Human Resources

Washoe County Medical Plan Comparison

2025 Washoe County Medical Plan Comparison 

Summary of the group health plans offered through the Health Benefits Program
Self-Funded PPO Plan High Deductible PPO Plan Surest Plan
Deductibles, Out-of-Pocket Maximums, Participating Hospitals

Plan Year Deductibles

(In-Network)

Individual: $375

Family: $750

Individual: $2,600

Family: $3,300

Not Applicable

Plan Year Deductible

(Out-of-Network)

Individual: $1,000

Family: $2,000

Individual: $4,500

Family: $5,500

Not Applicable

Not Applicable

Health Savings Account

(W.C. Contribution)
Not Applicable

Employee Only: $2,250

Employee + One: $2,500

Not Applicable

Plan Year Out of Pocket Max

(In-Network)

Individual: $1,450 medical $2,000 pharmacy

Family: $2,900 medical $4,000 pharmacy

Individual: $5,250

Family: $6,350

Individual: $4,000

Family: $8,000

Plan Year Out of Pocket Max

(Out-of-Network)

*provider may balance bill

 

Individual: $6675*

Family: $13,350*

Individual: $10,500*

Family: $10,750*

Individual: $8,000

Family: $16,000

Co-insurance

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

Plan pays: 80% after deductible

Member pays: 20% after deductible

Not Applicable

Co-insurance

(Out-of-Network)

Plan pays: 60% of U&C after deductible

Member pays: Remaining Balance

Plan pays: 60% of U&C after deductible

Member pays: Remaining Balance

Not Applicable
Participating Hospitals Renown, St. Mary's, Northern Nevada, Sierra Medical Center, & Carson Tahoe Renown, St. Mary's, Northern Nevada, Sierra Medical Center, & Carson Tahoe Renown, St. Mary's, Northern Nevada, Sierra Medical Center, & Carson Tahoe
Office Visits and Professional Services

Primary Care Physician

(In-Network)

Plan pays: 100% after co-pay

Member pays: $25 co-pay; no deductible

Plan pays: 100% after deductible

Member pays: 0% after deductible

$10-$65 to co-pay

Specialist

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

Plan pays: 100% after deductible

Member pays: $0 after deductible

$10-$65 to co-pay

Telemedicine

Teledoc*

Dr. On Demand**

*$0 - no deductible

*$54 before meeting deductible

*$0 after deductible

**$0 co-pay

Preventative Care

(In-Network)
0% - no deductible 0% - no deductible $0 co-pay

Diagnostic Outpatient Lab

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

Plan pays: 80% after deductible

Member pays: 20% after deductible

$0 co-pay

$20-$600 co-pay

Non-Routine/Diagnostic

X-Ray

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

Plan pays: 80% after deductible

Member pays: 20% after deductible

$0 co-pay

Complex Imaging (MRI,CT,PET)

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

Plan pays: 80% after deductible

Member pays: 20% after deductible

$60-$450 co-pay

Physical Therapy

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

Plan pays: 80% after deductible

Member pays: 20% after deductible

$10-$50 co-pay

Chiropractic

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

Limit 25 visits

Plan pays: 80% after deductible

Member pays: 20% after deductible

Limit 25 visits

$15 co-pay

Limit 60 visits

Mental Health & Substance Abuse

(Outpatient)

(In-Network)

 

Plan pays: 100%

Member pays: $25 co-pay; no deductilbe 

 

Plan pays: 100% after deductible

Member pays:0% after deductible

$10 co-pay

Weight-Loss Program

$25 co-pay

Plan pays: 100% after deductible

Not Applicable
Surgical and Hospital Services

Inpatient Hospital

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

Plan pays: 80% after deductible

Member pays: %20 after deductible

$150-$2,500 co-pay

Outpatient Surgery

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

 Plan pays: 80% after deductible

Member pays: 20% after deductible

$20-$2,500 co-pay

Maternity

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

Plan pays: 80% after deductible

Member pays: 20% after deductible

$625-$1,375 co-pay

Emergency Room

(In-Network)

Plan pays: 80% after deductible

Member pays: $75 co-pay + 20% after deductible

 Plan pays: 80% after deductible

Member pays: 20% after deductible

$350 co-pay

Urgent Care

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

Plan pays: 80% after deductible

Member pays: 20% after deductible

$35 co-pay

Ambulance

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

Plan pays: 80% after deductible

Member pays: 20% after deductible

$160 co-pay

Substance Abuse

(In-Patient)

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

Plan pays: 80% after deductible

Member pays: 20% after deductible

$1,600 co-pay

Skilled Nursing Facility

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

Plan pays: 80% after deductible

Member pays: 20% after deductible

$1,200 co-pay

Home Health Care

(In-Network)

Plan pays: 80% after deductible

Member pays: 20% after deductible

Plan pays: 80% after deductible

Member pays: 20% after deductible

$30 co-pay

Vision Services

See below

See below

See below
Prescription Drugs
Deductible Does Not Apply After Deductible Deductible Not Applicable
Generic: $7 co-pay Generic: $7 co-pay Tier 1: $10 co-pay
Preferred brand: $30 co-pay Preferred brand: $30 co-pay Tier 2: $35 co-pay
Non-preferred brand: $50 co-pay Non-preferred brand: $50 co-pay Tier 3: $70 co-pay
Prescription Drugs
Specialty ShaRx Advocacy Program ShaRx Advocacy Program $170-$230
Mail Order Benefit

3 months for 2 co-pays

Mandatory for Maintenance Drugs

3 months for 2 co-pays

Mandatory for Maintenance Drugs

3 months for 2.5 co-pays
Rx Maximum

$2,000 individual

$4,000 family

Combined with Medical Combined with Medical
All Enrollees are covered by the following
Dental Services

Self-funded Dental Plan

$50 Calendar year deductible on Basic, Major, and Orthodontic Services

Preventative -100%, Basic -80%, Major -50%, Orthodontic -50%

$3,000 maximum benefit per calendar year

$1,500 lifetime maximum for Orthodontic

Vision Services

Vision Services Plan (VSP)

$10 co-pay for annual exam

Basic lenses or contacts every 12 months

$175 allowance for frames every 12 months

Life Insurance

Enrollee:

$20,000 when under 65; $13,000 when age 65-69; $7,000 when age 70 and over

Covered Dependent: 

$1,000

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Call 311 to find resources, ask questions, and utilize Washoe County services. Learn More »