YOUR 2010 HEALTH PLAN OPTIONS AT A GLANCE
CORE PLAN BUY-DOWN PLAN
PPO BENEFIT HIGHLIGHTS
CALENDAR YEAR DEDUCTIBLE: In Network Out of Network In Network Out of Network
Individual $400 $550
Family $1,200 $1,650
COINSURANCE: 90% 60% 80% 50%
OUT-OF-POCKET MAXIMUM:
(After Calendar Year Deductible is
Satisfied)
Individual $2,000 $5,000 $3,500 $7,000
Family $4,000 $10,000 $7,000 $14,000
(Members responsible for 10% or (Members responsible for 20% or 40%
30% of eligible charges up to of eligible charges up to $20,000 per
$20,000 per Family) Family)
MAXIMUM LIFETIME BENEFIT: $2,000,000 $2,000,000
PHYSICIAN:
Office Visits $25 Copay 60% $25 Copay 50%
Hospital Visits 90% 60% 80% 50%
Outpatient Surgery 90% 60% 80% 50%
HOSPITAL:
Inpatient 90% 60% 80% 50%
Outpatient 90% 60% 80% 50%
Emergency Room Visit 90% 60% 90% 50%
(Additional $50 deductible per visit; (Additional $50 deductible per visit;
waived if admitted as bed patient) waived if admitted as bed patient)
Outpatient Surgery 90% 60% 80% 50%
PRESCRIPTION DRUGS:
$10 Copay Generic/$35 Copay $10 Copay Generic/$35 Copay Brand-
Drug Card Brand-Name Name
2 Copays for 90 Day Supply 2 Copays for 90 Day Supply (Generic
Mail Order Drug Program (Generic & Brand) & Brand)
PREVENTIVE: Mammograms and Pap Smears Mammograms and Pap Smears
90% 60% 80% 50%
Preventive Care - Children &
Adults Preventive Care - Children & Adults
Office Visits Office Visits
$25 Copay 60% $25 Copay 50%
(Limit of one office visit per year (Limit of one office visit per year for
for adults) adults)
Immunizations Immunizations
90% 60% 80% 50%
YOUR 2010 DENTAL PLAN OPTIONS AT A GLANCE
Core: $25 per person, $75 per family, per calendar year
DEDUCTIBLES
Buy-Down: $50 per person, $150 per family, per calendar year
ANNUAL MAXIMUM The maximum benefit paid per calendar year is $1,500 per person
BENEFITS AND COVERED SERVICES* In Network Out-Of-Network
DIAGNOSTIC & PREVENTIVE BENEFITS --
Oral examinations, routine cleanings, x-rays, fluoride
treatment, space maintainers, specialist consultations 80 % 80 %
BASIC BENEFITS -- Fillings, root canals,
periodontics (gum treatment), tissue removal (biopsy),
oral surgery (extractions), sealants 80 % 80 %
CROWNS, OTHER CAST RESTORATIONS --
Crowns, inlays, onlays and cast restorations 50 % 50 %
PROSTHODONTICS -- Bridges, partial dentures,
full dentures, implants 50 % 50 %
ORTHODONTIC BENEFITS adults and dependent
children 50 % 50 %
ORTHODONTIC MAXIMUMS $ 1,000 Lifetime $ 1,000 Lifetime
YOUR 2010 VISION PLAN AT A GLANCE
SERVICE FREQUENCY YOUR IN-NETWORK OUT-OF-NETWORK
COPAY (after copay) (after copay)
Eye Exam 12 months $10 100% Up to $45.00
Lenses 12 months $10 100% Up to $45.00/single vision
Up to $65.00/lined bifocal
Up to $85.00/lined trifocal
Frames 24 months $10 Frame allowance up to Up to $47
$120
Contact Lenses (in lieu of 12 months None Contact allowance up to Up to $105
frame and lenses) $120
OVERVIEW OF YOUR CITY BENEFITS
Review this section to learn about the different benefits available, including those that are provided
automatically at no cost to you, as well as benefits requiring you to contribute.
City of El Centro Benefits Who pays the cost?
Core and Buy-Down Health plans Employee and the City; City pays the majority of cost
Delta Dental Plan Employee and the City; City pays the majority of cost
Vision Service Plan (VSP) Employee and the City; City pays the majority of cost
Flexible Spending Accounts (FSA’s) Employee can elect to contribute
Short Term Disability City
Long Term Disability City
Basic Life and Accident Insurance City
Supplemental Life and Accident coverage Employee
Employee Assistance Program City
Voluntary Benefits: Aflac, Deferred Compensation Employee
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