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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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