Medical Benefits

We offer two plans so you can choose the coverage that is right for you and your family. We're proud to support your well-being and health journey.

What You Pay When You Need Care

Prescription Benefits

Your Costs Per Month

Medical Plan Options

Consumer Choice Plan

High-deductible health plan (HDHP)

Hybrid Plan

Preferred Provider Organization (PPO) plan

Stay In Network for the Greatest Benefits!

If your provider is out of network and they charge more than what the plan covers, you’re responsible for the extra charges. This is called "balance billing." Balance billing does not apply to your out-of-pocket maximum.

Use Rightway to Find an In-Network Provider

Plan Basics

Deductible

Consumer Choice Plan

In-Network

Individual | Family

$1,700 | $3,400

Out-of-Network

Individual | Family

$3,400 | $6,800

Deductible Type

Non-embedded

Hybrid Plan

In-Network

Individual | Family

$1,500 | $3,000

Out-of-Network

Individual | Family

$3,000 | $6,000

Deductible Type

Embedded

Embedded vs. Non-Embedded Deductibles

Coinsurance

Consumer Choice Plan

In-Network

Plan pays 80% | You pay 20%

Out-of-Network

Plan pays 60% | You pay 40%

Hybrid Plan

In-Network

Plan pays 80% | You pay 20%

Out-of-Network

Plan pays 60% | You pay 40%

Out-of-Pocket Maximum

Consumer Choice Plan

In-Network

Individual | Family

$3,000 | $6,000

Out-of-Network

Individual | Family

$6,000 | $12,000

Hybrid Plan

In-Network

Individual | Family

$4,000 | $8,000

Out-of-Network

Individual | Family

$8,000 | $16,000

Eligible for a Health Savings Account?

Consumer Choice Plan

Yes, plus, the county contributes!

Individual | Family

$900 | $1,800

Hybrid Plan

No

What You Pay When You Need Care

The benefits listed are what you pay when you need care.

Preventive Care

Consumer Choice Plan

In-Network

No charge

Out-of-Network

40% after deductible

Hybrid Plan

In-Network

No charge

Out-of-Network

40% after deductible

Telemedicine through CVS Virtual Care

Consumer Choice Plan

In-Network

No charge

Hybrid Plan

In-Network

No charge

Primary Care Visit

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

40% after deductible

Hybrid Plan

In-Network

$30 copay

Out-of-Network

40% after deductible

Specialist Office Visit

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

40% after deductible

Hybrid Plan

In-Network

$50 copay

Out-of-Network

40% after deductible

Urgent Care Visit

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

40% after deductible

Hybrid Plan

In-Network

$75 copay

Out-of-Network

$75 copay

Emergency Room

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

40% after deductible

Hybrid Plan

In-Network

$400 copay

Out-of-Network

$400 copay

Diagnostic Imaging (MRI, CT scan, etc.)

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

40% after deductible

Hybrid Plan

In-Network

$200 copay

Out-of-Network

40% after deductible

Inpatient & Outpatient Services

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

40% after deductible

Hybrid Plan

In-Network

20% after deductible

Out-of-Network

40% after deductible

Vasectomy

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

40% after deductible

Hybrid Plan

In-Network

Charges are based on where the service is performed. You'll pay based on a primary care visit, specialist office visit or outpatient procedure.

Out-of-Network

Charges are based on where the service is performed. You'll pay based on a primary care visit, specialist office visit or outpatient procedure.

Abortion

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

40% after deductible

Hybrid Plan

In-Network

20% after deductible

Out-of-Network

40% after deductible

Female Birth Control

Consumer Choice Plan

In-Network

No charge

Out-of-Network

40% after deductible

Hybrid Plan

In-Network

No charge

Out-of-Network

40% after deductible

Female birth control includes Depo-Provera, diaphragms, IUDs, tubal ligation, and a variety of birth control pills.

What You Pay for Retail Prescriptions

The benefits listed represent in-network coverage for retail prescriptions up to a 30-day supply. The benefits listed are what you pay when you need prescription medication.

Generic

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

Not covered

Hybrid Plan

In-Network

$10 copay

Out-of-Network

Not covered

Preferred Brand

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

Not covered

Hybrid Plan

In-Network

$40 copay

Out-of-Network

Not covered

Non-Preferred Brand

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

Not covered

Hybrid Plan

In-Network

$75 copay

Out-of-Network

Not covered

Specialty

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

Not covered

Hybrid Plan

In-Network

Maximum of $200 if your medication isn't on the PrudentRx list

Out-of-Network

Not covered

What You Pay for Mail-Order Prescriptions

The benefits listed represent in-network coverage for mail-order prescriptions up to a 90-day supply. The benefits listed are what you pay when you need prescription medication.

Generic

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

Not covered

Hybrid Plan

In-Network

$20 copay

Out-of-Network

Not covered

Preferred Brand

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

Not covered

Hybrid Plan

In-Network

$80 copay

Out-of-Network

Not covered

Non-Preferred Brand

Consumer Choice Plan

In-Network

20% after deductible

Out-of-Network

Not covered

Hybrid Plan

In-Network

$150 copay

Out-of-Network

Not covered

Prescription Benefits

Through the Boulder County medical plans, we help with your prescription costs through a variety of ways, including free preventive medications for the Consumer Choice Plan and the PrudentRx list for specialty medications on the Hybrid Plan.

More About Your Prescription Benefits

Your Cost Per Month

Employee

Consumer Choice Plan

$45.89

Hybrid Plan

$81.56

Employee + Spouse/Partner

Consumer Choice Plan

$211.09

Hybrid Plan

$295.42

Employee + Child(ren)

Consumer Choice Plan

$188.60

Hybrid Plan

$265.46

Employee + Family

Consumer Choice Plan

$294.77

Hybrid Plan

$412.57

Earn Rewards for Staying Well

You can earn discounts on medical premiums plus other fun rewards along the way! Spouses and partners enrolled in a Boulder County medical plan can also earn discounts.

More About Boulder County's Wellness Program