HMO/EPO Medical Plans
As an alternative to the Traditional PPO or Value PPO, you may be eligible to elect medical coverage with a local HMO (CA) or EPO (CT, MA, ME, NH, RI and VT). Generally, HMO participants need to select a PCP to provide or coordinate all care. An HMO does not have a deductible. However, care obtained outside the HMO and EPO network generally is covered only in emergencies, as defined by the plan. For more information visit UnitedHealthcare (UHC) HMO CA, Anthem EPO or Kaiser HMO Northern CA.
If you work in Hawaii, visit the Amgen Benefits Center for information about the HMSA medical plan option.
| United Healthcare HMO California | Anthem EPO New England | Kaiser HMO Northern California | ||||
|---|---|---|---|---|---|---|
| Coverage | In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network |
| Deductible | $0 | $0 | $0 | $0 | $500/staff member only $1,000/family |
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| Out-of-Pocket Maximum | $2,000/staff member only $6,000/family |
$6,250/staff member only $12,500/family |
$3,000/staff member only $6,000/family |
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| Preventive | No charge | Not covered | No charge | Not covered | No charge | Not covered |
| Primary care (including OB/GYN visit) | $25 copay/office visit; no charge virtual visits | Not covered | $25 copay/office visit | Not covered | $20 copay/office visit; no deductible | Not covered |
| Specialist visit | $50 copay/visit | Not covered | $45 copay/visit | Not covered | $20 copay/office visit; no deductible | Not covered |
| Inpatient hospital stay | $500 copay/admit | Not covered | $500 copay/admit | Not covered | 10% coinsurance | Not covered |
| Outpatient surgery | $50 copay/admit | Not covered | $50 copay/visit | Not covered | $20 copay for behavioral health & substance abuse/10% for all other; no deductible | Not covered |
| Emergency room visit | $150 copay/visit | $150 copay/visit | $150 copay/visit | $150 copay/visit | 10% coinsurance | 10% coinsurance |
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| Prescription Drug Copays Retail: Up to a 31-day supply; Mail order: Up to a 90-day supply |
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| Generic | ||||||
| Retail | $15 copay | Not covered | $10 copay | Not covered | $10 copay | Not covered |
| Mail order | $25 copay | Not covered | $25 copay | Not covered | $20 copay | Not covered |
| Preferred brand | ||||||
| Retail | $15 copay | Not covered | $30 copay | Not covered | $30 copay | Not covered |
| Mail order | $25 copay | Not covered | $75 copay | Not covered | $60 copay | Not covered |
| Non-preferred brand | ||||||
| Retail | $15 copay | Not covered | $50 copay | Not covered | $30 copay | Not covered |
| Mail order | $25 copay | Not covered | $125 copay | Not covered | $60 copay | Not covered |
| Specialty drugs | Not applicable | Not covered | Generic: $10 copay retail; $25 copay mail order Brand: $50 copay retail; $125 copay mail order |
20% up to $250; no deductible | Not covered | |