- Monthly Rates
- Plan Name
- Plan Summary
- Deductible
- Network
- Office Visits
- Co-insurance
- Maximum Out of Pocket
(includes Deductible)
- Preventive coverage
- X-ray and Lab Coverage
- Complex Outpatient Imaging
Subject to Deductible
(MRI, CAT, PET, etc)
- Maternity Coverage
- Rx Coverage
- Vision Coverage
- Lifetime Maximum
- On the Job Coverage
- % of clients choose
HSA
Eligible for HSA Account
Plan Not
Available in
your County
- HSA Qualified
- apply
- (rate)
- HSA HealthPays
- Detailed Info
- $2,750
Individual
- $5,500
Family
- Any Doctor or Hospital
- You pay 20% after deductible
- You pay 20%
- $5,100
Individual
- $10,200
Family
- You pay 20%
$300 max per person
($600 per family)
- You pay 20%
after deductible
- You pay 20%
pre-authorization
required
- No
- Discount Plan at a
Group Health Pharmacy
- No
- $2,000,000
per person
- For subscriber only
- 37%
Catastrophic
High Deductible with Office Visits
covered immediately
Plan Not
Available in
your County
-
- apply
- (rate)
- (rate)
- WiseEssentials Rx
- Detailed Info
- $1,850
- $2,500
- PPO
- *6 per person
covered at 75%
- You pay 25%
- $6,850
- $7,500
- Exam covered
same as office visit,
screenings at 100%
- You pay 25%, covered
Immediately only
on $1,850 plan
- You pay 25%
- No
- $15 co-pay generic drugs, brand name drugs are not covered
- No
- $2,000,000
per person
- For subscriber only
- 26%
Plan Not
Available in
your County
-
- apply
- (rate)
- Evolve Core
- Detailed Info
- $2,500
- PPO
- *4 per person
Covered at 100%
with $35 co-pay
- You pay 30%
- $10,000
- You pay 30%
Unlimited max
- 100% coverage up
to $400*
- You pay 50%
$1,500 annual maximum
- No
- Discount Plan
for formulary drugs
- No
- $2,000,000
per person
- For subscriber/spouse
when exempt from L&I
- 31%
Comprehensive
Includes coverage for Rx, Maternity, Vision and Office Visits
Plan Not
Available in
your County
-
- apply
- (rate)
- (rate)
- WiseChoices Prime
- Detailed Info
- $1,500
- $3,000
- PPO
- Covered at 100%
with $30 co-pay
- You pay 30%
- $8,000
- $9,500
- Exam and screenings
covered at 100%
- You pay 30% after
deductible
- You pay 30%
- Yes
- $10 co-pay generic,
then 30% or 50% for
Brand name drugs
covered to $3,000
Per calendar year (PCY)
- Exam with $30 co-pay
$200 hardware
every 2 years
- $2,000,000
per person
- For subscriber only
- 13%
Plan Not
Available in
your County
-
- apply
- (rate)
- (rate)
- Balance
- Detailed Info
- $1,250
- $1,750
- Any Doctor or Hospital
- You pay 20% after
deductible or $30 co-pay
at Group Health
- 20%
- 30%
- $6,250
- $7,750
- 100% coverage up to
$300 per person
- 20%
- 30%
- after deductible
- 20%
- 30%
- pre-authorization required
- Yes
- $15 co-pay generic,
then 30% or 50% for
Brand name drugs
covered to $3,000
Per calendar year (PCY)
- Exam with $30 co-pay
$200 hardware
every 12 months
- $2,000,000
per person
- For subscriber only
- 8%
Plan Not
Available in
your County
-
- apply
- (rate)
- (rate)
- Evolve Plus
- Detailed Info
- $1,000
- $2,500
- PPO
- *4 per person
covered at 100%
with $25 co-pay
- You pay 20%
- $6,500
- $8,000
- You pay 20%
Unlimited max
- 100% coverage up
to $400*
- You pay 50%
- Yes
- $15 co-pay generic,
$500 Rx deductible for
Preferred brand, then 50%
covered to $2,500 PCY
(3rd tier brand not covered)
- You pay 20% for
Exam and hardware
$150 max per year
- $2,000,000
per person
- For subscriber/spouse
when exempt from L&I
- 3%