Choosing the right plan supports both your physical health and your financial well-being. Use the resources below to help pick the medical plan option that best fits your needs.

 

Overview

Caring for you and your family is one of our most important priorities, which is why we've designed our benefits to support your total well-being. This includes providing comprehensive medical plans that offer flexibility and choice for all our associates. Learn more about which medical plan option may be right for you using these interactive guides.

Consumer-Driven Health Plan (CDHP) + Health Savings Account (HSA)
Preferred Provider Organizations (PPO) + Optional Health Care Flexible Spending Account (Health Care FSA)

Keep in mind:

  • You are automatically enrolled in an HSA when you enroll in the CDHP.
  • You are eligible to enroll in a Health Care FSA if you are enrolled in a PPO medical plan OR if you are not enrolled in a Capital One medical plan.
Compare your options with the Medical Plan Selector Tool

Marital status, dependents, health conditions: many factors go into deciding what’s the best medical plan for you. Take time to review your family’s medical history and the coverage you may need this upcoming year.

Then, use the Medical Plan Selector Tool to evaluate which plan is right for you and your family.

 

Side-by-side Medical Plan Comparison

As you compare the available plan options, it’s important to note the key distinctions between them. Note that the per paycheck cost of the Basic PPO and the CDHP are the same. Check out Cost of Coverage for more details.

Start with the basics

Here’s a quick explanation of some common terms you’ll see as you learn more about your Capital One medical plan options.

Deductible

the amount you pay in health care expenses before the plan starts paying a portion of your costs

Coinsurance

after you meet the deductible, coinsurance begins – this is the percentage of the cost you pay, and the plan pays the rest

Co-pay (PPOs only)

the flat fee you pay for doctor’s office visits and prescriptions; co-pays do not count towards your deductible

In-network/Out-of-network

you can see any doctor you want, but you’ll pay less if you go to providers who have agreed to be in your plan’s network

Out-of-Pocket Maximum

the most you’ll have to pay for health care in a year; if you reach this amount, the plan pays 100% of in-network costs for the remainder of the calendar year

Contributions

what you pay from your paycheck to have coverage; often called “premiums”

How the deductible works
Basic and Enhanced PPOsCDHP
  • Lower Deductibles: The deductible only applies to certain medical expenses and is lower compared to the CDHP.
  • Which Services Don’t Apply to the Deductible: Co-pays for office visits and prescription drugs are not subject to the deductible.
  • When You Cover Dependents: If you cover any dependents, the plan will begin to pay benefits for an individual once that individual’s deductible has been met. No individual is responsible for anything greater than the individual deductible.
  • Higher Deductible: The deductible applies to both medical and prescription drug expenses. The deductible is higher compared to the PPOs.
  • New Family Deductible: If you cover any dependents, the full family deductible must be met before the plan will begin to pay benefits for any one person. The individual deductible will only apply if you enroll in associate-only coverage.
How the out-of-pocket maximum works
Basic and Enhanced PPOsCDHP
  • Individual Out-of-pocket Maximum: If you cover any dependents, each person is only subject to their own individual out-of-pocket maximum and the plan will cover expenses for that one person's expenses at 100% for the remainder of the calendar year once the maximum is met. If multiple family members have expenses, all of the members' expenses accumulate towards the family out-of-pocket maximum. Once the family OOP max is met, the plan will pay 100% for all family members.
  • It is possible for the Family OOP max to be reached without any one person reaching the Individual OOP Max, but one person alone cannot reach the Family OOP max by themselves.
  • Full Family Out-of-pocket Maximum: If you cover any dependents, the full family out-of-pocket maximum must be met before the plan will begin to pay benefits at 100% for the remainder of the calendar year. One person or a combination of family members can satisfy the full amount. The individual out-of-pocket maximum will only apply if you enroll in associate-only coverage.

Side-by-side medical plan comparison chart

Here’s an overview of how your costs compare in the three medical plans for medical and prescription drug expenses.

CDHP Basic PPO Enhanced PPO
In-Network Out-Network In-Network Out-Network In-Network Out-Network
Annual Deductible (individual / family) $2,000 / $3,000 $4,000 / $6,000 $1,000 / $2,000 $3,000 / $6,000 $500 / $1,000 $1,500 / $3,000
Annual Out-of-Pocket Maximum (individual / family) $3,400 / $6,400 $6,800 / $12,800 $4,000 / $8,000 $10,000 / $20,000 $3,000 / $6,000 $6,000 / $12,000
Coinsurance 20% 40% 30% 50% 20% 40%
Preventive Care (Covered at 100%) No charge No charge No charge No charge No charge No charge
Office Visits (Primary Care) You pay 20% after deductible You pay 40% after deductible No charge You pay 50% after deductible No charge You pay 40% after deductible
Office Visits (OBGYN / Psychiatrist / Psychologist) You pay 20% after deductible You pay 40% after deductible $30 co-pay You pay 50% after deductible $20 co-pay You pay 40% after deductible
Office Visits (Specialist) You pay 20% after deductible You pay 40% after deductible $60 co-pay You pay 50% after deductible $40 co-pay You pay 40% after deductible
LiveHealth Online Telemedicine Visit You pay 20% after deductible N/A No charge N/A No charge N/A
Be Well Health Center Visit No charge for preventive care; $35 co-pay for all other care N/A No charge N/A No charge N/A
Urgent Care Visit You pay 20% after deductible You pay 40% after deductible $60 co-pay You pay 50% after deductible $40 co-pay You pay 40% after deductible
Emergency Room Visit* You pay 20% after deductible You pay 20% after deductible You pay 30% after deductible You pay 30% after deductible You pay 20% after deductible You pay 20% after deductible

*Non-emergency use of the emergency room is not covered.

Prescription Drug Coverage (In-network Only)
CDHP Basic PPO Enhanced PPO
Retail – up to 30-day Supply (Must use an in-network pharmacy) You pay 20% after the deductible
  • Generic – $10 co-pay
  • Preferred – $50 co-pay
  • Non-preferred – $100 co-pay
  • Generic – $10 co-pay
  • Preferred – $50 co-pay
  • Non-preferred – $100 co-pay
Mail Order or CVS – 90–day Supply You pay 20% after the deductible
  • Generic – $20 co-pay
  • Preferred – $100 co-pay
  • Non-preferred – $200 co-pay
  • Generic – $20 co-pay
  • Preferred – $100 co-pay
  • Non-preferred – $200 co-pay
Specialty* 30-day purchased through CVS Caremark Specialty Program You pay 20% after the deductible
  • Generic – $40 co-pay
  • Preferred – $100 co-pay
  • Non-preferred – $200 co-pay
  • Generic – $40 co-pay
  • Preferred – $100 co-pay
  • Non-preferred – $200 co-pay

*Specialty medications must be purchased through the CVS Caremark Specialty Pharmacy and will not be covered if filled at a regular retail pharmacy.

Wondering if the new CDHP is right for you?

You may want to consider a CDHP + HSA if you prefer low per paycheck costs and can pay more if and when you need to receive most types of medical care, if you want to benefit from the tax savings or long-term savings potential of the HSA, if you are generally healthy and expect low costs next year, or if you know you will reach your out-of-pocket maximum and can afford to pay for your medical expenses until your HSA funds build up.

Need more help? Check out these videos: