| Culpeper County Government 2024-2025 Benefit Plan Options | ||
| HealthKeepers 25 | Keycare HSA | |
| Annual Deductible |
$1500 individual $3000 family |
$2000 Individual $4000 Family |
| Out-of-Pocket Maximum | $4500 individual $9000 family |
$3500 individual $7000 family |
| Pre-Tax Account Availability | Flexible Benefits Administrators | Atlantic Union Bank |
| Preventative Care | 100 % covered | 100 % covered |
| Primary Care Visit | $30 copay | 10 % after Plan Year Deductible |
| Specialist Visit | $60 copay | 10 % after Plan Year Deductible |
| Urgent Care | $60 copay | 10 % after Plan Year Deductible |
| Annual Vision Exam | $15.00 copay | $15.00 copay child(ren) / Adults not covered |
| Emergency Room Facility | $250 copay per visit after Deductible, waived if admitted | 10% after Plan Year Deductible |
| Inpatient Hospital Care | $300/day not to exceed $1500 per admission, after plan year deductible | 10% after Plan Year Deductible |
| Prescription Drugs | Retail | Mail Order | Retail | Mail Order |
| Generic | $15 copay | $30 copay | 10% after Plan Year Deductible |
| Preferred Brand Name | $35 copay | $70 copay | 10% after Plan Year Deductible |
| Non-Preferred Brand Name | $55 copay or 20% coinsurance up to $200 | 20% coinsurance up to $200 | 10% after Plan Year Deductible |
| Out-of-Network Care | Balance billing applies | Balance billing applies |
| Annual Deductible | Not covered | $2000 / $4000 |
| Out-of-Pocket Maximum | Not covered | $6000 / $11900 |