Medical Coverage Level

Which Coverage Level Is Best?

You get to choose how much coverage you need and how you want to pay for it. When you choose your coverage level, you get to pick the one with the features you want. If you’re enrolling again, consider what changes you may be facing. Change is constant, so make sure you do your homework before sticking with what you had in the past.

Your coverage level determines how much you pay out of your paycheck (premiums). It also determines how much you pay out of your pocket when you receive care (deductibles, coinsurance, copays).

Don’t let the names of the coverage levels fool you. One option isn’t better than another. The coverage levels are designed to give you choices. It’s up to you to find the one that makes sense for your situation.

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Medical Coverage Level Options

You have several coverage levels to choose from. Each coverage level is available from different insurance carriers at different costs.

When you enroll, you’ll find plenty of tools and resources to help you choose a coverage level.

Bronze Bronze Plus Silver Gold Platinum
Option type High-deductible option with HSA High-deductible option with HSA PPO PPO PPO that offers limited benefits for out-of-network care**
Paycheck contributions $ $ $$ $$$ $$$$
2025 Annual Deductible
In-network (individual / family) $4,900 / $9,800 $2,500 / $5,000 $1,000 / $2,000 $800 / $1,600 $250 / $500
Out-of-network (individual / family) $4,900 / $9,800 $2,500 / $5,000 $2,000 / $4,000 $1,600 / $3,200 $5,000 / $10,000
Traditional or true family? Traditional True family Traditional Traditional Traditional
2025 Annual-Out-of-Pocket-Maximum
In-network (individual / family) $6,400 / $12,800 $4,500 / $9,000 $5,300 / $10,600 $3,600 / $7,200 $2,300 / $4,600
Out-of-network (individual / family) $12,800 / $25,600 $11,500 / $23,000 $10,600 / $21,200 $7,200 / $14,400 $11,500 / $23,000
Traditional or true family? Traditional True family Traditional Traditional Traditional
2025 In-Network Benefits
Preventive care Covered 100%, no deductible Covered 100%, no deductible Covered 100%, no deductible Covered 100%, no deductible Covered 100%, no deductible
Doctor's office visit You pay 25% after deductible You pay 25% after deductible You pay $30 for PCP visit and $50 for specialist visit, no deductible You pay $25 for PCP visit and $40 for specialist visit, no deductible You pay $25 for PCP visit and $40 for specialist visit, no deductible
Emergency room You pay 25% after deductible You pay 25% after deductible You pay $150, then 30% after deductible You pay $150, then 20% after deductible You pay $150, then 15% after deductible
Urgent care You pay 25% after deductible You pay 25% after deductible You pay $50 You pay $40 You pay $25
Inpatient care You pay 25% after deductible You pay 25% after deductible You pay 30% after deductible You pay 20% after deductible You pay 15% after deductible
Outpatient care You pay 25% after deductible You pay 25% after deductible If not an office visit, you pay 30% after deductible If not an office visit, you pay 20% after deductible If not an office visit, you pay 15% after deductible
**For some insurance carriers in CA, CO, DC, GA, MD, OR, VA, and WA, the Platinum coverage level is an HMO option that covers in-network care only.
$ - Bronze and Bronze Plus - lower price per paycheck, but higher costs when you receive care
$$ - Silver - moderate price per paycheck, and moderate costs when you receive care
$$$ / $$$$ - Gold and Platinum - higher price per paycheck with the lowest, most predictable cost when you receive care
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Prescription Drug Coverage

Bronze Bronze Plus Silver Gold Platinum
Preventive drugs You pay $0** You pay $0** You pay $0** You pay $0** You pay $0**
30-Day Retail Supply
Tier 1 (generally lowest cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $12 You pay $10 You pay $8
Tier 2 (generally medium cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $50 You pay $40 You pay $30
Tier 3 (generally highest cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $70 You pay $60 You pay $50
90-Day Mail Order Supply
Tier 1 (generally lowest cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $30 You pay $25 You pay $20
Tier 2 (generally medium cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $125 You pay $100 You pay $75
Tier 3 (generally highest cost options) You pay 100% until you've met the deductible, then you pay 25% You pay 100% until you've met the deductible, then you pay 25% You pay $175 You pay $150 You pay $125
**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 the TKC Benefits Portal at digital.alight.com/mytkcbenefits. 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 the TKC Benefits Portal at digital.alight.com/mytkcbenefits.


California Residents: Your options will be different, depending on the insurance carrier you choose. See what's different.

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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