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?
- Stay in-network.
- Get primary care at the DeKalb County Employee Health Center (Anthem members only)
- Ask for generic prescription drugs whenever possible.
- Explore tax-advantaged accounts.
Want some added protection?
Resources
Medical Plan
Anthem
Kaiser Permanente
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)
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.
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. |
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.