Washoe County Medical Plan Comparison
2025 Washoe County Medical Plan Comparison
| 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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