Medical Plan Options
Active Participants
Active participants may select from three medical plans: the Self-Funded PPO Plan, Kaiser HMO, and PacifiCare HMO.
The Self-Funded PPO Plan allows you to see any doctor, whether or not they are part of a network. With this plan, you pay annual deductibles before the plan pays any benefits. You may visit any provider, but your out-of-pocket costs will be less if you utilize a PPO provider. The current PPO network is the Anthem Blue Cross Prudent Buyer network.
Under the HMO options (PacifiCare & Kaiser), you must select a Primary Care Physician. This is the doctor you must always visit for all of your care. If you need to see a Specialist, your doctor will send you to another doctor for the necessary services. With an HMO, you do not pay an annual deductible and only pay a small fee for office visits. Kaiser participants must visit Kaiser facilities.
This chart will help you to compare many plan features side-by-side:
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| Network |
Enrollees in the PPO Plan may visit any provider. Your benefits are higher if you use PPO providers who are contracted with the Anthem Blue Cross Prudent Buyer Network. |
Enrollees in Kaiser must receive all their care at Kaiser clinics and hospitals. |
Enrollees in PacifiCare must receive all care at the Medical Group in which you enroll. Each family member may select a different Primary Care Physician (PCP) as long as they work at the same Medical Clinic. Care not authorized by your Medical Group is not covered. |
| Deductible |
$100 PPO/$300 non-PPO
(two per family) |
None |
None |
| Coinsurance/Co-Pays |
Plan pays 90% PPO/70% non-PPO |
Office Visits: $35
Hospitalization: $250
Emergency Room: $100 |
Office Visits
$20 co-pay primary care physician
$40 co-pay specialist
Hospitalization: $250 per day
Emergency Room: $100 |
| Out of Pocket Maximum per calendar year |
$600 PPO/$6,300 non-PPO |
$1,500 per person/$3,000 per family |
$2,000 per person/$6,000 per family |
| Prescription Drug |
Sav-Rx Card: $-0- generic/$10 brand name-formulary/$30 brand-nonformulary, up to $2,000 in benefits. After $2,000, prescription drug claims are reimbursed at 80% after the deductible has been met. |
$10 generic/$25 brand name |
$20 generic/
$30 brand – formulary only |
Retired Participants
Retired participants in the Trust have a different selection of medical plans. Medicare retirees can choose between the Self-Funded PPO Plan, Kaiser Senior Advantage, and PacifiCare Secure Horizons.
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| Network |
Participants in the PPO plan may visit any provider. Your benefits are higher if you use PPO providers who are contractd with the Anthem Blue Cross Prudent Buyer Network. |
Enrollees in Kaiser must receive all their care at Kaiser clinics and hospitals. |
Enrollees in PacifiCare must receive all care at the Medical Group in which you enroll. Each family member may select a different Primary Care Physician (PCP) as long as they work at the same Medical Clinic. Care not authorized by your Medical Group is not covered. |
| Deductible |
$100 PPO/$300 non-PPO
(two per family) |
None |
None |
| Coinsurance/Co-Pays |
Plan pays 90% PPO/70% non-PPO; Benefits will be coordinated with Medicare |
Office Visits: $25
Hospitalization: $250
Emergency Room: $50 |
Office Visits:
$10 co-pay primary care physician
$20 co-pay specialist
Hospitalization: $200 per admit
Emergency Room: $50
Outpatient Surgery: $100
Labs & X-rays: -0-
DME: Plan pays 80%
Renal Dialysis: Plan pays 80%
Other Outpatient Services: $25 |
| Out of Pocket Maximum per calendar year |
$600 PPO/$20,300 non-PPO |
$1,500 per person/$3,000 per family |
$2,000 per person |
| Prescription Drug |
Sav-Rx Card: Plan pays 80% up to $2,000 in benefits. After $2,000, prescription drug claims must be submitted to the Admnistration Office and will be reimbursed at 80% |
$10 generic/
$25 brand name |
$10 generic/
$25 brand – formulary/
$50 brand – non-formulary |
Non-medicare retirees can choose between the Self-Funded PPO, Kaiser HMO, and PacifiCare HMO.
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| Network |
Enrollees in the PPO Plan may visit any provider. Your benefits are higher if you use PPO providers who are contracted with the Anthem Blue Cross Prudent Buyer Network. |
Enrollees in Kaiser must receive all their care at Kaiser clinics and hospitals. |
Enrollees in PacifiCare must receive all care at the Medical Group in which you enroll. Each family member may select a different Primary Care Physician (PCP) as long as they work at the same Medical Clinic. Care not authorized by your Medical Group is not covered. |
| Deductible |
$100 PPO/$300 non-PPO (two per family) |
None |
None |
| Coinsurance/Co-Pays |
Plan pays 90% PPO/70% non-PPO |
Office Visits: $35
Hospitalization: $250
Emergency Room: $100
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Office Visits:
$20 co-pay primary care physician
$40 co-pay specialist
Hospitalization: $250 per day
Emergency Room: $100
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| Out of Pocket Maximum per calendar year |
$600 PPO/$20,300 non-PPO |
$1,500 per person/
$3,000 per family |
$2,000 per person/
$6,000 per family |
| Prescription Drug |
Sav-Rx Card: Plan pays 80% up to $2,000 in benefits. After $2,000, prescription drug claims must be submitted to the Administration Office and will be reimbursed at 80% |
$10 generic/ $25 brand name |
$20 generic/$30 brand-formulary only |