Medical Coverage

We realize that, for many employees, medical coverage is the most important benefit we offer. To ensure you have a good range of options, we will continue to offer three UMR medical plans for 2023.

In addition to these three medical plans, employees in California will continue to have the Kaiser HMO as a fourth option.

Employees residing in Hawaii are required to be covered under the available HMSA medical PPO Plan. Visit the Hawaii Employee Benefits page of this site to learn more about all the benefits available to residents of Hawaii.

Genesys offers the following medical coverage options to eligible U.S. employees. Click the links below to see the summary of benefits and coverage.

All medical options include prescription drug benefits. You do not need to make a separate prescription drug election.

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Telehealth Benefit

OC24health

Access telehealth services through secure video visits with U.S. board certified doctors any time, day or night. Set up your account and learn more about the services available through OC24health.

Medical and Prescription Drug Options

Provider access available through the UnitedHealthcare Choice Plus® Network, administered by UMR.

Plan Name HDHP 1 HDHP 2 PPO
IN-NETWORK OUT-OF-NETWORK  IN-NETWORK OUT-OF-NETWORK  IN-NETWORK OUT-OF-NETWORK 
Annual Deductible $2,000 individual / $3,000 family $3,000 individual / $6,000 family $3,000 individual / $6,000 family $4,000 individual / $8,000 family $500 individual / $1,000 family $500 individual / $1,000 family
Type of Family Deductible* Aggregate Embedded Embedded
Annual Out-of-Pocket Maximum $4,000 individual / $6,550 family $8,000 individual / $13,000 family $3,500 individual / $7,000 family $8,000 individual / $16,000 family $5,000 individual / $10,000 family $10,000 individual / $20,000 family
Type of Family Out-of-Pocket Maximum Embedded Embedded Embedded
Genesys Annual HSA Contribution** $750 individual*
/ $1,500 family*		 $750 individual*
/ $1,500 family*		 $750 individual*
/ $1,500 family*		 $750 individual*
/ $1,500 family*		 N/A N/A
Preventive Care Covered in full Not covered Covered in full Not covered Covered in full Not covered
Physician Office Visit You pay 20% after deductible You pay 40% after deductible You pay 10% after deductible You pay 30% after deductible $20 copay You pay 50%
Specialist Office Visit You pay 20% after deductible You pay 40% after deductible You pay 10% after deductible You pay 30% after deductible $20 copay You pay 50%
Urgent Care You pay 20% after deductible You pay 40% after deductible You pay 10% after deductible You pay 30% after deductible $50 copay You pay 50%
Emergency Room (copay waived if admitted) You pay 20% after deductible You pay 10% after deductible You pay 30%
Prescription Drug Retail (up to a 30-day supply)
Tier 1 (Generic) You pay 20% after deductible You pay 20% after deductible plus any network cost difference You pay 10% after deductible You pay 10% after deductible plus any network cost difference $8 copay $8 copay plus any network cost difference
Tier 2 (Brand-Preferred) You pay 20% after deductible You pay 20% after deductible plus any network cost difference You pay 10% after deductible You pay 10% after deductible plus any network cost difference $30 copay $30 copay plus any network cost difference
Tier 3 (Brand Non-Preferred) You pay 20% after deductible You pay 20% after deductible plus any network cost difference You pay 10% after deductible You pay 10% after deductible plus any network cost difference $50 copay $50 copay plus any network cost difference
Prescription Drug Mail Order (up to a 90-day supply)
Tier 1 (Generic) You pay 20% after deductible N/A You pay 10% after deductible N/A $20 copay N/A
Tier 2 (Brand-Preferred) You pay 20% after deductible N/A You pay 10% after deductible N/A $75 copay N/A
Tier 3 (Brand Non-Preferred) You pay 20% after deductible N/A You pay 10% after deductible N/A $125 copay N/A

* Learn more about aggregate and embedded deductibles and see how these deductibles work within each plan in the callout box below.

** One fourth of the annual Genesys contribution is deposited in your HSA account each calendar quarter, on or near the first business day of each quarter. Must be employed and enrolled in a High Deductible Health Plan by the 1st day of each calendar quarter (January 1, April 1, July 1 and October 1) in which the funding occurs in order to receive the employer contribution for that quarter.

Click here for machine-readable files (MRFs) listing in-network rates and out-of-network allowed amounts.

Aggregate vs. Embedded Deductible

What’s the difference?
If you’re considering enrolling yourself and your covered dependents in one of the HDHP medical plans, it’s important that you understand how the family deductible works under each of the options. HDHP Plan 1 has an “aggregate” family deductible, while HDHP Plan 2 has an “embedded” plan deductible. Here’s what those terms mean:

Aggregate Family Deductible:
The full family deductible must be met before the plan begins to pay a portion of expenses for any covered family members.

Embedded Plan Deductible:
If one covered family member has enough expenses in a calendar year to meet the individual deductible, the plan will begin paying a portion of that family member’s expenses for the remainder of the year. You do not have to meet the full family deductible before the plan begins to pay.

What is a Deductible?
The amount you need to pay each year before the plan starts paying benefits. For example, if your deductible is $2,000, your plan won’t pay anything until you’ve paid $2,000 for covered healthcare services, unless copays apply.

Click here to see an example scenario of how each plan’s deductible works.

Kaiser HMO Plan

Provider access available through the Kaiser Permanente Network. Available only to employees in California.

Plan Name Kaiser HMO Plan
IN-NETWORK ONLY
Annual Deductible None
Out-of-Pocket Maximum* $1,500 individual / $3,000 family
Genesys Annual HSA Contribution N/A
Primary Care Physician $20 copay
Specialist $20 copay
Preventive Care Covered in full
Urgent Care Physician Services $20 copay
Emergency Room $100 copay **
Chiropractic Office Visit $10 copay
Chiropractic Supports and Appliances Covered up to $50***
Prescription Drug
Tier 1 (Generic) $15 copay for up to 100-day supply
Tier 2 (Preferred Brand) $30 copay for up to 100-day supply
Tier 3 (Non-Preferred Brand) Not covered
Tier 4 (Specialty) $30 copay for up to 30-day supply

* Out-of-Pocket Maximum includes copays except for prescription drug copays.

** $100 copay waived if admitted.

*** If the amount of the appliance in the ASH Plans fee schedule exceeds $50, you will pay the amount in excess of $50. Covered chiropractic appliances are limited to: elbow supports, back supports, cervical collars, cervical pillows, heel lifts, hot or cold packs, lumbar braces and supports, lumbar cushions, orthotics, wrist supports, rib belts, home traction units, ankle braces, knee braces, rib supports, and wrist braces. You can read more about the Kaiser Permanente Chiropractic Benefit here.

Click here for machine-readable files (MRFs) listing in-network rates and out-of-network allowed amounts.

Key Features of Your Medical Plans

  • Preventive care services are covered at 100% with no deductible with in-network providers. An outline of preventive care services is listed in your Summary of Benefits and Coverage (SBC). Select your plan name under Medical Plans on the Resources Page of this site to find the Summary of Benefits and Coverage that corresponds with your plan.
  • Remember, out-of-network claims have a separate deductible to meet and services are covered at a much lower percentage.

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Medical Premiums (per Semi-Monthly Pay Period)

Employee premiums for medical coverage are based on the plan and coverage level you select.

HDHP Plan 1
Employee Only $21.00
Employee + Child(ren) $88.00
Employee + Spouse/Domestic Partner $109.50
Family $160.00
HDHP Plan 2
Employee Only $26.50
Employee + Child(ren) $97.50
Employee + Spouse/Domestic Partner $124.00
Family $171.50
PPO Plan
Employee Only $112.50
Employee + Child(ren) $218.50
Employee + Spouse/Domestic Partner $260.00
Family $366.50
Kaiser HMO
Employee Only $41.00
Employee + Child(ren) $119.00
Employee + Spouse/Domestic Partner $132.50
Family $183.50

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Preventive Care

Your medical benefits provide essential preventive care to keep you and your covered family members healthy. These services are provided at no cost to you and bypass the deductible. Preventive Care refers to a medical service category covered completely by your Genesys benefits when you utilize an in-network provider. Preventive care services are designated by the Affordable Care Act, and include screenings such as annual wellness checkups, preventive mammograms, certain immunizations, and more. For women, certain products are also included on this list such, as breastfeeding supplies, contraceptives, and certain supplements for pregnancy.

How to find an in-network provider:
In order for these services to be covered at 100% by your medical insurance, you must visit an in-network provider. If you need assistance with this process, employees enrolled in one of the HDHP Plans or the PPO Plan can always reach out to your Genesys Care Coordinators by visiting genesyshealthplan.com or by calling 1-877-498-3041. Kaiser HMO plan participants may find a provider by clicking here. Be sure to select your region (northern or southern California). Once done, you can search using a map or enter your zip code to view Kaiser doctors and locations in your area.

Your 2023 Medical ID Cards

All employees who enroll in either a HDHP or the PPO plan will receive a new Medical ID card, even if you do not update your elections. Please be on the lookout to receive this card in the mail by the end of this year.

For more information on your prescription benefits, including details on retail versus mail-order prescriptions as well as a list of prescriptions covered under each plan, please visit the Prescription Drug Plan page of this site.

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More Medical Plan Resources

For more resources, including summaries of benefits coverage please visit the Resources page of this site and look for the Medical Plan drop-down menu.

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