In-network: You pay $10 copay after deductible
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay $25 copay (after deductible)
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay $15 copay
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $40 copay (after deductible)
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $40 copay
Out-of-network: 40% after deductible

Specialist Office Visit

In-network: You pay $30 copay after deductible
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $25 copay (after deductible)
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $15 copay
Out-of-network: Not covered

Preventive/Well Child Care

N/A

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: Not covered

Preventive/Well Child Care

N/A

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: Not covered

Preventive/Well Child Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Preventive/Well Child Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Emergency Room

In-network: You pay $100 copay after deductible (copay waived if admitted)
Out-of-network: Not Covered

Emergency Room

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: You pay 20% (after deductible)
Plan pays 80%

Emergency Room

In-network: You pay $100 copay (waived if admitted)
Out-of-network: 40% after deductible

Emergency Room

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Emergency Room

In-network: You pay 20% Coinsurance
Out-of-network: You pay 20% Coinsurance

Emergency Room

In-network: You pay $100 per Visit
Out-of-network: You pay $100 per Visit

Urgent Care

In-network: You pay $40 copay with no deductible
Out-of-network: Not covered

Urgent Care

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Urgent Care

N/A

Urgent Care

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Urgent Care

In-network: You pay $25 copay with no deductible
Out-of-network: Not covered

Urgent Care

In-network: You pay $15 copay per Visit
Out-of-network: You pay $15 copay per Visit

Hospitalization

In-network: Inpatient 20% (after deductible)
Out-of-network Not covered
Outpatient: 20% (after deductible)

Hospitalization

In-network: Inpatient You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Inpatient Not covered
Outpatient: You pay 20% (after deductible)
Plan pays 80%
Outpatient: Not covered

Hospitalization

In-network: Inpatient $150/Per Day 5 Day Max
Out-of-network 40% after deductible
Outpatient Surgical Procedures: You pay $200 copay

Hospitalization

In-network: Inpatient You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Inpatient Not covered
Outpatient: You pay 30% (after deductible)
Plan pays 70%
Outpatient Not covered

Hospitalization

In-network: Inpatient You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered
Outpatient: You pay 20% (after deductible)
Plan pays 80%

Hospitalization

In-network: Inpatient You pay $250 / procedure
Out-of-network: Not covered
Outpatient: You pay $15 / procedure

Are you required to use network providers?

Yes.

Are you required to use network providers?

No (but your costs will be lower when you do)

Are you required to use network providers?

It is not required but recommended to avoid any balance bills or higher out of pocket costs.

Are you required to use network providers?

Yes.

Are you required to use network providers?

Yes.

Are you required to use network providers?

Yes.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

Yes.

Do you need a referral to a specialist?

Yes.

Do you need a referral to a specialist?

Yes.

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

Yes.

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

No, employees enrolled in a HDHP can only participate in a Limited Purpose FSA. A Limited Purpose FSA can only be used for dental and vision expenses.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

No, employees enrolled in a HDHP can only participate in a Limited Purpose FSA. A Limited Purpose FSA can only be used for dental and vision expenses.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

HSA Funding

N/A

HSA Funding

Wedgewood will fund $840 annually to each HSA. The HSA’s will be funded $70 per month. Employees enrolled under a HDHP plan can make pre-tax payroll contributions of up to $4,400 for individual coverage or up to $8,750 for family coverage.

HSA Funding

N/A

HSA Funding

Wedgewood will fund $840 annually to each HSA. The HSA’s will be funded $70 per month. Employees enrolled under a HDHP plan can make pre-tax payroll contributions of up to $4,400 for individual coverage or up to $8,750 for family coverage.

HSA Funding

N/A

HSA Funding

N/A

Preventive Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Preventive Care

N/A

Preventive Care

In-network: Plan pays 100%
Out-of-network: 40% after deductible

Preventive Care

N/A

Preventive Care

N/A

Preventive Care

N/A

Primary Care Office Visit

In-network: You pay $20 copay (after deductible)
Out-of-network: Not covered

Primary Care Office Visit

N/A

Primary Care Office Visit

In-network: You pay $20 copay
Out-of-network: 40% after deductible

Primary Care Office Visit

N/A

Primary Care Office Visit

N/A

Primary Care Office Visit

N/A

Routine radiology

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network Not covered

Routine radiology

N/A

Routine radiology

In-network $50 Copay
Out-of-network 40% after deductible

Routine radiology

N/A

Routine radiology

N/A

Routine radiology

N/A

Complex imaging (MRI/PET/CT)

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network Not covered

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

In-network $100 Copay
Out-of-network 40% after deductible

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

N/A

N/A

N/A

N/A

N/A

N/A

Member Coinsurance

N/A

Member Coinsurance

N/A

Member Coinsurance

In-network: None
Out-of-network: 40% after deductible

Member Coinsurance

N/A

Member Coinsurance

N/A

Member Coinsurance

N/A

Urgent Care Center

N/A

Urgent Care Center

N/A

Urgent Care Center

In-network: $40 copay
Out-of-network: 40% after deductible

Urgent Care Center

N/A

Urgent Care Center

N/A

Urgent Care Center

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

Yes.

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

  • Deductible

    The amount of covered expenses you must pay before the Plan starts paying benefits.

    In-network:

    Individual: $0
    Family: $0

    Employer Funding

    N/A

    Out-of-network:

    Individual: $2,500

    Family: $5,000

  • Member Coinsurance

    Out-of-pocket maximum (Indv/Fam)

    In-network:

    None

    Out-of-network:

    40% after deductible

  • Out-of-Pocket Maximum

    The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.

    In-network:

    Individual: $3,000
    Family: $6,000

    Out-of-network:

    Individual: $6,000

    Family: $12,000

  • Preventive Care

    Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.

    In-network:

    Plan pays 100%

    Out-of-network:

    40% after deductible

  • Primary Care Office Visit

    In-network:

    You pay $20 copay

    Out-of-network:

    40% after deductible

  • Specialist Office Visit

    Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).

    In-network:

    You pay $40 copay

    Out-of-network:

    40% after deductible

  • Hospitalization

    In-network: Inpatient

    $150/Per Day 5 Day Max

    Out-of-network

    40% after deductible

    Outpatient Surgical Procedures:

    You pay $200 copay

  • Routine radiology

    In-network

    $50 Copay

    Out-of-network

    40% after deductible

  • Complex imaging (MRI/PET/CT)

    In-network

    $100 Copay

    Out-of-network

    40% after deductible

  • Urgent Care Center

    Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.

    In-network:

    $40 copay

    Out-of-network:

    40% after deductible

  • Emergency Room

    Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital. If you are at an out-of-network hospital, you will need to be transferred to a network facility.

    In-network:

    You pay $100 copay (waived if admitted)

    Out-of-network:

    40% after deductible

  • Are you required to use network providers?

    It is not required but recommended to avoid any balance bills or higher out of pocket costs.

  • Do you need a referral to a specialist?

    No.

  • Can I use a Health Care Flexible Spending Account (FSA)?

    An account you contribute to before taxes, then use the money for qualified health-related expenses.

    Yes, for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Meritain HRA High Plan

Provider: Quantum Health Care Coordinators

Phone: 866-871-0630

Website: https://quantum-health.com/

Prescription

Provider: US-Rxcare

Website: https://usrxcare.com

US-Rx Prescription Documents:

  1. ACA zero copay list
  2. 2024 Formulary List
  3. Expanded Preventative List
  4. US-Rx Care Benefit Guide

Quantum Care Coordinator Support
Phone #: 866-871-0630
Website: Wedgewood.Quantum-Health.com
Hours of Operation:
M – FR 8:30AM – 10PM EST

Meritain High POS Plan Meritain HDHP Base Plan Meritain Low EPO Plan Kaiser HDHP Base Plan (CA employees only) Kaiser HMO Low Option (CA employees only) Kaiser HMO High Option (CA employees only)

Deductible

In-network: Individual: $0
Family: $0

Employer Funding

N/A
Out-of-network: Individual: $2,500

Family: $5,000

Deductible

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Not covered

Deductible

In-network: Individual: $750
Family: $1,500

Employer Funding

N/A
Out-of-network: Not covered

Deductible

In-network: Individual: $3,500
Family: $7,000
Out-of-network: Not covered

Deductible

In-network: Individual: $750
Family: $1,500

Deductible

N/A

Coinsurance

N/A

Coinsurance

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Coinsurance

In-network: 20% (after deductible)
Out-of-network: Not covered

Coinsurance

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Coinsurance

In-network: You pay 20% (after deductible)
Plan pays 80%

Coinsurance

In-network: You pay 20%
Plan pays 80%
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Individual: $6,000

Family: $12,000

Out-of-Pocket Maximum

In-network: Individual: $6,000
Family: $12,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $4,000
Family: $8,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $6,000
Family: $12,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $1,500
Family: $3,000
Out-of-network: Not covered

Doctor’s Office Visit

N/A

Doctor’s Office Visit

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Doctor’s Office Visit

N/A

Doctor’s Office Visit

In-network: You pay $10 copay after deductible
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay $25 copay (after deductible)
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay $15 copay
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $40 copay
Out-of-network: 40% after deductible

Specialist Office Visit

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $40 copay (after deductible)
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $30 copay after deductible
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $25 copay (after deductible)
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $15 copay
Out-of-network: Not covered

Preventive/Well Child Care

N/A

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: Not covered

Preventive/Well Child Care

N/A

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: Not covered

Preventive/Well Child Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Preventive/Well Child Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Emergency Room

In-network: You pay $100 copay (waived if admitted)
Out-of-network: 40% after deductible

Emergency Room

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: You pay 20% (after deductible)
Plan pays 80%

Emergency Room

In-network: You pay $100 copay after deductible (copay waived if admitted)
Out-of-network: Not Covered

Emergency Room

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Emergency Room

In-network: You pay 20% Coinsurance
Out-of-network: You pay 20% Coinsurance

Emergency Room

In-network: You pay $100 per Visit
Out-of-network: You pay $100 per Visit

Urgent Care

N/A

Urgent Care

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Urgent Care

In-network: You pay $40 copay with no deductible
Out-of-network: Not covered

Urgent Care

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Urgent Care

In-network: You pay $25 copay with no deductible
Out-of-network: Not covered

Urgent Care

In-network: You pay $15 copay per Visit
Out-of-network: You pay $15 copay per Visit

Hospitalization

In-network: Inpatient $150/Per Day 5 Day Max
Out-of-network 40% after deductible
Outpatient Surgical Procedures: You pay $200 copay

Hospitalization

In-network: Inpatient You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Inpatient Not covered
Outpatient: You pay 20% (after deductible)
Plan pays 80%
Outpatient: Not covered

Hospitalization

In-network: Inpatient 20% (after deductible)
Out-of-network Not covered
Outpatient: 20% (after deductible)

Hospitalization

In-network: Inpatient You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Inpatient Not covered
Outpatient: You pay 30% (after deductible)
Plan pays 70%
Outpatient Not covered

Hospitalization

In-network: Inpatient You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered
Outpatient: You pay 20% (after deductible)
Plan pays 80%

Hospitalization

In-network: Inpatient You pay $250 / procedure
Out-of-network: Not covered
Outpatient: You pay $15 / procedure

Are you required to use network providers?

It is not required but recommended to avoid any balance bills or higher out of pocket costs.

Are you required to use network providers?

No (but your costs will be lower when you do)

Are you required to use network providers?

Yes.

Are you required to use network providers?

Yes.

Are you required to use network providers?

Yes.

Are you required to use network providers?

Yes.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

Yes.

Do you need a referral to a specialist?

Yes.

Do you need a referral to a specialist?

Yes.

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

Yes.

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

No, employees enrolled in a HDHP can only participate in a Limited Purpose FSA. A Limited Purpose FSA can only be used for dental and vision expenses.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

No, employees enrolled in a HDHP can only participate in a Limited Purpose FSA. A Limited Purpose FSA can only be used for dental and vision expenses.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

HSA Funding

N/A

HSA Funding

Wedgewood will fund $840 annually to each HSA. The HSA’s will be funded $70 per month. Employees enrolled under a HDHP plan can make pre-tax payroll contributions of up to $4,400 for individual coverage or up to $8,750 for family coverage.

HSA Funding

N/A

HSA Funding

Wedgewood will fund $840 annually to each HSA. The HSA’s will be funded $70 per month. Employees enrolled under a HDHP plan can make pre-tax payroll contributions of up to $4,400 for individual coverage or up to $8,750 for family coverage.

HSA Funding

N/A

HSA Funding

N/A

Preventive Care

In-network: Plan pays 100%
Out-of-network: 40% after deductible

Preventive Care

N/A

Preventive Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Preventive Care

N/A

Preventive Care

N/A

Preventive Care

N/A

Primary Care Office Visit

In-network: You pay $20 copay
Out-of-network: 40% after deductible

Primary Care Office Visit

N/A

Primary Care Office Visit

In-network: You pay $20 copay (after deductible)
Out-of-network: Not covered

Primary Care Office Visit

N/A

Primary Care Office Visit

N/A

Primary Care Office Visit

N/A

Routine radiology

In-network $50 Copay
Out-of-network 40% after deductible

Routine radiology

N/A

Routine radiology

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network Not covered

Routine radiology

N/A

Routine radiology

N/A

Routine radiology

N/A

Complex imaging (MRI/PET/CT)

In-network $100 Copay
Out-of-network 40% after deductible

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network Not covered

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

N/A

N/A

N/A

N/A

N/A

N/A

Member Coinsurance

In-network: None
Out-of-network: 40% after deductible

Member Coinsurance

N/A

Member Coinsurance

N/A

Member Coinsurance

N/A

Member Coinsurance

N/A

Member Coinsurance

N/A

Urgent Care Center

In-network: $40 copay
Out-of-network: 40% after deductible

Urgent Care Center

N/A

Urgent Care Center

N/A

Urgent Care Center

N/A

Urgent Care Center

N/A

Urgent Care Center

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

Yes.

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

  • Deductible

    The amount of covered expenses you must pay before the Plan starts paying benefits.

    In-network:

    Individual: $3,500
    Family: $7,000

    Out-of-network:

    Not covered

  • Coinsurance

    Cost-sharing between you and the company. This is applied after you meet your deductible.

    In-network:

    You pay 30% (after deductible)
    Plan pays 70%

    Out-of-network:

    Not covered

  • Out-of-Pocket Maximum

    The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.

    In-network:

    Individual: $6,000
    Family: $12,000

    Out-of-network:

    Not covered

  • Doctor’s Office Visit

    In-network:

    You pay $10 copay after deductible

    Out-of-network:

    Not covered

  • Specialist Office Visit

    Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).

    In-network:

    You pay $30 copay after deductible

    Out-of-network:

    Not covered

  • Preventive/Well Child Care

    Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.

    In-network:

    You pay $0
    Plan pays 100%

    Out-of-network:

    Not covered

  • Emergency Room

    Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital.

    In-network:

    You pay 30% (after deductible)
    Plan pays 70%

    Out-of-network:

    Not covered

  • Urgent Care

    Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.

    In-network:

    You pay 30% (after deductible)
    Plan pays 70%

    Out-of-network:

    Not covered

  • Hospitalization

    In-network: Inpatient

    You pay 30% (after deductible)
    Plan pays 70%

    Out-of-network: Inpatient

    Not covered

    Outpatient:

    You pay 30% (after deductible)
    Plan pays 70%

    Outpatient

    Not covered

  • Are you required to use network providers?

    Yes.

  • Do you need a referral to a specialist?

    Yes.

  • Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

    A feature of high-deductible or consumer-driven medical plans, this is a tax-advantaged savings account you can use for medical expenses now or save for later.

    Yes.

  • Can I use a Health Care Flexible Spending Account (FSA)?

    An account you contribute to before taxes, then use the money for qualified health-related expenses.

    No, employees enrolled in a HDHP can only participate in a Limited Purpose FSA. A Limited Purpose FSA can only be used for dental and vision expenses.

  • HSA Funding

    Wedgewood will fund $840 annually to each HSA. The HSA’s will be funded $70 per month. Employees enrolled under a HDHP plan can make pre-tax payroll contributions of up to $4,400 for individual coverage or up to $8,750 for family coverage.

Kaiser HDHP Base Plan (CA employees only)

Provider: Kaiser

Phone: 800-464-4000

Website: https://healthy.kaiserpermanente.org/washington/front-door

Kaiser HDHP Base Plan (CA employees only) Meritain HDHP Base Plan Meritain Low EPO Plan Meritain High POS Plan Kaiser HMO Low Option (CA employees only) Kaiser HMO High Option (CA employees only)

Deductible

In-network: Individual: $3,500
Family: $7,000
Out-of-network: Not covered

Deductible

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Not covered

Deductible

In-network: Individual: $750
Family: $1,500

Employer Funding

N/A
Out-of-network: Not covered

Deductible

In-network: Individual: $0
Family: $0

Employer Funding

N/A
Out-of-network: Individual: $2,500

Family: $5,000

Deductible

In-network: Individual: $750
Family: $1,500

Deductible

N/A

Coinsurance

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Coinsurance

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Coinsurance

In-network: 20% (after deductible)
Out-of-network: Not covered

Coinsurance

N/A

Coinsurance

In-network: You pay 20% (after deductible)
Plan pays 80%

Coinsurance

In-network: You pay 20%
Plan pays 80%
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $6,000
Family: $12,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $6,000
Family: $12,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $4,000
Family: $8,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Individual: $6,000

Family: $12,000

Out-of-Pocket Maximum

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $1,500
Family: $3,000
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay $10 copay after deductible
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Doctor’s Office Visit

N/A

Doctor’s Office Visit

N/A

Doctor’s Office Visit

In-network: You pay $25 copay (after deductible)
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay $15 copay
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $30 copay after deductible
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $40 copay (after deductible)
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $40 copay
Out-of-network: 40% after deductible

Specialist Office Visit

In-network: You pay $25 copay (after deductible)
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $15 copay
Out-of-network: Not covered

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: Not covered

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: Not covered

Preventive/Well Child Care

N/A

Preventive/Well Child Care

N/A

Preventive/Well Child Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Preventive/Well Child Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Emergency Room

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Emergency Room

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: You pay 20% (after deductible)
Plan pays 80%

Emergency Room

In-network: You pay $100 copay after deductible (copay waived if admitted)
Out-of-network: Not Covered

Emergency Room

In-network: You pay $100 copay (waived if admitted)
Out-of-network: 40% after deductible

Emergency Room

In-network: You pay 20% Coinsurance
Out-of-network: You pay 20% Coinsurance

Emergency Room

In-network: You pay $100 per Visit
Out-of-network: You pay $100 per Visit

Urgent Care

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Urgent Care

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Urgent Care

In-network: You pay $40 copay with no deductible
Out-of-network: Not covered

Urgent Care

N/A

Urgent Care

In-network: You pay $25 copay with no deductible
Out-of-network: Not covered

Urgent Care

In-network: You pay $15 copay per Visit
Out-of-network: You pay $15 copay per Visit

Hospitalization

In-network: Inpatient You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Inpatient Not covered
Outpatient: You pay 30% (after deductible)
Plan pays 70%
Outpatient Not covered

Hospitalization

In-network: Inpatient You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Inpatient Not covered
Outpatient: You pay 20% (after deductible)
Plan pays 80%
Outpatient: Not covered

Hospitalization

In-network: Inpatient 20% (after deductible)
Out-of-network Not covered
Outpatient: 20% (after deductible)

Hospitalization

In-network: Inpatient $150/Per Day 5 Day Max
Out-of-network 40% after deductible
Outpatient Surgical Procedures: You pay $200 copay

Hospitalization

In-network: Inpatient You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered
Outpatient: You pay 20% (after deductible)
Plan pays 80%

Hospitalization

In-network: Inpatient You pay $250 / procedure
Out-of-network: Not covered
Outpatient: You pay $15 / procedure

Are you required to use network providers?

Yes.

Are you required to use network providers?

No (but your costs will be lower when you do)

Are you required to use network providers?

Yes.

Are you required to use network providers?

It is not required but recommended to avoid any balance bills or higher out of pocket costs.

Are you required to use network providers?

Yes.

Are you required to use network providers?

Yes.

Do you need a referral to a specialist?

Yes.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

Yes.

Do you need a referral to a specialist?

Yes.

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

Yes.

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Care Flexible Spending Account (FSA)?

No, employees enrolled in a HDHP can only participate in a Limited Purpose FSA. A Limited Purpose FSA can only be used for dental and vision expenses.

Can I use a Health Care Flexible Spending Account (FSA)?

No, employees enrolled in a HDHP can only participate in a Limited Purpose FSA. A Limited Purpose FSA can only be used for dental and vision expenses.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

HSA Funding

Wedgewood will fund $840 annually to each HSA. The HSA’s will be funded $70 per month. Employees enrolled under a HDHP plan can make pre-tax payroll contributions of up to $4,400 for individual coverage or up to $8,750 for family coverage.

HSA Funding

Wedgewood will fund $840 annually to each HSA. The HSA’s will be funded $70 per month. Employees enrolled under a HDHP plan can make pre-tax payroll contributions of up to $4,400 for individual coverage or up to $8,750 for family coverage.

HSA Funding

N/A

HSA Funding

N/A

HSA Funding

N/A

HSA Funding

N/A

Preventive Care

N/A

Preventive Care

N/A

Preventive Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Preventive Care

In-network: Plan pays 100%
Out-of-network: 40% after deductible

Preventive Care

N/A

Preventive Care

N/A

Primary Care Office Visit

N/A

Primary Care Office Visit

N/A

Primary Care Office Visit

In-network: You pay $20 copay (after deductible)
Out-of-network: Not covered

Primary Care Office Visit

In-network: You pay $20 copay
Out-of-network: 40% after deductible

Primary Care Office Visit

N/A

Primary Care Office Visit

N/A

Routine radiology

N/A

Routine radiology

N/A

Routine radiology

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network Not covered

Routine radiology

In-network $50 Copay
Out-of-network 40% after deductible

Routine radiology

N/A

Routine radiology

N/A

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network Not covered

Complex imaging (MRI/PET/CT)

In-network $100 Copay
Out-of-network 40% after deductible

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

N/A

N/A

N/A

N/A

N/A

N/A

Member Coinsurance

N/A

Member Coinsurance

N/A

Member Coinsurance

N/A

Member Coinsurance

In-network: None
Out-of-network: 40% after deductible

Member Coinsurance

N/A

Member Coinsurance

N/A

Urgent Care Center

N/A

Urgent Care Center

N/A

Urgent Care Center

N/A

Urgent Care Center

In-network: $40 copay
Out-of-network: 40% after deductible

Urgent Care Center

N/A

Urgent Care Center

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

Yes.

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

  • Deductible

    The amount of covered expenses you must pay before the Plan starts paying benefits.

    In-network:

    Individual: $750
    Family: $1,500

  • Coinsurance

    Cost-sharing between you and the company. This is applied after you meet your deductible (if applicable).

    In-network:

    You pay 20% (after deductible)
    Plan pays 80%

  • Out-of-Pocket Maximum

    The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.

    In-network:

    Individual: $3,000
    Family: $6,000

    Out-of-network:

    Not covered

  • Doctor’s Office Visit

    In-network:

    You pay $25 copay (after deductible)

    Out-of-network:

    Not covered

  • Specialist Office Visit

    Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).

    In-network:

    You pay $25 copay (after deductible)

    Out-of-network:

    Not covered

  • Preventive/Well Child Care

    Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.

    In-network:

    Plan pays 100% with no deductible

    Out-of-network:

    Not covered

  • Emergency Room

    Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital. If you are at an out-of-network hospital, you will need to be transferred to a network facility.

    In-network:

    You pay 20% Coinsurance

    Out-of-network:

    You pay 20% Coinsurance

  • Urgent Care

    Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.

    In-network:

    You pay $25 copay with no deductible

    Out-of-network:

    Not covered

  • Hospitalization

    In-network: Inpatient

    You pay 20% (after deductible)
    Plan pays 80%

    Out-of-network:

    Not covered

    Outpatient:

    You pay 20% (after deductible)
    Plan pays 80%

  • Are you required to use network providers?

    Yes.

  • Do you need a referral to a specialist?

    Yes.

  • Can I use a Health Care Flexible Spending Account (FSA)?

    An account you contribute to before taxes, then use the money for qualified health-related expenses.

    Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Kaiser HMO Low Option (CA employees only)

Provider: Kaiser

Phone: 800-464-4000

Website: https://healthy.kaiserpermanente.org/washington/front-door

Kaiser HMO Low Option (CA employees only) Meritain HDHP Base Plan Meritain Low EPO Plan Meritain High POS Plan Kaiser HDHP Base Plan (CA employees only) Kaiser HMO High Option (CA employees only)

Deductible

In-network: Individual: $750
Family: $1,500

Deductible

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Not covered

Deductible

In-network: Individual: $750
Family: $1,500

Employer Funding

N/A
Out-of-network: Not covered

Deductible

In-network: Individual: $0
Family: $0

Employer Funding

N/A
Out-of-network: Individual: $2,500

Family: $5,000

Deductible

In-network: Individual: $3,500
Family: $7,000
Out-of-network: Not covered

Deductible

N/A

Coinsurance

In-network: You pay 20% (after deductible)
Plan pays 80%

Coinsurance

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Coinsurance

In-network: 20% (after deductible)
Out-of-network: Not covered

Coinsurance

N/A

Coinsurance

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Coinsurance

In-network: You pay 20%
Plan pays 80%
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $6,000
Family: $12,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $4,000
Family: $8,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Individual: $6,000

Family: $12,000

Out-of-Pocket Maximum

In-network: Individual: $6,000
Family: $12,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $1,500
Family: $3,000
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay $25 copay (after deductible)
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Doctor’s Office Visit

N/A

Doctor’s Office Visit

N/A

Doctor’s Office Visit

In-network: You pay $10 copay after deductible
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay $15 copay
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $25 copay (after deductible)
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $40 copay (after deductible)
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $40 copay
Out-of-network: 40% after deductible

Specialist Office Visit

In-network: You pay $30 copay after deductible
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $15 copay
Out-of-network: Not covered

Preventive/Well Child Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: Not covered

Preventive/Well Child Care

N/A

Preventive/Well Child Care

N/A

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: Not covered

Preventive/Well Child Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Emergency Room

In-network: You pay 20% Coinsurance
Out-of-network: You pay 20% Coinsurance

Emergency Room

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: You pay 20% (after deductible)
Plan pays 80%

Emergency Room

In-network: You pay $100 copay after deductible (copay waived if admitted)
Out-of-network: Not Covered

Emergency Room

In-network: You pay $100 copay (waived if admitted)
Out-of-network: 40% after deductible

Emergency Room

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Emergency Room

In-network: You pay $100 per Visit
Out-of-network: You pay $100 per Visit

Urgent Care

In-network: You pay $25 copay with no deductible
Out-of-network: Not covered

Urgent Care

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Urgent Care

In-network: You pay $40 copay with no deductible
Out-of-network: Not covered

Urgent Care

N/A

Urgent Care

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Urgent Care

In-network: You pay $15 copay per Visit
Out-of-network: You pay $15 copay per Visit

Hospitalization

In-network: Inpatient You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered
Outpatient: You pay 20% (after deductible)
Plan pays 80%

Hospitalization

In-network: Inpatient You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Inpatient Not covered
Outpatient: You pay 20% (after deductible)
Plan pays 80%
Outpatient: Not covered

Hospitalization

In-network: Inpatient 20% (after deductible)
Out-of-network Not covered
Outpatient: 20% (after deductible)

Hospitalization

In-network: Inpatient $150/Per Day 5 Day Max
Out-of-network 40% after deductible
Outpatient Surgical Procedures: You pay $200 copay

Hospitalization

In-network: Inpatient You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Inpatient Not covered
Outpatient: You pay 30% (after deductible)
Plan pays 70%
Outpatient Not covered

Hospitalization

In-network: Inpatient You pay $250 / procedure
Out-of-network: Not covered
Outpatient: You pay $15 / procedure

Are you required to use network providers?

Yes.

Are you required to use network providers?

No (but your costs will be lower when you do)

Are you required to use network providers?

Yes.

Are you required to use network providers?

It is not required but recommended to avoid any balance bills or higher out of pocket costs.

Are you required to use network providers?

Yes.

Are you required to use network providers?

Yes.

Do you need a referral to a specialist?

Yes.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

Yes.

Do you need a referral to a specialist?

Yes.

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

Yes.

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

No, employees enrolled in a HDHP can only participate in a Limited Purpose FSA. A Limited Purpose FSA can only be used for dental and vision expenses.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

No, employees enrolled in a HDHP can only participate in a Limited Purpose FSA. A Limited Purpose FSA can only be used for dental and vision expenses.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

HSA Funding

N/A

HSA Funding

Wedgewood will fund $840 annually to each HSA. The HSA’s will be funded $70 per month. Employees enrolled under a HDHP plan can make pre-tax payroll contributions of up to $4,400 for individual coverage or up to $8,750 for family coverage.

HSA Funding

N/A

HSA Funding

N/A

HSA Funding

Wedgewood will fund $840 annually to each HSA. The HSA’s will be funded $70 per month. Employees enrolled under a HDHP plan can make pre-tax payroll contributions of up to $4,400 for individual coverage or up to $8,750 for family coverage.

HSA Funding

N/A

Preventive Care

N/A

Preventive Care

N/A

Preventive Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Preventive Care

In-network: Plan pays 100%
Out-of-network: 40% after deductible

Preventive Care

N/A

Preventive Care

N/A

Primary Care Office Visit

N/A

Primary Care Office Visit

N/A

Primary Care Office Visit

In-network: You pay $20 copay (after deductible)
Out-of-network: Not covered

Primary Care Office Visit

In-network: You pay $20 copay
Out-of-network: 40% after deductible

Primary Care Office Visit

N/A

Primary Care Office Visit

N/A

Routine radiology

N/A

Routine radiology

N/A

Routine radiology

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network Not covered

Routine radiology

In-network $50 Copay
Out-of-network 40% after deductible

Routine radiology

N/A

Routine radiology

N/A

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network Not covered

Complex imaging (MRI/PET/CT)

In-network $100 Copay
Out-of-network 40% after deductible

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

N/A

N/A

N/A

N/A

N/A

N/A

Member Coinsurance

N/A

Member Coinsurance

N/A

Member Coinsurance

N/A

Member Coinsurance

In-network: None
Out-of-network: 40% after deductible

Member Coinsurance

N/A

Member Coinsurance

N/A

Urgent Care Center

N/A

Urgent Care Center

N/A

Urgent Care Center

N/A

Urgent Care Center

In-network: $40 copay
Out-of-network: 40% after deductible

Urgent Care Center

N/A

Urgent Care Center

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

Yes.

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

  • Coinsurance

    Cost-sharing between you and the company. This is applied after you meet your deductible (if applicable).

    In-network:

    You pay 20%
    Plan pays 80%

    Out-of-network:

    Not covered

  • Out-of-Pocket Maximum

    The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.

    In-network:

    Individual: $1,500
    Family: $3,000

    Out-of-network:

    Not covered

  • Doctor’s Office Visit

    In-network:

    You pay $15 copay

    Out-of-network:

    Not covered

  • Specialist Office Visit

    Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).

    In-network:

    You pay $15 copay

    Out-of-network:

    Not covered

  • Preventive/Well Child Care

    Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.

    In-network:

    Plan pays 100% with no deductible

    Out-of-network:

    Not covered

  • Emergency Room

    Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital. If you are at an out-of-network hospital, you will need to be transferred to a network facility.

    In-network:

    You pay $100 per Visit

    Out-of-network:

    You pay $100 per Visit

  • Urgent Care

    Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.

    In-network:

    You pay $15 copay per Visit

    Out-of-network:

    You pay $15 copay per Visit

  • Hospitalization

    In-network: Inpatient

    You pay $250 / procedure

    Out-of-network:

    Not covered

    Outpatient:

    You pay $15 / procedure

  • Are you required to use network providers?

    Yes.

  • Do you need a referral to a specialist?

    Yes.

  • Can I use a Health Care Flexible Spending Account (FSA)?

    An account you contribute to before taxes, then use the money for qualified health-related expenses.

    Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Kaiser HMO High Option (CA employees only)

Provider: Kaiser

Phone: 800-464-4000

Website: https://healthy.kaiserpermanente.org/washington/front-door

Kaiser HMO High Option (CA employees only) Meritain HDHP Base Plan Meritain Low EPO Plan Meritain High POS Plan Kaiser HDHP Base Plan (CA employees only) Kaiser HMO Low Option (CA employees only)

Deductible

N/A

Deductible

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Not covered

Deductible

In-network: Individual: $750
Family: $1,500

Employer Funding

N/A
Out-of-network: Not covered

Deductible

In-network: Individual: $0
Family: $0

Employer Funding

N/A
Out-of-network: Individual: $2,500

Family: $5,000

Deductible

In-network: Individual: $3,500
Family: $7,000
Out-of-network: Not covered

Deductible

In-network: Individual: $750
Family: $1,500

Coinsurance

In-network: You pay 20%
Plan pays 80%
Out-of-network: Not covered

Coinsurance

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Coinsurance

In-network: 20% (after deductible)
Out-of-network: Not covered

Coinsurance

N/A

Coinsurance

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Coinsurance

In-network: You pay 20% (after deductible)
Plan pays 80%

Out-of-Pocket Maximum

In-network: Individual: $1,500
Family: $3,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $6,000
Family: $12,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $4,000
Family: $8,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Individual: $6,000

Family: $12,000

Out-of-Pocket Maximum

In-network: Individual: $6,000
Family: $12,000
Out-of-network: Not covered

Out-of-Pocket Maximum

In-network: Individual: $3,000
Family: $6,000
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay $15 copay
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Doctor’s Office Visit

N/A

Doctor’s Office Visit

N/A

Doctor’s Office Visit

In-network: You pay $10 copay after deductible
Out-of-network: Not covered

Doctor’s Office Visit

In-network: You pay $25 copay (after deductible)
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $15 copay
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $40 copay (after deductible)
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $40 copay
Out-of-network: 40% after deductible

Specialist Office Visit

In-network: You pay $30 copay after deductible
Out-of-network: Not covered

Specialist Office Visit

In-network: You pay $25 copay (after deductible)
Out-of-network: Not covered

Preventive/Well Child Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: Not covered

Preventive/Well Child Care

N/A

Preventive/Well Child Care

N/A

Preventive/Well Child Care

In-network: You pay $0
Plan pays 100%
Out-of-network: Not covered

Preventive/Well Child Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Emergency Room

In-network: You pay $100 per Visit
Out-of-network: You pay $100 per Visit

Emergency Room

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: You pay 20% (after deductible)
Plan pays 80%

Emergency Room

In-network: You pay $100 copay after deductible (copay waived if admitted)
Out-of-network: Not Covered

Emergency Room

In-network: You pay $100 copay (waived if admitted)
Out-of-network: 40% after deductible

Emergency Room

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Emergency Room

In-network: You pay 20% Coinsurance
Out-of-network: You pay 20% Coinsurance

Urgent Care

In-network: You pay $15 copay per Visit
Out-of-network: You pay $15 copay per Visit

Urgent Care

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered

Urgent Care

In-network: You pay $40 copay with no deductible
Out-of-network: Not covered

Urgent Care

N/A

Urgent Care

In-network: You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Not covered

Urgent Care

In-network: You pay $25 copay with no deductible
Out-of-network: Not covered

Hospitalization

In-network: Inpatient You pay $250 / procedure
Out-of-network: Not covered
Outpatient: You pay $15 / procedure

Hospitalization

In-network: Inpatient You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Inpatient Not covered
Outpatient: You pay 20% (after deductible)
Plan pays 80%
Outpatient: Not covered

Hospitalization

In-network: Inpatient 20% (after deductible)
Out-of-network Not covered
Outpatient: 20% (after deductible)

Hospitalization

In-network: Inpatient $150/Per Day 5 Day Max
Out-of-network 40% after deductible
Outpatient Surgical Procedures: You pay $200 copay

Hospitalization

In-network: Inpatient You pay 30% (after deductible)
Plan pays 70%
Out-of-network: Inpatient Not covered
Outpatient: You pay 30% (after deductible)
Plan pays 70%
Outpatient Not covered

Hospitalization

In-network: Inpatient You pay 20% (after deductible)
Plan pays 80%
Out-of-network: Not covered
Outpatient: You pay 20% (after deductible)
Plan pays 80%

Are you required to use network providers?

Yes.

Are you required to use network providers?

No (but your costs will be lower when you do)

Are you required to use network providers?

Yes.

Are you required to use network providers?

It is not required but recommended to avoid any balance bills or higher out of pocket costs.

Are you required to use network providers?

Yes.

Are you required to use network providers?

Yes.

Do you need a referral to a specialist?

Yes.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

No.

Do you need a referral to a specialist?

Yes.

Do you need a referral to a specialist?

Yes.

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

Yes.

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Savings Account (HSA)?

N/A

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

No, employees enrolled in a HDHP can only participate in a Limited Purpose FSA. A Limited Purpose FSA can only be used for dental and vision expenses.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, for qualified expenses and they may always use for medical, dental, vision and pharmacy.

Can I use a Health Care Flexible Spending Account (FSA)?

No, employees enrolled in a HDHP can only participate in a Limited Purpose FSA. A Limited Purpose FSA can only be used for dental and vision expenses.

Can I use a Health Care Flexible Spending Account (FSA)?

Yes, after you meet your deductible for qualified expenses and they may always use for medical, dental, vision and pharmacy.

HSA Funding

N/A

HSA Funding

Wedgewood will fund $840 annually to each HSA. The HSA’s will be funded $70 per month. Employees enrolled under a HDHP plan can make pre-tax payroll contributions of up to $4,400 for individual coverage or up to $8,750 for family coverage.

HSA Funding

N/A

HSA Funding

N/A

HSA Funding

Wedgewood will fund $840 annually to each HSA. The HSA’s will be funded $70 per month. Employees enrolled under a HDHP plan can make pre-tax payroll contributions of up to $4,400 for individual coverage or up to $8,750 for family coverage.

HSA Funding

N/A

Preventive Care

N/A

Preventive Care

N/A

Preventive Care

In-network: Plan pays 100% with no deductible
Out-of-network: Not covered

Preventive Care

In-network: Plan pays 100%
Out-of-network: 40% after deductible

Preventive Care

N/A

Preventive Care

N/A

Primary Care Office Visit

N/A

Primary Care Office Visit

N/A

Primary Care Office Visit

In-network: You pay $20 copay (after deductible)
Out-of-network: Not covered

Primary Care Office Visit

In-network: You pay $20 copay
Out-of-network: 40% after deductible

Primary Care Office Visit

N/A

Primary Care Office Visit

N/A

Routine radiology

N/A

Routine radiology

N/A

Routine radiology

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network Not covered

Routine radiology

In-network $50 Copay
Out-of-network 40% after deductible

Routine radiology

N/A

Routine radiology

N/A

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

In-network: You pay 20% (after deductible)
Plan pays 80%
Out-of-network Not covered

Complex imaging (MRI/PET/CT)

In-network $100 Copay
Out-of-network 40% after deductible

Complex imaging (MRI/PET/CT)

N/A

Complex imaging (MRI/PET/CT)

N/A

N/A

N/A

N/A

N/A

N/A

Member Coinsurance

N/A

Member Coinsurance

N/A

Member Coinsurance

N/A

Member Coinsurance

In-network: None
Out-of-network: 40% after deductible

Member Coinsurance

N/A

Member Coinsurance

N/A

Urgent Care Center

N/A

Urgent Care Center

N/A

Urgent Care Center

N/A

Urgent Care Center

In-network: $40 copay
Out-of-network: 40% after deductible

Urgent Care Center

N/A

Urgent Care Center

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

Yes.

Can I use a Health Savings Account (HSA) or Health Reimbursement Account (HRA)?

N/A