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.

Bronze Bronze Plus Silver Gold Gold II Platinum
Aetna

In- and out-of-network

In- and out-of-network

In- and out-of-network

In- and out-of-network

N/A

In- and out-of-network

Anthem Blue Cross and Blue Shield

In- and out-of-network

In- and out-of-network

In- and out-of-network

In- and out-of-network

N/A

In- and out-of-network

Cigna

In- and out-of-network

In- and out-of-network

In- and out-of-network

In- and out-of-network

N/A

In-network only

Health Net

In- and out-of-network

In- and out-of-network

In- and out-of-network

N/A

In-network only

In- and out-of-network

Kaiser Permanente

In-network only

In-network only

In-network only

N/A

In-network only

In-network only

United Healthcare

In- and out-of-network

In- and out-of-network

In- and out-of-network

In- and out-of-network

N/A

In- and out-of-network

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Medical Coverage Level

Bronze Bronze Plus Silver Gold Gold II Platinum
Option type

High-deductible option with HSA

High-deductible option with HSA

PPO

PPO

HMO

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

N / A

$250 / $500

Out-of-network (individual / family)

$4,900 / $9,800

$2,500 / $5,000†◆

$2,000 / $4,000

$1,600 / $3,200

N / A

$5,000 / $10,000

Traditional or true family?

Traditional

True family

Traditional

Traditional

N / A

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

$5,400 / $10,800

$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

N / A

$11,500 / $23,000

Traditional or true family?

Traditional

True family

Traditional

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%

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

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 30% after copay

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 $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 30%

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 30%

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.
†Under Health Net and Kaiser Permanente, these options feature a traditional annual deductible. If you cover dependents under the Bronze Plus coverage level, no covered member pays more than $3,300 toward the family deductible.
‡Under Health Net and Kaiser Permanente, these options feature a traditional annual out-of-pocket maximum.
◆Under Health Net, if you cover dependents under the Bronze Plus coverage level, the family deductible is $4,950.
$ - 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, Gold II 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 Gold II Platinum
Preventive drugs You pay $0** 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 $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 $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 $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 $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 $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 $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.


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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