California Medical Coverage Level

Live in California?

Your options will be different, depending on the insurance carrier you choose.

For starters, each insurance carrier in California can elect to offer each coverage level either as an option that offers in- and out-of-network benefits (e.g., a PPO) or an option that offers in-network benefits only (e.g., an HMO).

Also, insurance carriers can choose to offer either the standard Gold option or a Gold II option—not both. The Gold II option offers only in-network benefits.

Review the table below to see which insurance carriers offer out-of-network benefits for the coverage levels you're considering.

Aetna
Cigna
Health Net
Kaiser Permanente
United Healthcare
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Medical Coverage Level

Option type
Paycheck contributions
2025 Annual Deductible
In-network (individual / family)
Out-of-network (individual / family)
Traditional or true family?
2025 Annual Out-of-Pocket Maximum
In-network (individual / family)
Out-of-network (individual / family)
Traditional or true family?
2025 In-Network Benefits
Preventive care
Doctor's office visit
Emergency room
Urgent care
Inpatient care
Outpatient care
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Prescription Drug Coverage

Preventive drugs
30-Day Retail Supply
Tier 1 (generally lowest cost options)
Tier 2 (generally medium cost options)
Tier 3 (generally highest cost options)
90-Day Mail Order Supply
Tier 1 (generally lowest cost options)
Tier 2 (generally medium cost options)
Tier 3 (generally highest cost options)
**Preventive drugs are determined by the insurance carrier or pharmacy benefit manager. You must have a doctor's prescription for the medication—even for products sold over the counter (OTC)—and you must use an in-network retail pharmacy or mail-order service.
These charts may not take into account how each coverage level covers any state-mandated benefits, its plan administration capabilities, or the approval from the state Department of Insurance of the benefits offered by the plan. If you have questions about a specific benefit, contact the insurance carrier for additional information. Individual carriers may offer coverage that differs slightly from the standard coverage reflected here. In the event that there is a discrepancy between this site and the official plan documents, the official plan documents will control.

These charts are a high-level listing of commonly covered benefits across carriers and coverage levels for the Aon Benefit Experience. They are intended to provide you with a snapshot of benefits provided across coverage levels. In general, carriers have agreed to the majority of standardized plan benefits recommended by BenX.

For a more detailed look at these and additional coverages, go to at . It does account for any carrier adjustments to standardized plan benefits. To see summaries when you enroll online, check the boxes next to the options you want to review and click Compare. In order to get the most comprehensive information about any specific coverage, you will need to call the carrier directly.

Note: For additional comparison, you may find Summaries of Benefits and Coverage on at .


Out-of-Area: Your specific options are based on your home zip code. If you live outside the service areas of all the insurance carriers, you can choose an out-of-area option at the Silver coverage level. Aetna will be the insurance carrier.

Choosing a Primary Care Physician: Certain options require you to choose a primary care physician. You may need to designate a primary care physician to coordinate your care if you choose Kaiser Permanente or Health Net as your insurance carrier.

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Do You Take Any Prescription Drugs?

Your prescription drug coverage will be provided through your insurance carrier’s pharmacy benefit manager.

While your coverage level will determine your coverage for prescription drugs, each pharmacy benefit manager has its own rules. You need to make sure you’re comfortable with how your family's medications will be covered. Get the details.

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Questions?

Check out the Frequently Asked Questions (PDF) and the Glossary.

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