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Blue Shield Access+ HMO EPO Trio HMO

Anthem Blue Cross Select HMO Traditional HMO

Sharp Performance Plus

UnitedHealthcare SignatureValue Alliance & Harmony

Western Health Advantage HMO

Kaiser Permanente

Health Net

Benefits

Emergency Services Emergency Room Deductible Emergency (copay waived if admitted as an inpatient or for observation as an outpatient) Non-Emergency (copay waived if admitted as an inpatient or for observation as an outpatient)

N/A

N/A

N/A

N/A

N/A

N/A

N/A

$50

$50

$50

$50

$50

$50

$50

$50

$50

$50

$50

$50

$50

$50

Physician Services (including Mental Health and Substance Abuse) Office Visits (copay for each service provided) $15 $15

$15

$15

$15

$15

$15

No Charge

No Charge

No Charge

No Charge

No Charge

No Charge

No Charge

Inpatient Visits

$15

$15

$15

$15

$15

$15

$15

Outpatient Visits

$15

$15

$15

$15

$15

$15

$15

Urgent Care Visits

No Charge

No Charge

No Charge

No Charge

No Charge

No Charge

No Charge

Preventive Services

No Charge

No Charge

No Charge

No Charge

No Charge

No Charge

No Charge

Surgery/Anesthesia

Diagnostic X-ray/Lab

No Charge

No Charge

No Charge

No Charge

No Charge

No Charge

No Charge

2025 Health Benefit Summary | 17

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