Your 2025 medical, dental and vision plan options
Here are highlights of your 2025 medical (including prescription drugs), dental and vision plan options.
If you need help selecting a medical plan, ask Sara, our virtual guide, during your online enrollment experience. She can help you make the right choice when you enroll online.
If you live in California, you can choose Blue Cross Blue Shield of Arizona or Kaiser Permanente for your medical coverage. Dental and vision plan options are the same, no matter where you live.
Medical annual deductibles
The deductible is what you pay out-of-pocket before your insurance starts paying its share of your costs. It doesn’t include copays or amounts taken out of your paycheck for premiums.
If you have family coverage, the deductible for all three plans works the same. Once a covered family member meets the individual deductible, your insurance will begin paying benefits for that family member. Charges for all covered family members will continue to count toward the family deductible. Once the family deductible is met, your insurance will pay benefits for all covered family members.
| BlueCross Blue Shield (in-network) (available nationwide) |
Kaiser Permanente (in-network only) (available in California) |
|||||
|---|---|---|---|---|---|---|
| VALUE | CORE | PREMIUM | VALUE | CORE | PREMIUM | |
| Deductible Individual |
$2,750 |
$1,250 |
$1,000 |
$2,750 |
$1,250 |
$1,000 |
| Family | $5,500 | $2,500 | $2,000 | $5,500 | $2,500 | $2,000 |
Medical annual out-of-pocket maximum
The out-of-pocket maximum is the most you and your covered family members would have to pay in a year for health care costs.
All plans have a traditional out-of-pocket maximum. Once a covered family member meets the individual out-of-pocket maximum, your insurance will pay the full cost of covered charges for that family member. Charges for all covered family members will continue to count toward the family out-of-pocket maximum. Once the family out-of-pocket maximum is met, your insurance will pay the full cost of covered charges for all covered family members.
| BlueCross Blue Shield (in-network*) (available nationwide) |
Kaiser Permanente (in-network only) (available in California) |
|||||
|---|---|---|---|---|---|---|
| VALUE | CORE | PREMIUM | VALUE | CORE | PREMIUM | |
| Annual out-of-pocket maximum | ||||||
| Individual | $8,000 | $6,000 | $4,000 | $8,000 | $6,000 | $4,000 |
| Family | $16,000 | $12,000 | $8,000 | $16,000 | $12,000 | $8,000 |
Medical in-network benefits
| BlueCross Blue Shield (in-network*) (available nationwide) |
Kaiser Permanente (in-network only) (available in California) |
|||||
|---|---|---|---|---|---|---|
| VALUE | CORE | PREMIUM | VALUE | CORE | PREMIUM | |
| Preventive Care | Covered 100%, no deductible | Covered 100%, no deductible | ||||
| Doctor’s office visit | ||||||
| Primary Care | $50 | $40 | $30 | $50 | $40 | $30 |
| Specialist | $100 | $80 | $60 | $50 | $40 | $30 |
| Telemedicine | $50 | $40 | $30 | $0 | $0 | $0 |
| Emergency care | ||||||
| ER visit | You pay $150 copay+30% after deductible (up to two visits) You pay $500 copay+30% after deductible (three or more visits) |
You pay $150 copay+30% after deductible (up to two visits) You pay $500 copay+30% after deductible (three or more visits) |
You pay $150 copay+20% after deductible (up to two visits) You pay $500 copay+20% after deductible (three or more visits) |
You pay 30% after deductible | You pay 30% after deductible | You pay 25% after deductible |
| Urgent care | $100 copay, no deductible | $80 copay, no deductible | $60 copay, no deductible | $50 copay, no deductible | $40 copay, no deductible | $30 copay, no deductible |
| Inpatient and outpatient care | 30% after deductible | 30% after deductible | 25% after deductible | 30% after deductible | 30% after deductible | 25% after deductible |
*For the Blue Cross Blue Shield of Arizona plans: The Value and Core plans offer out-of-network benefits while the Premium plan offers in-network benefits only.
Which plans cover out-of-network services?
As you consider the right coverage for your needs, you may want to consider which plans cover in-network and out-of-network expenses. Blue Cross Blue Shield of Arizona’s Value and Core plans cover both in-network and out-of-network expenses, while the Premium plan covers in-network expenses only. The Kaiser Permanente plans offered in California do not cover out-of-network charges, with the exception of urgent and emergency care, and you must designate a primary physician to coordinate your care.
Attention Kaiser Permanente members (California only):
- Kaiser Permanente collaborates with Cigna to provide access to urgent care services when traveling outside of areas where Kaiser Permanente provides care. For more information, contact Kaiser Permanente’s travel support at 1-951-268-3900.
- Also, Kaiser Permanente offers 24/7 medical advice by phone or video from a Kaiser Permanente physician.
- Mental health and addiction medicine support is also available. You can book mental health appointments Monday through Friday, 8:00 a.m. to 5:30 p.m. PT by calling:
- Southern CA: 1-833-579-4848
- Northern CA: 1-800-464-4000
- Manage your care online
- Kaiser Permanente offers flexible options for you to receive care beyond the doctor’s office, with most virtual care options available at no cost, and you can manage your care anytime with the Kaiser Permanente app. For an overview, see this flyer, or visit kp.org/getcare. To learn more about Kaiser Permanente’s care options, view benefit information, self-navigate a virtual tour and much more—visit the Kaiser Permanente/Swift online site at select.kp.org/swift (available to members and non-members).
- Get care now
- Talk with a Kaiser Permanente clinician by video or phone for the same high-quality care as an in-person visit.1
- Access 24/7 medical advice by phone or online.
- Email your doctor’s office with non-urgent questions.2
- Virtual Physical Therapy.1
- Managing care3
- Schedule or cancel routine appointments.
- Refill most prescriptions.
- Check your medical records and pay bills.
- View most lab test results.
- Kaiser Permanente offers flexible options for you to receive care beyond the doctor’s office, with most virtual care options available at no cost, and you can manage your care anytime with the Kaiser Permanente app. For an overview, see this flyer, or visit kp.org/getcare. To learn more about Kaiser Permanente’s care options, view benefit information, self-navigate a virtual tour and much more—visit the Kaiser Permanente/Swift online site at select.kp.org/swift (available to members and non-members).
1Where appropriate and available.
2If you travel out of state, phone appointments and video visits may not be available due to state laws that may prevent doctors from providing care across state lines.
3Available when you receive care from Kaiser Permanente facilities.
Prescription drugs
CVS Caremark is our prescription drug provider for all plans offered through Blue Cross Blue Shield of Arizona. CVS Caremark offers you convenience and savings:
- Short-term prescriptions (30-day supply or less) can be filled through any CVS retail stores nationwide, along with other local pharmacies in the CVS Caremark network, including Walgreens and other major retail and supermarket pharmacies.
- Maintenance medications (those taken on an ongoing basis) can be filled through CVS Caremark’s mail service (delivering your prescription to your door) or at a local CVS pharmacy. You choose what is convenient for you.*
- Specialty medications at no cost to you: If you take specialty medications, enroll in the PrudentRx copay program and you’ll pay $0 for any medication on the Specialty Drug List. Call PrudentRx at 1-800-578-4403, Monday through Friday, from 8:00 a.m. to 8:00 p.m. ET to sign up.
Kaiser Permanente provides prescription coverage for their plans.
* Except where prohibited by state laws.
Prescription benefits
| BlueCross Blue Shield (available nationwide) |
Kaiser Permanente (available in California) |
|||||
|---|---|---|---|---|---|---|
| VALUE | CORE | PREMIUM | VALUE | CORE | PREMIUM | |
| Retail: Your Cost | ||||||
| Generic | $15 | $12 | $10 | $15 | $15 | $15 |
| Preferred | 30%; max $85 |
$60 | $50 | 30%; max $75 | $50 | $40 |
| Non-preferred Brand | 30%; max $135 |
$80 | $70 | 30%; max $75 | $50 | $40 |
| Specialty drugs | 30% standard, PrudentRx member cost is $0 | Applicable generic, preferred and non-preferred brand cost shares may apply | ||||
| 90-Day Supply (Mail or Retail): Your Cost | ||||||
| Generic | $40 | $30 | $25 | $30 | $30 | $30 |
| Preferred | 30%; max $215 |
$150 | $125 | 30%; max $75 | $100 | $80 |
| Non-preferred Brand | 30%; max $340 |
$200 | $175 | 30%; max $75 | $100 | $80 |
| Specialty drugs | 30% standard, PrudentRx member cost is $0 | Applicable generic, preferred and non-preferred brand cost shares may apply | ||||
Note: Pharmacy coinsurance is not subject to the medical deductible.
Dental benefits
| Delta Dental | ||||||
|---|---|---|---|---|---|---|
| VALUE | CORE | PREMIUM | ||||
| In-network | Out-of-network1 | In-network | Out-of-network1 | In-network | Out-of-network1 | |
| Reimbursement Preventive (e.g., routine cleanings) |
Plan pays 100% |
Plan pays 100% |
Plan pays 100% |
Plan pays 100% |
Plan pays 100% |
Plan pays 100% |
| Basic (e.g., root canal, gum disease treatment)2 | You pay 20% | You pay 20% | You pay 20% | You pay 20% | You pay 20% | You pay 20% |
| Major (e.g., implants, dentures)2 | Not covered | Not covered | You pay 40% | You pay 40% | You pay 20% | You pay 20% |
| Deductible | Basic services only | Basic and major services | Basic and major services | |||
| Individual | $100 | $100 | $50 | |||
| Family | $300 | $300 | $150 | |||
| Calendar year maximum (applies to preventive, basic and major) | $1,000 | $1,000 | $1,500 | $1,500 | $2,500 | $2,500 |
| Orthodontia3 | Not Covered | Not Covered | You pay 50% | You pay 50% | You pay 50% | You pay 50% |
| Lifetime Maximum | Not Covered | Not Covered | $1,500 | $1,500 | $2,000 | $2,000 |
1May incur higher out-of-pocket costs when seeing a Premier or out-of-network dentist. See “Important Plan Information & Documents” on deltadentalaz.com/swift.
2Deductible applies to these services.
3Core Plan: covered at 50% for dependents up to age 19; Premium Plan: covered at 50% for dependents, with no age limit.
Vision benefits
| VSP | ||||||
|---|---|---|---|---|---|---|
| VALUE—EXAM ONLY PLAN | CORE | PREMIUM | ||||
| In-network | Out-of-network | In-network | Out-of-network | In-network | Out-of-network | |
| Routine exam1 | Covered in full ($0 copay) |
$45 allowance | Covered in full after $20 exam copay | $45 allowance | Covered in full after $10 exam copay | $45 allowance |
| Retinal imaging | Up to $39 | Not covered | Up to $392 | Applied to exam allowance | Up to $392 | Applied to exam allowance |
| Materials/eyewear | N/A | N/A | $20 copay | N/A | $10 copay | N/A |
| Standard corrective lenses | 20% discount available at private locations | Not covered | See below | See below | See below | See below |
| Single vision | $40 | N/A | Covered in full3 | $30 allowance3 | Covered in full3 | $30 allowance3 |
| Lined bifocal | $60 | N/A | $50 allowance3 | $50 allowance3 | ||
| Lined trifocal | $75 | N/A | $65 allowance3 | $65 allowance3 | ||
| Lenticular | $75 | N/A | $100 allowance3 | $100 allowance3 | ||
| Contacts (instead of glasses) | 15% savings on contact lens professional fees; no discount or coverage for materials | N/A |
|
Up to $105 allowance, including contact lens professional fees |
|
Up to $105 allowance, including contact lens professional fees |
1Comprehensive exam of visual functions and prescription of corrective eyewear.
2Includes 15% discount.
3Subject to copay, if any.
Save on eyewear and so much more!
As a VSP member, you can access Exclusive Member Extras, totaling more than $3,000 in savings. You’ll also save on contacts, glasses and sunglasses when you use your benefits on eyeconic.com®—the VSP preferred online retailer—at eyeconic.com.