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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
                                              Choose between 2 of the                                           Examinations, Lens, and Contact                                  provided health

                                               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
                                           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:             $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
 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
 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.
 Generic/$40 Brand                                                                                    

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.

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