Medical

Medical coverage offers healthcare protection for you and your family. You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.

Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers. The key difference between the plans is the amount of money you’ll pay each pay period and when you need care.

    Each plan has different:

    • Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
    • Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
    • Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
    • Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.

    Premera CDHP + HSA

    Plan Information

    Plan Name: Premera CDHP + HSA

    Policy Number: 4002747

    Effective Date: 01/01/2025

    Provider Network: Premera

    In-Network Benefit Highlights

    Deductible (Individual/Family)
    $XX/$XX

    Out-of-Pocket Max (Individual/Family)
    $XX/$XX

    Preventive Care
    $XX

    Primary Care Visit
    $XX

    Specialist Visit
    $XX

    Urgent Care
    $XX

    Emergency Room
    $XX

    Benefit Highlights

    In-Network
    Out-of-Network
    Deductible (Individual/Family) Deductible (Individual/Family)
    $1,650/$3,300 $3,300/$6,600
    Out-of-Pocket Max (Individual/Family) Out-of-Pocket Max (Individual/Family)
    $3,300/$6,600 $6,600/$13,200
    Preventive Care Preventive Care
    Plan pays 100% Plan pays 60% after deductible
    Emergency Room Emergency Room
    Plan pays 80% after deductible Plan pays 80% after deductible
    Office Visit Office Visit
    Plan pays 80% after deductible Plan pays 80% after deductible
    Retail Rx (Up to 30-Day Supply)
    Retail Rx (Up to 30-Day Supply)
    Generic Generic
    $10 copay after deductible Plan pays 60% after deductible
    Preferred Brand Preferred Brand
    $30 copay after deductible Plan pays 60% after deductible
    Non-Preferred Brand Non-Preferred Brand
    30% after deductible Plan pays 60% after deductible
    Specialty Specialty
    $50 copay after deductible Plan pays 60% after deductible
    Mail-Order Rx (Up to 90-Day Supply)
    Mail-Order Rx (Up to 90-Day Supply)
    Generic Generic
    2x retail copay Not covered
    Preferred Brand Preferred Brand
    2x retail copay Not covered
    Non-Preferred Brand Non-Preferred Brand
    2x retail copay Not covered
    Specialty Specialty
    2x retail copay
    		 Not covered

    Plan Documents

    2025 Premera CDHP + HSA Summary of Benefits & Coverage

    Contact Information

    (844) 236-1842

    premera.com

    Premera CDHP + HRA

    Plan Information

    Plan Name: Premera CDHP + HRA

    Policy Number: 4002747

    Effective Date: 01/01/2025

    Provider Network: Premera

    In-Network Benefit Highlights

    Deductible (Individual/Family)
    $XX/$XX

    Out-of-Pocket Max (Individual/Family)
    $XX/$XX

    Preventive Care
    $XX

    Primary Care Visit
    $XX

    Specialist Visit
    $XX

    Urgent Care
    $XX

    Emergency Room
    $XX

    Benefit Highlights

     
    In-Network
    Out-of-Network
    Deductible (Individual/Family) Deductible (Individual/Family)
    $2,000/$4,000 $4,000/$8,6000
    Out-of-Pocket Max (Individual/Family) Out-of-Pocket Max (Individual/Family)
    $3,300/$6,600 $6,600/$13,200
    Preventive Care Preventive Care
    Plan pays 100% Plan pays 60% after deductible
    Emergency Room Emergency Room
    Plan pays 80% after deductible Plan pays 80% after deductible
    Office Visit Office Visit
    Plan pays 80% after deductible Plan pays 60% after deductible
     
    Retail Rx (Up to 30-Day Supply)
    Retail Rx (Up to 30-Day Supply)
    Generic Generic
    $10 copay after deductible Plan pays 60% after deductible
    Preferred Brand Preferred Brand
    $30 copay after deductible Plan pays 60% after deductible
    Non-Preferred Brand Non-Preferred Brand
    30% after deductible Plan pays 60% after deductible
    Specialty Specialty
    $50 copay after deductible Plan pays 60% after deductible
    Mail-Order Rx (Up to 90-Day Supply)
    Mail-Order Rx (Up to 90-Day Supply)
    Generic Generic
    2x retail copay Not covered
    Preferred Brand Preferred Brand
    2x retail copay Not covered
    Non-Preferred Brand Non-Preferred Brand
    2x retail copay Not covered
    Specialty Specialty
    2x retail copay Not covered

    Plan Documents

    2025 Premera CDHP + HRA Summary of Benefits & Coverage

    Contact Information

    (844) 236-1842

    premera.com

    Premera High Deductible Basic

    Plan Information

    Plan Name: Premera High Deductible Basic

    Policy Number: 4002747

    Effective Date: 01/01/2025

    Provider Network: Premera

    In-Network Benefit Highlights

    Deductible (Individual/Family)
    $XX/$XX

    Out-of-Pocket Max (Individual/Family)
    $XX/$XX

    Preventive Care
    $XX

    Primary Care Visit
    $XX

    Specialist Visit
    $XX

    Urgent Care
    $XX

    Emergency Room
    $XX

    Benefit Highlights

    In-Network
    Out-of-Network
    Deductible (Individual/Family) Deductible (Individual/Family)
    $5,000/$10,000 $5,000/$10,000
    Out-of-Pocket Max (Individual/Family) Out-of-Pocket Max (Individual/Family)
    $6,000/$12,000 $6,000/$12,000
    Preventive Care Preventive Care
    Plan pays 100% Plan pays 50% after deductible
    Emergency Room Emergency Room
    Plan pays 80% after deductible Plan pays 80% after deductible
    Office Visit Office Visit
    Plan pays 70% after deductible Plan pays 50% after deductible
    Retail Rx (Up to 30-Day Supply)
    Retail Rx (Up to 30-Day Supply)
    Generic Generic
    $10 copay after deductible Plan pays 60% after deductible
    Preferred Brand Preferred Brand
    $30 copay after deductible Plan pays 60% after deductible
    Non-Preferred Brand Non-Preferred Brand
    30% after deductible Plan pays 60% after deductible
    Specialty Specialty
    $50 copay after deductible Plan pays 60% after deductible
    Mail-Order Rx (Up to 90-Day Supply)
    Mail-Order Rx (Up to 90-Day Supply)
    Generic Generic
    2x retail copay Not covered
    Preferred Brand Preferred Brand
    2x retail copay Not covered
    Non-Preferred Brand Non-Preferred Brand
    2x retail copay Not covered
    Specialty Specialty
    2x retail copay
    		 Not covered

    Plan Documents

    2025 Premera High Deductible Basic Summary of Benefits & Coverage

    Contact Information

    (844) 236-1842

    premera.com

    BCBS Global Expat PPO

    Plan Information

    Plan Name: BCBS Global Expat PPO

    Policy Number: 4EL-7687-25

    Effective Date: 01/01/2025

    Provider Network: Blue Cross Blue Shield

    In-Network Benefit Highlights

    Deductible (Individual/Family)
    $XX/$XX

    Out-of-Pocket Max (Individual/Family)
    $XX/$XX

    Preventive Care
    $XX

    Primary Care Visit
    $XX

    Specialist Visit
    $XX

    Urgent Care
    $XX

    Emergency Room
    $XX

    Medical Benefit Highlights

     
    Outside the U.S.
    In-Network
    Out-of-Network
    Deductible (Individual/Family) Deductible (Individual/Family) Deductible (Individual/Family)
    $0/$0 $0/$0 $1,000/$2,500
    Out-of-Pocket Max (Individual/Family) Out-of-Pocket Max (Individual/Family) Out-of-Pocket Max (Individual/Family)
    $0/$0 $2,000/$5,000 $2,000/$5,000
    Preventive Care Preventive Care Preventive Care
    Plan pays 100% Plan pays 100% Plan pays 60%
    Emergency Room Emergency Room Emergency Room
    Plan pays 100% Plan pays 80% after deductible Plan pays 60% after deductible
    Office Visit Office Visit Office Visit
    Plan pays 100% $30 copay after deductible Plan pays 60%
     
    Retail Rx (Up to 30-Day Supply)
    Retail Rx (Up to 30-Day Supply)
    Retail Rx (Up to 30-Day Supply)
    Generic Generic Generic
    $10 copay after deductible $10 copay after deductible $10 copay after deductible
    Preferred Brand Preferred Brand Preferred Brand
    $10 copay after deductible $25 copay after deductible $25 copay after deductible
    Non-Preferred Brand Non-Preferred Brand Non-Preferred Brand
    $10 copay after deductible 30% copay after deductible; $150 maximum 30% copay after deductible; $150 maximum
    Specialty Specialty Specialty
    N/A N/A N/A
    Mail-Order Rx (Up to 90-Day Supply)
    Mail-Order Rx (Up to 90-Day Supply)
    Mail-Order Rx (Up to 90-Day Supply)
    Generic Generic Generic
    $30 copay after deductible $30 copay after deductible Not covered
    Preferred Brand Preferred Brand Preferred Brand
    $30 copay after deductible $75 copay after deductible Not covered
    Non-Preferred Brand Non-Preferred Brand Non-Preferred Brand
    $30 copay after deductible 30% copay after deductible; $450 maximum Not covered
    Specialty Specialty Specialty
    N/A N/A N/A

    Plan Documents

    2025 BCBS Global Expat PPO Member Guide

    2025 BCBS Global Expat PPO Summary of Benefits & Coverage

    Contact Information

    U.S.: (888) 412-6403

    Outside the U.S.: (610) 254-5830

    geo-blue.com

    HMSA

    Plan Information

    Plan Name: HMSA

    Policy Number: UIC

    Effective Date: 07/01/2025

    Provider Network: Hawaii Medical Service Association

    In-Network Benefit Highlights

    Deductible (Individual/Family)
    $XX/$XX

    Out-of-Pocket Max (Individual/Family)
    $XX/$XX

    Preventive Care
    $XX

    Primary Care Visit
    $XX

    Specialist Visit
    $XX

    Urgent Care
    $XX

    Emergency Room
    $XX

    Comprehensive Benefit Highlights

     
    In-Network
    Out-of-Network
    Deductible (Individual/Family) Deductible (Individual/Family)
    $0 $0
    Out-of-Pocket Max (Individual/Family) Out-of-Pocket Max (Individual/Family)
    $2,500/$7,500 (medical plan) $3,600/$4,200 (prescription drugs)  
    Preventive Care Preventive Care
    $0 $0
    Emergency Room Emergency Room
     20% coinsurance 20% coinsurance
    Office Visit Office Visit
    $14 copay 20% coinsurance
     
    Retail Rx (Up to 30-Day Supply)
    Retail Rx (Up to 30-Day Supply)
    Tier 1 Tier 1
    $7 copay $7 copay and 20% coinsurance
    Tier 2 Tier 2
    $30 copay $30 copay and 20% coinsurance
    Tier 3 Tier 3
    $30 copay $30 copay and 20% coinsurance
    Tier 4 Tier 4
    $100 copay Not Covered
    Tier 5 Tier 5
    $200 copay Not Covered
    Mail-Order Rx (Up to 90-Day Supply)
    Mail-Order Rx (Up to 90-Day Supply)
    Tier 1 Tier 1
    $11 copay Not covered
    Tier 2 Tier 2
    $65 copay Not covered
    Tier 3 Tier 3
    $65 copay Not covered
    Tier 4 & 5 Tier 4 & 5
    Not Covered Not covered

    HPH Benefit Highlights

     
    In-Network
    Out-of-Network
    Deductible (Individual/Family) Deductible (Individual/Family)
    $0 N/A
    Out-of-Pocket Max (Individual/Family) Out-of-Pocket Max (Individual/Family)
    $2,500/$7,500 (medical plan) $3,600/$4,200 (prescription drugs) N/A
    Preventive Care Preventive Care
    $0 copay Not Covered
    Emergency Room Emergency Room
    $100 copay $100 copay
    Office Visit Office Visit
    $20 copay Not Covered
     
    Retail Rx (Up to 30-Day Supply)
    Retail Rx (Up to 30-Day Supply)
    Tier 1 Tier 1
    $7 copay $7 copay and 20% coinsurance
    Tier 2 Tier 2
    $30 copay $30 copay and 20% coinsurance
    Tier 3 Tier 3
    $30 copay $30 copay and 20% coinsurance
    Tier 4 Tier 4
    $100 copay Not Covered
    Tier 5 Tier 5
    $200 copay Not Covered
    Mail-Order Rx (Up to 90-Day Supply)
    Mail-Order Rx (Up to 90-Day Supply)
    Tier 1 Tier 1
    $11 copay Not covered
    Tier 2 Tier 2
    $65 copay Not covered
    Tier 3 Tier 3
    $65 copay Not covered
    Tier 4 & 5 Tier 4 & 5
    Not Covered Not covered

    PPP Benefit Highlights

     
    In-Network
    Out-of-Network
    Deductible (Individual/Family) Deductible (Individual/Family)
    $0 $100/$300
    Out-of-Pocket Max (Individual/Family) Out-of-Pocket Max (Individual/Family)
    $2,500/$7,500 (medical plan) $3,600/$4,200 (prescription drugs)  
    Preventive Care Preventive Care
    $0 copay 30% coinsurance; deductible does not apply.
    Emergency Room Emergency Room
    $12 copay $12 copay; deductible does not apply.
    Office Visit Office Visit
    $12 copay 30% coinsurance
     
    Retail Rx (Up to 30-Day Supply)
    Retail Rx (Up to 30-Day Supply)
    Tier 1 Tier 1
    $7 copay $7 copay and 20% coinsurance
    Tier 2 Tier 2
    $30 copay $30 copay and 20% coinsurance
    Tier 3 Tier 3
    $30 copay $30 copay and 20% coinsurance
    Tier 4 Tier 4
    $100 copay Not Covered
    Tier 5 Tier 5
    $200 copay Not Covered
    Mail-Order Rx (Up to 90-Day Supply)
    Mail-Order Rx (Up to 90-Day Supply)
    Tier 1 Tier 1
    $11 copay Not covered
    Tier 2 Tier 2
    $65 copay Not covered
    Tier 3 Tier 3
    $65 copay Not covered
    Tier 4 & 5 Tier 4 & 5
    Not Covered Not covered

    Plan Documents

    2025 BCBS CompMed Summary of Benefits & Coverage

    2025 BCBS CompMed Member Guide

    2025 BCBS HPH Summary of Benefits & Coverage

    2025 BCBS HPH Member Guide

    2025 BCBS PPP Summary of Benefits & Coverage

    2025 BCBS PPP Member Guide

    Contact Information

     

    bcbs.com