Medical
Rakuten International offers different medical plans for different needs and budgets. Here are some considerations when selecting the right medical plan for you and your family:
High Deductible Health Plan (HDHP)
Plan Option: Aetna HDHP
Consider an HDHP if:
- You want to be able to see any provider, even a specialist, without a High Deductible Health Plan referral
- You want to reduce your healthcare payroll deductions
- You are willing to pay more to see out-of-network providers
- You want tax-free savings on your healthcare costs
- You want to build a savings account for future healthcare costs for you and your eligible family members
Preferred Provider Option (PPO)
Plan Option: Aetna PPO
Consider a PPO if:
- You want to be able to see any provider, even a specialist, without a referral
- You are willing to pay more to see out-of-network providers
Health Maintenance Organization (HMO) or Exclusive Provider Organization (EPO)
Plan Options: Aetna EPO or Kaiser HMO (CA)
Consider an HMO or an EPO if:
- You want lower, predictable out-of-pocket costs
- You like having one doctor to manage your care
- You are happy with the selection of network providers
- You don’t see any doctors that are out-of-network
- You have convenient access to Kaiser facilities
Aetna HDHP
Plan Information
Plan Name: Aetna HDHP
Policy Number: 804020
Effective Date: 01/01/2025
Provider Network: Aetna
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Individual Family/Family)
$2,000/$3,300/$4,000
Out-of-Pocket Max (Individual/Family)
$4,000 per individual, up to $8,000 per family
Preventive Care
$0 (deductible waived)
Primary Care Visit
10% after deductible
Specialist Visit
10% after deductible
Urgent Care
10% after deductible
Emergency Room
You pay 10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay after deductible
Preferred Brand
$35 copay after deductible
Non-Preferred Brand
$50 copay after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay after deductible
Preferred Brand
$70 copay after deductible
Non-Preferred Brand
$100 copay after deductible
Out-of-Network
Deductible (Individual/Family)
$4,000/$8,000
Out-of-Pocket Max (Individual/Family)
$8,000/$16,000
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
40% after applicable deductible and copay
Preferred Brand
40% after applicable deductible and copay
Non-Preferred Brand
40% after applicable deductible and copay
Retail Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Plan Documents
Contact Information
Aetna PPO
Plan Information
Plan Name: Aetna PPO
Policy Number: 804020
Effective Date: 01/01/2025
Provider Network: Aetna
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$250 per individual, up to $750 per family
Out-of-Pocket Max (Individual/Family)
$3,000 per individual, up to $6,000 per family
Preventive Care
$0 (deductible waived)
Primary Care Visit
$20 copay (deductible waived)
Specialist Visit
$30 copay (deductible waived)
Urgent Care
$25 copay (deductible waived)
Emergency Room
$100 copay plus 10% (deductible waived; copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$35 copay
Non-Preferred Brand
$50 copay
Mail-Order Rx (Up to 30-Day Supply)
Generic
$20 copay
Preferred Brand
$70 copay
Non-Preferred Brand
$100 copay
Out-of-Network
Deductible (Individual/Family)
$250 per individual, up to $750 per family
Out-of-Pocket Max (Individual/Family)
$6,000 per individual, up to $12,000 per family
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
$100 copay plus 10% (deductible waived; copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
30% after applicable deductible and copay
Preferred Brand
30% after applicable deductible and copay
Non-Preferred Brand
30% after applicable deductible and copay
Aetna PPO Mail-Order Rx
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Plan Documents
Contact Information
Aetna EPO
Plan Information
Plan Name: Aetna EPO
Policy Number: 804020
Effective Date: 01/01/2025
Provider Network: Aetna
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
None
Out-of-Pocket Max (Individual/Family)
$5,050 per individual, up to $10,100
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$30 copay
Urgent Care
$35 copay
Emergency Room
$75 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$35 copay
Non-Preferred Brand
$50 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$70 copay
Non-Preferred Brand
$100 copay
Plan Documents
Contact Information
Kaiser HMO (CA)
Plan Information
Plan Name: Kaiser HMO (CA)
Policy Number: NCAL: 605444; SCAL: 233406
Effective Date: 01/01/2025
Provider Network: Kaiser
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0
Out-of-Pocket Max (Individual/Family)
$1,500/$3,000
Preventive Care
$0
Primary Care Visit
$30 copay
Specialist Visit
$30 copay
Urgent Care
$30 copay
Emergency Room
$75 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$30 copay
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$60 copay
Plan Documents
2025 Kaiser HMO Benefit Summary (N. CA)
2025 Kaiser HMO Benefit Summary (S. CA)
2025 Kaiser HMO Chiropractic & Acupuncture Benefit Summary (N. CA)
2025 Kaiser HMO Chiropractic & Acupuncture Benefit Summary (S. CA)
2025 Kaiser HMO Summary of Benefits & Coverage (N. CA)
2025 Kaiser HMO Summary of Benefits & Coverage (S. CA)