Benefits Guide 2025

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SUMMARY OF BENEFITS - COMPARISON CHART

KAISER

KERN LEGACY

KERN LEGACY

MAXCHOICE

CLASSIC CHOICE

PERMANENTE

1-800-464-4000

1-855-537-6767

1-855-537-6767

Exclusive Provider Organization

In-Network

HMO Plan

Out-of-Network

Member (some services require

Anthem Blue Cross Provider

Kaiser Permanente Providers

Anthem Blue Cross Provider

prior authorization)

$200 member

$250 member

$0

$0

$500 family

$400 family (2 mbrs)

Medical:

Medical:

Medical:

Combined

$5,000/member; $10,000/ family

$1,000/member; $3,000/family

$2,000/ member; $4,000/ family

Medical/Pharmacy:

Pharmacy:

Pharmacy:

Pharmacy:

$1,500/member; $3,000/ family

$5,600/member; $10,200/family

$1,000/member; $3,000/ family

$5,600/member; $10,200/family

$10 copay

$10 cooav 1

$15 cooav

70% coverage R&C 1

20% coinsurance 1

70% coverage R&C 1

$25 copay

$10 copay

$20 copay Kern Medical 1

$10 copay

$15 copay

$10 copay 1

70% coverage R&C 1

$0copay

70% coverage R&C 1

$0 copay (deductible waived)

$0 copay

$0 copay

Not Covered

$0 copay (deductible waived)

$0copay

$0 copay Kern Medical

$10 copay

20% coinsurance 1

70% coverage R&C1

$50 copay Kern Medical 1

$100 copay

per procedure

20% coinsurance 1

$0 copay Kern Medical

$250 copay

$100 copay/day at Kern Medical (up to $2500 per admission) 1

70% coverage R&C 1

$150 copay/day, up to $750

per admission

$150 copay' (waived if admitted)

$75 copay (waived if admitted)

$75 copay (waived if admitted)

$10 copay

$15 copay 1

$15 copay

70% coverage R&C 1

$0 copay

Not Covered

$0 copay (deductible waived)

$0copay

$0 copay

$0 copay (deductible waived)

70% coverage R&C 1

$0copay

$0copay 1

$0copay

70% coverage R&C 1

$0 copay

$0copay

70% coverage R&C 1

$0 copay

20% coinsurance 1

20% coinsurance 1

$0copay

70% coverage R&C 1

$10 copay

(max. 60 visits/year combined)

(max. 60 visits/year combined)

(max 60 visits/year combined)

After $100 prescription deductible:

Up to a 100 day supply

CVS Pharmacies or WellDyne Mail Order

CVS Pharmacies or WellDyne Mail Order

Kaiser pharmacy:

$5 Generic $15 Brand

(up to 90 days):

(up to 90 days).

$0 Generic / $15 Preferred Name brand

$0 Generic; $25 Preferred Brand; $50 Non-Preferred Brand 5

$30 Non-Preferred Name brand 5

Retail Pharmacy (Up to 30 days) $5 Generic; $50 Preferred Brand;

Retail Pharmacy (Up to 30 day) $5 Generic; $15 Preferred Brand;

Up to a 100 day:

$5 Generic

$90 Non-Preferred Brand 5

$30 Non-Preferred Brand 5

$15 Brand

Specialty Medications:

$50/$90/$120

This is a summary of the most frequently asked-about benefits. This chart does not explain benefits, out of pocket maximums, exclusion or limitations, nor does it list all benefits. For a complete explanation, please refer to the County of Kern Plan Documentdescribing the Kern Legacy Health Plans. 9 - KERN MEDICAL - BENEFITS SUMMARY