New to having coverage? Check out our resource for an overview of plan types: Choosing Your Health Plan.
Changes from 2026:
- For Moda Medical Plans: Garner Health is an optional add-on benefit with Moda medical plans which provides up to $1,000 of reimbursement (individual) or $2,000 reimbursement (family) when members see Garner-identified top providers.
- For Kaiser Medical Plans: Launched in 2026 and continuing in 2027, through Kaiser's Rewards Program, members can earn up to $150 in reimbursement, deposited onto a pre-paid VISA card, by completing health-related activities.
- Looking for the dental comparison chart? Dental Plan Comparison Chart
- Looking for information formatted in our previous pdf style?
- Document2027 Medical Plan Comparison Chart (387.48 KB)
General Care - Medical Plan Comparison
| Plan: | Moda PPO 400 | Moda Major Medical PPO | Kaiser 10/20 | Kaiser Maintenance (Part-time employees only) | ||
|---|---|---|---|---|---|---|
| In-network | Out-of-network | In network | Out-of-network | Services must be provided, prescribed, referred, or authorized. | ||
Annual deductible | $400 per individual; $1,200 per family | Out-of-pocket max includes deductibles, coinsurance & copays, but doesn't include Rx, vision, and hearing. | $1,000 per individual; $2,500 per family | Out-of- pocket max includes deductibles, coinsurance, copays & Rx, but doesn't include vision or hearing. | No deductible | $500 per individual; $1,500 per family |
Annual out- of- pocket maximum | $2,000 per individual; $6,000 per family. | Out-of-pocket max includes deductibles, coinsurance & copays, but doesn't include Rx, vision, and hearing. | $6,150 per individual; $12,300 per family. | Out-of-pocket max includes deductibles, coinsurance, copays & Rx, but doesn't include vision or hearing. | $600 per individual; $1,200 per family. Out of pocket max includes copays; excludes hearing & vision. | $2,000 per individual; $6,000 per family. Out of pocket max includes deductibles and copays; excludes hearing & vision. |
Office visits | Primary: $20 copay, Specialty or Urgent: $40 copay, deductible waived; No copays for chronic condition benefit. | 35% after deductible | 30% after deductible | 50% after deductible | Primary care: $5 copay first 3 visits per year, then $10 copay; Specialty care: $20 copay; Urgent care: $30 copay; Telehealth: $0 | Primary care: $5 copay first 3 visits per year, then $20 copay; Specialty care: 20% after deductible; Urgent care: $20 copay; Telehealth: $0 |
Preventive care services* | No charge | 35% after deductible | No charge | 50% after deductible | No charge | No charge |
Diagnostic lab and x-ray | 15% after deductible | 35% after deductible | 30% after deductible | 50% after deductible | No charge | $10 copay |
*Please note, not all lab work that your doctor may order for you during your routine physical is considered part of the preventive benefits.
Urgent & Emergent Care - Medical Plan Comparison
| Plan: | Moda PPO 400 | Moda Major Medical PPO | Kaiser 10/20 | Kaiser Maintenance (Part-time employees only) | ||
|---|---|---|---|---|---|---|
| In-network | Out-of-network | In network | Out-of-network | Services must be provided, prescribed, referred, or authorized. | ||
Outpatient surgery | 15% after deductible | 35% after deductible | 30% after deductible | 50% after deductible | $25 copay | 20% after deductible |
Hospital inpatient | 15% after deductible | 35% after deductible | 30% after deductible | 50% after deductible | $50 per day copay up to $250 max per admission | 20% after deductible |
Ambulance | 15% after deductible | 30% after deductible | $50 copay | 20% after deductible | ||
Emergency room (copay waived if admitted) | $100 copay; deductible applies - then an additional 15% | $100 copay; deductible applies - then an additional 30% | $50 copay | 20% after deductible | ||
Pharmacy - Medical Plan Comparison
| Plan: | Moda PPO 400 in-network | Moda Major Medical PPO in-network | Kaiser 10/20 | Kaiser Maintenance (Part-time employees only) |
|---|---|---|---|---|
| Annual Deductible | None | $300 per individual | None | None |
| Annual Out-of-Pocket Maximum | $2,000 per individual / $6,000 per family; Rx Deductibles & Out-of-Pocket costs not included in Medical Deductibles or Max Out-of-Pocket | Accrues toward Medical Max Out-of-Pocket | Accrues toward Medical Max Out-of-Pocket | Accrues toward Medical Max Out-of-Pocket |
| Prescription Costs | ||||
| Moda PPO 400* | Value / Low Cost Tier | Tier 1 | Tier 2 | Tier 3 |
| 30-day retail | ≤ $4 | 20% to $50 max per Rx Includes specialty | 50% | |
| 90-day mail order | ≤ $8 | 20% up to $30 max | 20% up to $125 max | |
| Moda Major Medical* | Value / Low Cost Tier | Tier 1 | Tier 2 | Tier 3 |
| 30-day retail | ≤ $4 | 30% after deductible, includes specialty | ||
| 90-day mail order | ≤ $8 | 30% after deductible | ||
| Kaiser 10/20 | Value / Low Cost Tier | Tier 1 | Tier 2 | Tier 3 |
| 30-day retail | ≤ $10 | $10 copay for generic; $20 copay for brand | Same as Tier 2; requires physician approval | |
| 90-day mail order | ≤ $20 | $20 copay for generic; $40 copay for brand | ||
| Kaiser Maintenance | Value / Low Cost Tier | Tier 1 | Tier 2 | Tier 3 |
| 30-day retail | ≤ $15 | $15 copay for generic; $30 copay for brand | Same as Tier 2; requires physician approval | |
| 90-day mail order | ≤ $30 | $30 copay for generic; $60 copay for brand | ||
* Moda Plans - Pharmacy benefits are covered under the Moda ArrayRx Core network. CVS pharmacies are excluded on this plan. You can find in-network pharmacies with the Navitus Pharmacy Search tool.
What is a Tier?
Covered prescription drugs are assigned to 1 of 3 different levels with corresponding copayment or coinsurance amounts. The levels are organized as follows:
- Level or Tier 1: Generic drugs, which could be low-cost preferred generics or general preferred generics
- Level or Tier 2: Brand-name drugs, including preferred and nonpreferred options
- Level or Tier 3: Highest-cost drugs
Behavioral Health Care - Medical Plan Comparison
| Plan: | Moda PPO 400 | Moda Major Medical PPO | Kaiser 10/20 | Kaiser Maintenance (Part-time employees only) | ||
|---|---|---|---|---|---|---|
| In network | Out of network | In network | Out of network | Services must be provided, prescribed, referred, or authorized. | ||
Mental health: residential treatment | 15% after deductible | 35% after deductible | 30% after deductible | 50% after deductible | $50 per day copay up to $250 max per admission | 20% after deductible; $20 copay for day treatment |
Chemical dependency or mental health: outpatient treatment | 15% after deductible | 35% after deductible | 30% after deductible | 50% after deductible | $10 copay | $20 copay |
Chemical dependency: detox or inpatient treatment | 15% after deductible | 35% after deductible | 30% after deductible | 50% after deductible | $50 per day copay up to $250 max per admission | 20% after deductible |
Alternative Care - Medical Plan Comparison
| Plan: | Moda PPO 400 | Moda Major Medical PPO | Kaiser 10/20 | Kaiser Maintenance (Part-time employees only) | ||
|---|---|---|---|---|---|---|
| In network | Out of network | In network | Out of network | Services must be provided, prescribed, referred, or authorized. | ||
Chiropractic, naturopathic & acupuncture office visits | $20 copay nauturopathic, $40 copay others | 35% after deductible | 30% after deductible | 50% after deductible | $15 copay for chiropractic care (limit 20 visits), $15 copay for acupuncture (limit 20 visits), regular copay for naturopathy as a PCP office visit. | $15 copay for chiropractic care (limit 20 visits), $15 copay for acupuncture (limit 20 visits), regular copay for naturopathy as a PCP office visit. |
Spinal manipulation, massage therapy & naturopathic supplies | 50% with deductible waived. Spinal manipulation up to 20 visits. Massage up to 12 visits. | 50% with deductible waived. Spinal manipulation up to 20 visits. Massage up to 12 visits. | $25 copay for massage therapy (limit 12 visits) | $25 copay for massage therapy (limit 12 visits) | ||
Acupuncture | 15% after deductible; 20 visits per year. | 35% after deductible, 20 visits per year. | 30% after deductible, 20 visits per year. | 50% after deductible, 20 visits per year | $15 copay for acupuncture (limit 20 visits) | $15 copay for acupuncture (limit 20 visits) |
Vision Coverage - Medical Plan Comparison
(Vision is bundled with most medical plans and cannot be purchased separately)
| Plan: | Moda PPO 400 (Vision Services Provider - VSP) | Moda Major Medical PPO | Kaiser 10/20 | Kaiser Maintenance (Part-time employees only) | |
|---|---|---|---|---|---|
| In network | Out of network | No Vision Included | Services must be provided, prescribed, referred, or authorized. | ||
| Routine Vision Exam | $0 | $70 allowance | N/A | Adults - $10 co-pay; Children - $0 | $20 co-pay |
| Vision Hardware | Adults - Plan pays up to $200 for frames every 2 yrs; 100% for standard lenses every year Children - Plan pays up to $200 for frames and 100% for lenses every year | N/A | Adults - $150 allowance per 2 calendar yr period for lenses & frames, or contacts Children - no charge | Not covered | |