Retiree Benefit Comparison
2025 Washoe County Retiree Medical Plan Comparison
| Self-Funded PPO Plan | High Deductible PPO Plan | Surest Plan | Medicare Advantage Plan | |
|---|---|---|---|---|
| Deductibles, Out-of-Pocket Maximums, Participating Hospitals | ||||
| Plan Year Deductible (In-Network) | Individual: $375 Family: $750 |
Individual: $2,600 Family: $3,300 |
Not Applicable | Not Applicable |
| Plan Year Deductible (Out-of-Network) | Individual: $1,000 Family: $2,000 |
Individual: $4,500 Family: $5,500 |
None | Not Covered |
| Health Reimbursement Account (Washoe County Contribution) | Not Applicable | Retiree Only: $2,250 *If enrolled after 1/1/2025 prorated |
Not Applicable | 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 |
$2,500 per year |
| Plan Year Out-of-Pocket Max (Out-of-Network) | Individual: $6,675* Family: $13,350* |
Individual: $10,500* Family: $10,750* |
Individual: $8,000 Family: $16,000 |
Not Covered |
| 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 | Not Covered |
| 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 | Not Covered |
| 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 | 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 co-pay | $10 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 co-pay | $25 co-pay |
| Telemedicine Teladoc*, Dr. On Demand** | *$0 – no deductible | *$54 before deductible *$0 after deductible |
**$0 co-pay | *$0 co-pay |
| Preventative Care (In-Network) | 0% – no deductible | 0% – no deductible | $0 co-pay | $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 | $0 co-pay |
| 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 | $20 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 | CT: $40 co-pay MRI & PET: $60 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 | $10 co-pay |
| Chiropractic (In-Network) | Plan pays: 80% after deductible; Limit 25 visits | Plan pays: 80% after deductible; Limit 25 visits | $15 co-pay; Limit 60 visits | $10 co-pay |
| Mental Health & Substance Abuse (Outpatient, In-Network) |
Plan pays: 100% Member pays: $25 co-pay; no deductible |
Plan pays: 100% after deductible Member pays: $0 after deductible |
$10 co-pay | $25 co-pay |
| Weight-Loss Program | $25 co-pay | Plan pays: 100% after deductible | Not Applicable | 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 | $175 per day(s) 1–3 |
| 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 | $175 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 | Not Covered |
| 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 | $125 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 | $10 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 | $225 per trip |
| 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 | $175 per day(s) 1–3 |
| 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 | $20/day (1–20) / $100/day (21–34) |
| 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 | $0 per visit |
| Vision Services | See below | See below | See below | See below |
| Prescription Drugs | ||||
| Generic: $7 co-pay Preferred brand: $30 co-pay Non-preferred brand: $50 co-pay |
Generic: $7 co-pay Preferred brand: $30 co-pay Non-preferred brand: $50 co-pay |
Tier 1: $10 co-pay Tier 2: $35 co-pay Tier 3: $70 co-pay |
Preferred generic: $2 co-pay Non-preferred generic: $8 co-pay Preferred brand: $41 co-pay Non-preferred brand: 50% co-insurance Mail Order: 2 × 30-day supply |
|
| Specialty & Mail Order | ||||
| Specialty | ShaRx Advocacy Program | ShaRx Advocacy Program | $170–$230 | 33% co-insurance |
| 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 | 2.5 × 30-day supply at retail (2 × 30-day at mail order) |
| Rx Maximum | $2,000 individual / $4,000 family | Combined with medical | 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, Orthodontic. Preventative: 100%; Basic: 80%; Major: 50%; Orthodontic: 50%. $3,000 maximum/year; $1,500 lifetime orthodontic. |
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| Vision Services | Vision Services Plan (VSP); Eye Med for Senior Care Plus Members: $10 co-pay exam; basic lenses/contacts every 12 months; $175 frame allowance per 12 months. |
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| Life Insurance | Enrollee: $20,000 (<65), $13,000 (65–69), $7,000 (70+) Covered Dependents: $1,000 |
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