South Bay
General Agency | Health Insurance Services
Employee Health Benefits
2026-2027 Annual Open Enrollment Ends 07/31/2026
PPO
Gold 80 350/25
In Network Out of Network
Deductible Individual
Deductible Family
OOP Max Individual
OOP Max Family
Coinsurance
PCP Visit Copay
Specialist Visit Copay
Rx Deductible Ind./Family
Rx Retail
$350
$700
$7,800
$15,600
20%
$25
$50
Integrated
$15/$50/$80
$1,000
$2,000
$12,800
$25,700
50%
50%
50%
N/A
N/A
PPO
Silver 70 2500/55
In Network Out of Network
Deductible Individual
Deductible Family
OOP Max Individual
OOP Max Family
Coinsurance
PCP Visit Copay
Specialist Visit Copay
Rx Deductible Ind./Family
Rx Retail
$2,500
$5,000
$8,600
$17,200
35%
$55
$90
$300/$600
$20/$75/$105
$5,000
$10,000
$13,250
$26,500
50%
50%
50%
N/A
N/A
PPO
Bronze 60 5800/60
In Network Out of Network
Deductible Individual
Deductible Family
OOP Max Individual
OOP Max Family
Coinsurance
PCP Visit Copay
Specialist Visit Copay
Rx Deductible Ind./Family
Rx Retail
$5,800
$11,600
$9,800
$19,600
40%
$60
$95
$450/$900
$20/40%/$500 Max
$11,600
$23,200
$19,600
$39,200
50%
50%
50%
None
N/A
HMO
Trio Platinum 90 0/20
In Network Out of Network
Deductible Individual
Deductible Family
OOP Max Individual
OOP Max Family
Coinsurance
PCP Visit Copay
Specialist Visit Copay
Rx Deductible Ind./Family
Rx Retail A
Rx Retail B
$0
$0
$4,500
$9000
10%
$20
$30
$0/$0
$5/$20/$30
$7/$35/$50
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
HMO
Trio Gold 80 250/35
In Network Out of Network
Deductible Individual
Deductible Family
OOP Max Individual
OOP Max Family
Coinsurance
PCP Visit Copay
Specialist Visit Copay
Rx Deductible Ind./Family
Rx Retail
$250
$500
$7,800
$15,600
20%
$35
$55
Integrated
$15/$40/$70
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
HMO
Trio Silver 70 2500/55
In Network Out of Network
Deductible Individual
Deductible Family
OOP Max Individual
OOP Max Family
Coinsurance
PCP Visit Copay
Specialist Visit Copay
Rx Deductible Ind./Family
Rx Retail
$2,500
$5,000
$8,750
$17,500
35%
$55
$90
$300/$600
$19/$85/$110
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
HMO
Trio Bronze 60 7000/65
In Network Out of Network
Deductible Individual
Deductible Family
OOP Max Individual
OOP Max Family
Coinsurance
PCP Visit Copay
Specialist Visit Copay
Rx Deductible Ind./Family
Rx Retail A
Rx Retail B
$7,000
$14,000
$9,800
$19,600
50%
$65
$75
Integrated
$25/$115/$160
$30/$145/$210
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
HMO
Silver 70 2000/65
In Network Out of Network
Deductible Individual
Deductible Family
OOP Max Individual
OOP Max Family
Coinsurance
PCP Visit Copay
Specialist Visit Copay
Rx Deductible Ind./Family
Rx Retail
$2,000
$4,000
$8,900
$17,800
45%
$65
$100
Integrated
$20/$100/$100
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
HMO
Bronze 60 5800/60
In Network Out of Network
Deductible Individual
Deductible Family
OOP Max Individual
OOP Max Family
Coinsurance
PCP Visit Copay
Specialist Visit Copay
Rx Deductible Ind./Family
Rx Retail
$5,800
$11,600
$9,800
$19,600
40%
$60
$95
$450/$900
$20/40%/$500 max
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Calculate your Premium
Step 1:
Complete your Application
or Waive Coverage
Step 2:
or
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If you do not wish to enroll in an employer health plan, please click Waive to complete a mandatory waiver.
You will be directed to a secure online form.
Thank you for cooperation.
Call (310) 954-9100 for assistance.