4 MEDICAL Medical insurance helps you pay for preventive care, routine health needs, prescriptions, and advanced procedures by cost-sharing with your insurance provider. Hover over the insurance terms below to learn what they mean. Please note: HMO plans are for California Employees Only. Y O U R J O U R N E Y T O HEALTH DEDUCTIBLE Individual: $2,000 | Family: $5,000 If enrolled as Member + Family Coverage, then Deductibles are: Individual: $3,400 | Family: $5,000 Individual: 6,000 Family: $12,000 Individual: $3,000 Family: $6,000 Individual: $3,000 Family: $6,000 Individual: $9,000 Family: $18,000 COINSURANCE 90% 70% 70% 70% 50% OFFICE VISITS Primary Care: 90%* Specialist: 90%* Urgent Care: 90%* Primary Care: 70%* Specialist: 70%* Urgent Care:70%* Primary Care: $30 Copay Specialist: $50 Copay Urgent Care: $30 Copay Primary Care: $30 Copay Specialist: $60 Copay Urgent Care: $30 Copay Primary Care: 50%* Specialist: 50%* Urgent Care: 50%* PROCEDURES Inpatient: 90%* Outpatient: 90%* Emergency Room: 90%* OP Lab & X-ray: 90%* Radiology: 90%* Inpatient: 70%* Outpatient: 70%* Emergency Room: 70%* OP Lab & X-ray: 70%* Radiology: 70%* Inpatient: 70%* Outpatient: 70%* Emergency Room: $250 then 70%* OP Lab & X-ray: $0 Copay Radiology: $125 Copay/Day* Inpatient: $750 Copay/Admin. Outpatient: $500 Copay* Emergency Room: $250 Copay* (Deductible Waived if Admitted) OP Lab & X-ray: $60 Copay* Radiology: $200 Copay/Day* Inpatient: 50%* Outpatient: 50%* Emergency Room: $250 Copay* (Deductible Waived if Admitted) OP Lab & X-ray: 50%* Radiology: 50%* PRESCRIPTIONS Retail: $5*/$15*/$40*/$60* Mail Order: $10*/$30*/$100*/$150* Retail: 30% up to $250 per Rx* Mail Order: Not Covered Rx Deductible (Doesn’t apply to Tier 1a or Tier 1b): $500/Person | $1,500/Family Retail: $5*/$20*/$50*/$75* Mail Order: $10*/$40*/$125*/$188* Retail: $5/$20/$30/$50 Mail Order: $10/$40/$75/$125 Retail: 50% up to $250/Rx* Mail Order: 50% up to $250/Rx* OUT-OF-POCKET MAXIMUM Individual: $4,250 Family: $8,500 Individual: $12,750 Family: $25,500 Individual: $6,400 Family: $12,800 Individual: $8,000 Family: $16,000 Individual: $24,000 Family: $48,000 Anthem HDHP Anthem HMO HRA Anthem PPO *Deductible applies first Review Plan Summaries Anthem HDHP Anthem HMO HRA Anthem PPO In-Network In-Network Only (No Out-of-Network Benefits) In-Network Out-of-Network Out-of-Network Click to View 2026 Anthem Medical Premiums The benefits and rates in this guide are for illustrative purposes only. Please refer to the Summary of Benefits for specific benefits. To the extent the rates or the benefit plan information summa- rized herein differs from the underlying plan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlying insurance documents will govern in all cases. Staff Principals Directors Associates & Managers