Docstoc

COUNTY OF YUBA

Document Sample
COUNTY OF YUBA Powered By Docstoc
					                                                                                    COUNTY OF YUBA
                                                                                    SUMMARY OF BENEFITS
                                                                                        Dental                                Vision                       Life Insurance
                  PPO                                    HMO                                                                                                                           Waiver
                                                                                   Delta Dental PPO                    Medical Eye Services               ING – ReliaStar
 PPO Plans administered by Blue            HMO: Must be referred to a           Choose between the              The following information reflects     Basic Life Insurance:     Proof of other
 Cross. The following information          Specialist by the primary care       following Plan Options:         services obtained from a                                         coverage MUST be
                                                                                                                                                       YCEA & DSA/MSA
 reflects services obtained from a         physician.                                                           participating provider.                                          provided in order to
                                                                                        Basic Plan:                                                    employees receive
 Preferred Provider.                                                                                                                                                             waive County
                                                                                                                                                       $20,000
                                              Choose between 2 of the                                           Examinations, Lens, and Contact                                  provided health
          www.calpers.ca.gov
                                               following Plan Options:          Annual Maximum                  Lens are covered every 12              DDAA & Non-               coverage and receive
          PERS Select:                                                          Coverage:                       months on a rolling calendar           Represented               premium incentive
 80/20% Plan                                       Blue Shield                  $1,500 per person per           year. (i.e. If you receive an eye      employees receive         savings.
                                           Doctor MUST accept Blue              calendar year                   exam in August the next eye            $50,000
 $20 Co-Pay
                                           Shield                                                               exam covered will be August of                                   Premium Incentive
 Deductible: $500/$1,000                                                        Deductible:                     the following year.                       Basic Accidental           Savings:
                                           No Deductibles
 Out-of-Pocket Maximum:                                                         Per calendar year                                                              Death &
                                           $15 Co-Pays                                                                 Examinations:                                             YCEA & Non-
 $3,000/$6,000                                                                  $50 per person                                                            Dismemberment
                                           No charge for preventive care                                        $25 Deductible                                                   Represented receive
          PERS Choice:                                                          $150 per family                                                              Insurance:
                                           visits (i.e. well-baby, periodic                                                                                                      $150 per month
 80/20% Plan                               health exams, immunizations,                                                      Lens:                     YCEA & DSA/MSA
                                                                                      Premium Plan:                                                                              DSA/MSA & DDAA
 $20 Co-Pay                                allergy testing and treatment).                                      Lens Allowance Depends on              employees receive
                                                                                                                                                                                 employees receive:
                                           Out-of-Pocket Maximum:                                               Prescription                           $20,000
 Deductible: $500/$1,000                                                        Annual Maximum                                                                                   $250 per month
                                           $1,500/3,000                         Coverage:                       Standard Lens Covered:
 Out-of-Pocket Maximum:                                                                                                                                DDAA & Non-
 $3,000/$6,000                             Retail Prescriptions: $5             $2,000 per person per           Single Vision, Bifocal, Trifocal,                                Waiver premiums are
                                                                                                                                                       Represented
                                           Generic/$15 Brand                    calendar year                   Aphakic Monofocal and Aphakic                                    taxable.
           PERS Care:                                                                                                                                  employees receive
                                           Mail-Order Prescriptions: $10                                        Multifocal
 90/10% Plan                                                                                                                                           $50,000
                                           Generic/$25 Brand                    Deductible:                     Progressive Lens for dependent                                        Special Open
 $20 Co-Pay                                                                     Per calendar year                                                                                 Enrollment Period:
                                           A list of Providers is available                                     children through 18 years               Basic Dependent Life
 Deductible: $500/$1,000                   at: www.blueshieldca.com             $50 per person                  covered up to $89.50.                        Insurance:          There is a Special 30-
                                                                                $100 per family                                                                                  Day Open Enrollment
 Out-of-Pocket Maximum:                                                                                         Polycarbonate Lens covered up          DDAA & Non-
                                                Kaiser Permanente                                                                                                                Period when other
 $2,000/$4,000                                                                                                  to $85.00.                             Represented
                                           Service Area is determined by               Orthodontic:                                                                              coverage is lost (i.e.
      Prescriptions for PERS                                                                                                                           employees have the
                                           Zip Code. A list of zip codes in                                                                                                      spouse changes jobs
      (Select, Choice & Care):                                                                                           Contact Lens:                 option of three plans:
                                           the service area is attached.        Orthodontic coverage is                                                                          or loses job).
 Retail: $5 Generic/$15 Brand                                                                                   Contact Lens Allowance covered                  $1,000
                                                                                included.                                                                                        Coverage cannot
 Mail-Order: $10 Generic/$25 Brand         No Deductibles                                                       up to $105.00 toward the contact                $2,000
                                                                                                                                                                                 lapse, it must be
                                                                                                                lens evaluation, fitting costs and              $5,000
               PORAC:*                     $15 Co-Pay                           Orthodontic coverage                                                                             continuous. If an
                                                                                                                materials.
 90/10% Plan                               No charge for preventive care        does not count against                                                                           employee misses the
                                                                                                                                                          Supplemental Life
                                           visits (excludes allergy             your annual maximum.                                                                             Special Enrollment
 $20 Co-Pay                                                                                                                  Frames:                          Insurance:
                                           testing).                                                                                                                             Period they must wait
 $300 per person deductible                                                                                     Frame Allowance covered up to          All County employees
                                                                                A list of PPO Dentists is                                                                        until the annual open
                                           Out-of-Pocket Maximum:                                               $100.00 every 24 month in a            may purchase
 $900 per family deductible                                                     available at:                                                                                    enrollment period to
                                           $1,500/3,000                                                         rolling calendar year (i.e. If you     additional
                                                                                www.deltadentalca.org                                                                            enroll.
 Out-of-Pocket Maximum:                    Retail Prescriptions:                                                receive frames in August 2007          Supplemental Life
 $3,000/$6,000                             $5 Generic/$15 Brand                                                 the next time frames will be           Insurance for self,
 Retail Prescriptions: $10                 Mail-Order Prescriptions:                                            covered is August 2009).               spouse and dependent
 Generic/$25 Brand                         $5 Generic/$15 Brand                                                 A list of Participating Providers is   children. Packets
 Mail-Order Prescriptions: $20                                                                                  available at:                          available in Personnel.
                                           www.kaiserpermanente.org
 Generic/$40 Brand                                                                                              www.mesvision.com

Employees may elect to pay their share of premium payments with pre-tax dollars (premium conversation plan options).
* Membership in PORAC is required to enroll in this plan.

				
DOCUMENT INFO
Shared By:
Categories:
Stats:
views:14
posted:4/1/2010
language:English
pages:1