Medical Plans Overview | State Farm Total Rewards

Your health needs aren’t one-size-fits-all, and your medical coverage shouldn’t be either. That’s why State Farm offers four medical plan options through Blue Cross and Blue Shield of Illinois (BCBSIL), Kaiser Permanente, and Aetna. The plans available to you depend on where you live, and your cost will vary based on the plan you choose and whom you choose to cover.

Your medical plan options Jump to Section Choosing a medical plan Jump to Section How the plans compare Jump to Section How to save on your healthcare premiums Jump to Section

Your medical plan options

You can choose from the following plans:

BCBSIL PPO (with HRA)
BCBSIL QHDHP (with HSA)
Kaiser Permanente HMO (available only in CA, CO, GA, HI, WA, and mid-Atlantic states)
Aetna ACO (available only in the Phoenix, Arizona and Dallas, Texas areas)

All the plans provide comprehensive coverage that includes:

In-network preventive care at no cost to you
Prescription drug coverage
Network medical providers and facilities
Coverage for medical emergencies

Choosing a medical plan

Not sure which medical plan is right for you? We’re here to help. While the plans generally cover many of the same health care services and supplies, they differ in how you pay for care — your copays, coinsurance, and deductibles — and how much comes out of each paycheck. Coverage details can vary by plan and location, so be sure to check the plan documents for specifics. To determine which plans are available to you based on your home zip code and how much you’ll pay for coverage, use the Pricing Modeler.

BCBSIL PPO (with HRA)

This plan comes with a Health Reimbursement Account (HRA) that State Farm funds each year — $1,000 per individual or $2,000 per family (prorated if you join midyear). HRA funds are automatically used to pay eligible medical expenses as claims are processed.
Paycheck contributions are higher, but this is offset by an HRA that covers eligible medical expenses up front. Additionally, the plan pays a slightly higher coinsurance amount after you meet the deductible.
You can use any provider. This is the only medical plan we offer with both in-network and out-of-network coverage. When you see out-of-network providers, your out-of-pocket costs will be higher.

BCBSIL QHDHP (with HSA)

This plan has lower paycheck contributions than most of the other plans.
You can only use in-network providers (except for emergencies).
This plan has the highest individual deductible. You’ll have less deducted from your paycheck, but you’ll pay more when you need care, because the full deductible (medical and prescription drugs) must be met before the plan starts to pay.
This is the only State Farm plan paired with a tax-advantaged Health Savings Account (HSA) to help you pay for health care expenses. State Farm contributes annually to your HSA ($600 per individual or $1,200 per family). Contributions are made bimonthly (no contribution during the third pay period) and accumulate over time. You can also contribute to your HSA. Total annual contributions must not exceed the IRS maximum.

Aetna ACO

This plan is available only to employees who reside within eligible Phoenix, Arizona and Dallas, Texas area zip codes.
Paycheck contributions vary based on location, with lower deductibles and out-of-pocket maximums, compared to the BCBSIL plans.
Benefit from predictable costs at the time of care through copays or coinsurance for many eligible services and prescriptions.
You can only use in-network providers (except for emergencies).

Kaiser Permanente HMO

This plan is available only to employees who reside within eligible CA, CO, GA, HI, WA, and mid-Atlantic state zip codes.
Paycheck contributions are higher, with lower deductibles and out-of-pocket maximums, compared to the BCBSIL plans.
Benefit from predictable costs at the time of care through copays or coinsurance for many eligible services and prescriptions.
You can receive in-network care only (except for emergencies) and are required to have an in-network primary care physician (PCP) who coordinates your care and referrals.

Looking for a provider who really gets you?

Included Health can help you find culturally competent, inclusive care that meets your unique needs — even if you aren’t enrolled in a medical plan through State Farm.

See what’s offered

How the plans compare

This table provides a side-by-side overview of our four available health care plans. For more details, review each plan’s Summary of Benefits and Coverage (SBC) on the My State Farm Benefits Resource website (auto sign-on with SSO | log in). On the home page, select Plan Documents from the left navigation, then select the Health and Insurance dropdown.

Here’s how the plans stack up against each other for in-network care:

Plan feature	BCBSIL PPO (with HRA)	BCBSIL QHDHP (with HSA)	Kaiser Permanente HMO¹	Aetna ACO
Coverage	Out-of-network coverage is available, at a higher coinsurance percentage and higher out-of-pocket maximum	No out-of-network coverage, except for emergencies	No out-of-network coverage, except for emergencies	No out-of-network coverage, except for emergencies
Annual deductible	Individual: $3,000 Family: $6,000 (medical only²)	Individual: $3,400 Family: $6,000 (combined medical and prescription drug)	Individual: $350 Family: $700 (medical only)	Individual: $500 Family: $1,000 (medical only)
Out-of-pocket maximum	Individual: $6,000 Family: $12,000 (medical) Individual: $2,000 Family: $4,000 (prescription drug)	Individual: $6,000 Family: $12,000 (combined medical and prescription drug)	Individual: $3,000 Family: $6,000 (combined medical and prescription drug)	Individual: $2,000 Family: $4,000 (combined medical and prescription drug)
Primary care visit	You pay 15% after deductible	You pay 20% after deductible	$30 copay	$30 copay
Specialty care visit	You pay 15% after deductible	You pay 20% after deductible	$50 copay	$50 copay
Coinsurance (costs that you and the plan share after you meet the deductible)	You pay 15% after deductible	You pay 20% after deductible	You pay 20% after deductible	You pay 20% after deductible
Virtual care	Accolade Care: $0 Teladoc: $0	Accolade Care: $0 Teladoc: $0	Virtual options available at $0	98point6: $0
Emergency care	You pay $200 copay plus 15% after deductible. Copay waived if admitted	You pay $200 copay plus 20% after deductible. Copay waived if admitted	You pay 20% after deductible	You pay 20% after deductible

¹Excludes Kaiser Hawaii. For rates, review the Kaiser Hawaii Summary Plan Description on the My State Farm Benefits Resource website (auto sign-on with SSO | log in). On the home page, select Plan Documents from the left navigation, then select the Health and Insurance dropdown.

²Prescription drugs aren’t subject to an annual deductible.

Prescription drug coverage

View the tables below to see how prescription drug coverage compares under each plan. The BCBSIL PPO (with HRA) has separate out-of-pocket maximums for prescription drug expenses of $2,000 (individual) and $4,000 (family).

Find more information about prescription drug coverage under the BCBSIL PPO, BCBSIL QHDHP, Kaiser Permanente HMO, and Aetna ACO plans.

30-day retail supply

Drug tier	BCBSIL PPO (with HRA)	BCBSIL QHDHP (with HSA)	Kaiser Permanente HMO	Aetna ACO
Tier 1: Generic	You pay 20%; $10 min. / $25 max.	You pay 20% after deductible	$15 copay	$10 copay
Tier 2: Preferred brand	You pay 30%; $15 min. / $150 max.	You pay 20% after deductible	$35 copay	You pay 30%
Tier 3: Non-preferred brand	You pay 50%; $15 min. / $200 max.	You pay 20% after deductible	$65 copay (not available in California)	You pay 50%

90-day mail-order and maintenance supply

Drug tier	BCBSIL PPO (with HRA)	BCBSIL QHDHP (with HSA)	Kaiser Permanente HMO¹	Aetna ACO
Tier 1: Generic	You pay 20%; $20 min. / $50 max.	You pay 20% after deductible	Varies by location	$20 copay
Tier 2: Preferred brand	You pay 30%; $30 min. / $300 max.	You pay 20% after deductible	Varies by location	You pay 30%
Tier 3: Non-preferred brand	You pay 50%; $30 min. / $400 max.	You pay 20% after deductible	Varies by location	You pay 50%

¹Kaiser Permanente HMO members can receive a 90- to 100-day supply of medication through mail order depending on the drug. To review your plan’s Summary of Benefits and Coverage (SBC) for mail-order costs, go to the My State Farm Benefits Resource website (auto sign-on with SSO | log in). On the home page, select Plan Documents from the left navigation, then select the Health and Insurance dropdown.

How to save on your healthcare premiums

You can save up to $15 per month ($180 per year) on your healthcare premiums next year when you complete the State Farm Wellness Premium Incentive Program action items this year. Here’s what you need to do to qualify for savings:

Complete your annual preventive care visit and lab work within the 12 months leading up to Annual Enrollment.
When you enroll in your State Farm medical plan during Annual Enrollment, provide the date of your lab work and/or preventive care visit.

For details, review the Wellness Premium Incentive Program document.