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Port of Seattle 2018 Medical Plans:
Comparison of Coverage

NOTE: This page is currently being updated in preparation for 2018 Open Enrollment, which begins Nov. 13, 2017. The 2018 rates and coverages listed here are pending final review. This notice will be removed once final review of the page is complete. The 2017 comparison of coverage is still available through the PDF linked below.

This is a summary of the benefits available under each health care plan's contract. Please see each plan's Benefits Booklet for complete detail. This summary does not include all covered items, limitations, and exclusions.

PDF Version | 2017 Comparison of Coverage PDF

Type of Coverage Kaiser Permanente
Core Plan
Aetna High Deductible Health Plan (HDHP) Aetna Deductible PlanDeductible Plan
Providers You must use Kaiser Permanente Core providers, unless your Kaiser Permanente Core provider refers you outside the network. You must use an Aetna Choice POS II network provider to receive maximum benefits. It is the member’s responsibility to ensure the chosen providers are in this network. If out-of-network providers are used, coverage will be significantly less, balance billing may occur, and in some cases, services will not be covered. You must use an Aetna Choice POS II network provider to receive maximum benefits. It is the member’s responsibility to ensure the chosen providers are in this network. If out-of-network providers are used, coverage will be significantly less, balance billing may occur, and in some cases, services will not be covered.
Alternative Providers May self-refer to an acupuncturist for up to 12 visits/year.  Self-refer to naturopath for up to 3 visits per medical condition per year; additional with approval. Self-refer to nutritionist.  Massage therapy requires pre-authorization. May use acupuncturist, nutritionist, naturopath, massage therapist. May use acupuncturist, nutritionist, naturopath, massage therapist.
Deductible – paid by member and applies to all expenses unless waived. None In-network: $1,400/employee only; $2,800/employee & family per calendar year. 
 
Out of network: $2,100/employee only; $4,200/employee & family per calendar year.
In-network: $400/person; $1,200 family maximum per calendar year.
 
Out-of-network: $600/person; $1,800 family per calendar year.
Copayment – paid by member $35 copay per outpatient visit, plus 20% coinsurance. None, unless specified. None, unless specified.
Coinsurance – paid by member 20% of allowable charges up to the annual out-of-pocket maximum for in-network services. 20% of allowable charges up to the annual out-of-pocket maximum for in-network services. 40% of allowable charges up to the annual out of pocket maximum for out-of-network services. 20% of allowable charges up to the annual out-of-pocket maximum for in-network services. 40% of allowable charges up to the annual out-of-pocket maximum for out-of-network services.
Out of Pocket Maximum
(Stop Loss) – including deductible, coinsurance and copays, if any.  Paid by member.
$1,500 per person ($3,000 family) per calendar year.

In-network: $3,000/employee only ($6,000 employee & family) per calendar year.

Out-of-network: $9,000/employee only; $18,000/employee & family per calendar year.

In-network: $1,800/person ($5,400/family) per calendar year.

Out-of-network: $5,400/person; $16,200/family per calendar year.
Routine Vision Exam, Lenses and Frames Exam:  One exam every 12 months. $35 copay in-network.

Lenses and frames: Covered at 100% up to $150 per 24 months.

Out of network not covered and coinsurance is waived.
Exam: One every 12 months. $30 copay in-network, up to $45 covered out-of-network.

Lenses & Frames: Covered at 100% up to $200 every 12 months, up to $128 every 12 months out-of-network.
Exam: One every 12 months. $30 copay in-network, up to $45 covered out-of-network.

Lenses & Frames: Covered at 100% up to $200 every 12 months, up to $128 every 12 months out-of-network.
Prescription Drugs – at participating retail pharmacies For 30 day supply, $15 copay for generic drugs and $30 copay for preferred brand name drugs. For 30 to 90 day supply, paid at 80% after deductible is met up to out-of-pocket maximum. Deductible waived for certain generic preventative medications (see list). For 30 day supply, $5 copay for generic, $35 copay for preferred brand name, and $50 copay for non-preferred brand name.  30 to 90 day supply can be purchased with 1x, 2x or 3x copay applying.
Prescription Drugs – 90-day supply by mail order $30 copay for a 90-day generic supply and $60 copay for 90-day preferred brand name supply. Paid at 80% after deductible is met up to out-of-pocket maximum. $10 copay for generic, $70 copay for preferred brand name, and $100 copay for non-preferred brand name.
Preventive Services
See Aetna and Kaiser Permanente Core websites for details
Paid at 100% Paid at 100% in-network.
Some out-of-network not covered.
Paid at 100% in-network.
Some out-of-network not covered.
​Telemedicine $35 copay per visit plus 20% coinsurance $40 per visit before deductible is met; then, paid at 80%. When Teladoc provider is used. $40 per visit before deductible is met; then, paid at 80%. When Teladoc provider is used.
X-Ray and Lab Charges Paid at 80% Paid at 80% in network, 60% out-of-network Paid at 80% in network, 60% out-of-network
Hospital Services (inpatient confinements) Paid at 80% Paid at 80% in network, 60% out-of-network Paid at 80% in network, 60% out-of-network
Hospital Services (Outpatient) $50 copay, plus 20% coinsurance Paid at 80% in network, 60% out of network Paid at 80% in network, 60% out of network
Emergency Room $100 copayment per visit (waived if admitted from emergency room), plus 20% coinsurance. Paid at 80% in-network and out-of-network $75 copay (waived if admitted from the emergency room), plus 20% coinsurance in-network and out-of-network
Mental Health Care Outpatient: $35 copay per visit, plus 20% coinsurance.

Inpatient: Paid at 80%.
Outpatient and inpatient: Paid at 80% in-network, 60% out-of-network Outpatient and inpatient: Paid at 80% in-network, 60% out-of-network.
Chemical Dependency Outpatient: $35 copay per visit, plus 20% coinsurance
 
Inpatient: Paid at 80%.
Outpatient and inpatient: Paid at 80% in-network, 60% out-of-network Outpatient and inpatient: Paid at 80% in-network, 60% out-of-network
Rehabilitative Care Benefit limits: 60 outpatient visits and 60 inpatient days per calendar year. 
 
Outpatient: $35 copay per visit, plus 20% coinsurance. 
 
Inpatient: Paid at 80%.
Physical, occupational, speech and massage therapy. Benefit limits: 45 outpatient visits and 30 inpatient days per calendar year. Cardiac & pulmonary rehabilitation: 36 days. 
 
Outpatient and inpatient: Paid at 80% in-network, 60% out-of-network
Physical, occupational, speech and massage therapy. Benefit limits: 45 outpatient visits and 30 inpatient days per calendar year. Cardiac & pulmonary rehabilitation: 36 days. 
 
Outpatient and inpatient: Paid at 80% in-network, 60% out-of-network
Chiropractic Care / Manipulative Therapy Self-refer to a Group Health-designated Specialist for up to 10 visits per year.  $35 copay per visit, plus 20% coinsurance. Additional visits when approved. 12 spinal adjustments per calendar year. Paid at 80% in-network and 60% out-of-network 12 spinal adjustments per calendar year. Paid at 80% in-network and 60% out-of-network
Routine Hearing Exam $35 copay plus 20% coinsurance. 1 exam per calendar year. Paid at 80% in-network, 60% out-of-network 1 exam per calendar year. Paid at 80% in-network, 60% out-of-network
Hearing Hardware Covered up to $1,000 per ear (i.e., $2,000 for both ears), every 36 months. In-network and out-of-network:  Paid at 80% of allowable charges, up to a maximum benefit of $3,000 per enrollee in a period of three (3) consecutive calendar years. In-network and out-of-network: Deductible waived.  Paid at 80% of allowable charges, up to a maximum benefit of $3,000 per enrollee in a period of three (3) consecutive calendar years.