Medical Plans

DeKalb County offers five medical plan options so you can choose a plan that best meets your health care needs.

Similarities Between the Plans

All our medical plan options provide quality coverage, which includes:

  • 100% coverage for preventive care (annual physicals, screenings and immunizations)
  • An out-of-pocket maximum to protect you by limiting the amount you have to pay out-of-pocket during a single year
  • Prescription drug coverage

Differences Between the Plans

There are a few important differences to consider:

  • Who administers the plan: Three plans are administered by Anthem and two are administered by Kaiser.
  • Whether out-of-network coverage is offered: The Blue Open Access HMO and Kaiser Permanente options generally only allow you to receive coverage from an in-network provider. If you want the flexibility of going out-of-network, be sure to choose one of the other options.
  • How prescription drug coverage works: The provider and coverage details will depend on the medical plan you choose. See Prescription Drugs below for details.
  • Out-of-of pocket expenses: Be sure to consider not only the biweekly premiums you’ll pay, but also how much you’ll pay out-of-pocket if you need care.

Quick comparison of key cost features for in-network coverage

The plans highlighted in blue in the chart below generally only allow you to receive coverage from an in-network provider.

Anthem Options Kaiser Permanente Options
Blue Open Access POS Blue Open Access HMO Blue Open Access HSA Kaiser HMO Kaiser HSA
Deductible
Individual / Family
$750 / $1,500 $500 / $1,500 $1,500 / $3,000 $350 / $1,050 $1,800 / $5,400
Out-of-Pocket Maximum $5,500 / $11,000 $7,900 / $15,800 $6,750 / $13,500 $7,900 / $15,800 $6,000 / $12,000
Coinsurance 20% after deductible 10% after deductible 20% after deductible 10% after deductible 30%
Biweekly Premiums $$$$$ $$$$ $$ $$$ $

Looking for easy ways to save?

Want some added protection?

Consider supplemental medical coverage.

Resources

Medical Plan
Anthem

anthem.com 

Kaiser Permanente

my.kp.org/dekalbcounty 

Documents & Tools

Medical Plan Resources 
Summary of Benefits and Coverage 
How an HSA Plan Works 

Prescription drug
CVS Caremark

caremark.com 
Advanced Control Formulary 
Specialty Formulary 

Anthem/CarelonRx
(for Blue Open Access HSA)

anthem.com 
National Drug List 

Note: The Blue Open Access HSA and Kaiser HSA plans both require you to meet the deductible before the plan begins paying ANY benefits except preventive benefits; this means you pay the full cost of non-preventive services and prescription drugs until you meet the deductible. After that you pay a percentage of your costs (referred to as coinsurance). To help cover out-of-pocket expenses in the HSA plans, DeKalb contributes to a special account called a Health Savings Account (HSA).

Biweekly Medical Premiums
Employee Only Employee + 1 Dependent Employee + Family
Anthem Options
Blue Open Access POS $81.06 $209.96 $251.30
Blue Open Access HMO $98.44 $254.96 $305.16
Blue Open Access HSA $30.26 $78.37 $93.79
Kaiser Permanente Options
Kaiser HMO $64.32 $166.65 $199.12
Kaiser HSA $25.38 $65.64 $78.43

Working Spouse Surcharge
If your spouse/domestic partner is employed and eligible for medical coverage through his or her employer and decides to enroll in DeKalb County’s medical coverage, you will be required to pay the $75 per month surcharge. This surcharge allows us to continue to provide the higher-quality and lower-cost plan options to you and your family, while managing our expenses.

Prescription Drug Coverage

Prescription drug coverage is provided automatically when you enroll in one of DeKalb County’s medical plan options. The provider and coverage details will depend on the plan you choose.

View quick comparison of in-network prescription drug coverage.
The plans highlighted in blue in the chart below generally only allow you to receive coverage from an in-network provider. In addition, keep in mind that the Blue Open Access POS doesn’t cover out-of-network prescription drugs.

 

Anthem Options Kaiser Permenante Options
Blue Open Access POS Blue Open Access HMO Blue Open Access HSA Kaiser HMO Kaiser HSA
Provider CVS Caremark CVS Caremark Anthem/CarelonRx Kaiser Kaiser
Retail (30-day supply)
Generic $15 copay $15 copay $10 copay, after deductible $15 copay $15 copay, after deductible
Formulary 30% ($40 min / $100 max) 30% ($40 min / $100 max) $30 copay, after deductible 30% ($40 min / $100 max) 30% ($40 min / $100 max), after deductible
Non-Formulary 40% ($80 min / $120 max) 40% ($80 min / $120 max) $50 copay, after deductible 40% ($80 min / $180 max) 40% ($80 min / $180 max), after deductible
Specialty 30% ($100 max) 30% ($100 max) 30% ($100 max), after deductible Applicable generic, formulary, or non-formulary coinsurance and/or copay will apply. After deductible, applicable generic, formulary, or non-formulary coinsurance and/or copay will apply.
Mail Order (90-day supply)
Generic $30 copay $30 copay $20 copay, after deductible $30 copay $30 copay, after deductible
Formulary 30% ($80 min / $200 max) 30% ($80 min / $200 max) $60 copay, after deductible 30% ($80 min / $200 max) 30% ($80 min / $200 max), after deductible
Non-Formulary 40% ($160 min / $240 max) 40% ($160 min / $240 max) $100 copay, after deductible 40% ($180 min / $360 max) 40% ($180 min / $360 max), after deductible
Specialty Not covered Not covered Not covered Applicable generic, formulary, or non-formulary coinsurance and/or copay will apply. After deductible, applicable generic, formulary, or non-formulary coinsurance and/or copay will apply.

View a detailed comparison 

Biweekly Medical Premiums

Employee Only Employee + 1 Dependent Employee + Family
Anthem Options
Blue Open Access POS $81.06 $209.96 $251.30
Blue Open Access HMO $98.44 $254.96 $305.16
Blue Open Access HSA $30.26 $78.37 $93.79
Kaiser Permanente Options
Kaiser HMO $64.32 $166.65 $199.12
Kaiser HSA $25.38 $65.64 $78.43

Looking for easy ways to save?

  • Stay in-network.
  • Ask for generic prescription drugs whenever possible.
  • Explore tax-advantaged accounts.

Contacts & Resources

Medical Plan
Anthem

anthem.com 

Kaiser Permanente

my.kp.org/dekalbcounty 

Programs and Tools for Medical Plan Members

Visit Resources section 

Prescription drug
CVS Caremark

www.caremark.com 

Anthem/CarelonRx
(for Blue Open Access HSA)

www.anthem.com