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Home My WebLink AboutMinutes - July 25, 2000 SS60V CITY OF LODI INFORMAL INFORMATIONAL MEETING "SHIRTSLEEVE" SESSION CARNEGIE FORUM, 305 WEST PINE STREET TUESDAY, JULY 25, 2000 An Informal Informational Meeting ("Shirtsleeve" Session) of the Lodi City Council was held Tuesday, July 25, 2000 commencing at 7:05 a.m. ROLL CALL Present: Council Members — Hitchcock, Land, Nakanishi and Pennino Absent: Council Members — Mann (Mayor) Also Present: City Manager Flynn, City Attorney Hays and City Clerk Blackston TOPIC(S) 1. Medical Benefits This matter was introduced by Human Resources Analyst II Evans and information was presented by Karla Purcell, with CalPERS Health Benefits Program. Speaking on the matter were the following persons: • Ron Dancer • Felix Heurta • Dave Towne • George Bradley ADJOURNMENT No action was taken by the City Council. The meeting was adjourned at approximately 8:17 a.m. ATTEST: Susan J. Blacks an City Clerk City of Lodi Renewal Rate Comparisons with CAPERS Current Rates: Single 88 2 -Party 126 3 or More 2200 Office Visit Hospital OOP Max Rx Benefit Max Elson Insurance, Inc. Lrfe and Heahh division of MW -Central Vailey Insurance Producers, Inc. Premium $149,481.12 $168,166.70 $167,542.98 $164,743.74 $179,902.00 Single $5 100% $2,000 2 -Party $101$10 2 Family Max Elson Insurance, Inc. Lrfe and Heahh division of MW -Central Vailey Insurance Producers, Inc. Premium $149,481.12 $168,166.70 $167,542.98 $164,743.74 $179,902.00 $1,000 Single $5 100% $ 2,000 2 -Party $101$10 $2 500 Family Max Elson Insurance, Inc. Lrfe and Heahh division of MW -Central Vailey Insurance Producers, Inc. Premium $149,481.12 $168,166.70 $167,542.98 $164,743.74 $179,902.00 $1,000 Single $5 100% $2,000 2 -Party $101$10 $2,500 Family Max Elson Insurance, Inc. Lrfe and Heahh division of MW -Central Vailey Insurance Producers, Inc. Premium $149,481.12 $168,166.70 $167,542.98 $164,743.74 $179,902.00 $1,500 single $5 100% $3,000 2 -party $51$5 $41500 family Max Elson Insurance, Inc. Lrfe and Heahh division of MW -Central Vailey Insurance Producers, Inc. Premium $149,481.12 $168,166.70 $167,542.98 $164,743.74 $179,902.00 1,500 single $5 100% $3,000 2 -party $51$5 $4,500 famil Max Elson Insurance, Inc. Lrfe and Heahh division of MW -Central Vailey Insurance Producers, Inc. Premium $149,481.12 $168,166.70 $167,542.98 $164,743.74 $179,902.00 HEALTH BENEFIT COMPARISONS for City of Lodi Max Elson Insurance, Inc. Life and Health division of Mid -Central Valley Insurance Producers, Inc. HEALTH BENEFIT COMPARISONS for City of Lodi $35 No Charge up to 30 days per calendar year $20 per visit/20 visits per calendar yea No Charge $5 per visit/20 visits per calendar year up to 100 days per $40 For SEVERE MENTAL. No Charge, no calendar limit $5 per visit, no calendar limit (other than "SEVERE") No purge, up to 30 days per calendar ye; for Chem Rehab & Mental Illness, DETOX No Charge, no calendar limit $20 per visit up to 20 visits per calendar No Charge up to 100 days per No Charge for inpatient visits at a hospital or skilled nursing facility. 1$5 for Inpatient/Outpatient therapy, as loi $5/visit for outpatient and home visits. as significant improvement is expected. $5 per visit/20 visits per calendar year I not Max Elson Insurance, Inc. We and Health division of Mid -Central Valley Insurance Producers, Inc. Net (This is ME1 MAX ELSON INSURANCE, INC. July 21, 2000 City of Lodi PO Box 3006 Lodi, CA 95242 RE: Important Notes The following is a list of important items to consider while comparing the difference between your current group health benefits with Health Net and Ca1PERS: 1) Benefits A) Mandated Legislative changes are not included in the current CalPERS benefits. However they are included in the renewal Health Net benefits. These include the following: AB 12 Second opinions must be authorized. AB 39 All FDA approved contraceptives must be covered. AB 88 Inpatient mental health services covered in full with no day limit and Outpatient mental health covered with no visit limit and with a co -pay the same as the plans office visit charge. SB 64 Over-the-counter diabetic supplies and education. SB 148 Testing and treatment for Phenylketonuria (PKU). II) Costs A) Renewal date for current Health Net benefit contract is 9/01/2000 through 713112001. These rates reflect all of the above costs for the mandated benefit changes. B) The current CalPERS rates will increase effective January 01, 2001 and will be in effect until December 31, 2001. C) The annual trend for increase in cost for medical benefits is somewhere around 8 to 10%. Dancer, CIC Max Elson Insurance, Inc. An affiliate of Mid -Central Valley Insurance Producers, Inc. P.O. Box 490, Lodi, CA 95242 (209) 334-4242 - Stockton 957-4030 - FAX (209) 337-3103 License 90390755 Survey Cities that are members of CaIPERS Health Program (there are 15 survey cities) city 1 Davis 2 Fairfield 3 Manteca 4 Modesto 5 Roseville 6 Trac 7 Vacaville L8: Woodland SAN JOAQUIN SANTA CRUZ COUNTle: COUNTY: LATHROP CAPITOLA MANTECA SANTA CRUZ TRACY SHASTA COUNTY: SAN LUIS OBISPO SIIASTA LAKE COUNTY: MORRO BAY SISICIYOU COUNTY: PISMO BEACH EITNA SAN LUIS OBISPO FORT JONES, TOWN OF SAN MATEO SOLANO COUNTY: COUNTY: AMERICAN CANYON ATHERTON. TOWN OF DIXON BELMONT FAIRFJrLD BRISBANE RIO VISTA BURLINGAME VACAViLLLE COLMA,TOWN OF VALLEJO DALY CITY HALF MOON BAY SONOMA COUNTY: 111L1 SBOROUCII, PrTALUMA TOWN 01. SANTA ROSA MENLO PARK MILLBRAE STANISLAUS PACIFICA COUNTY: REDWOOD CITY MODESTO SAN CARLOS SAN MATEO SUTTER COUNTY: WOODM DILTOWN OF I.iV1; OAK YU13A CITY ., SANTA BARBARA CaZPERS COUNTY: TULARE COUNTY: BUELI ONE FARM rRSVILLE CARPIN'TERIA GUADALUPE VENTURA COUNTY: SANTA10ARIA MOC11tPARK California Public SOLVANG OJAI Employees' Retirement OXNARD SAN -1'A CL.AItA PORTMIFNI'MV. System COUNTY: SANTA PAULA CUPF.RTINO TIIOUCAND OAKS public Agency GILROY LOS ALTOS IIII.r -';, YOLO COUNTY: Information/Marketing TOWN OF DAVIS (916) 658-1233 I.01 (IATON W1:ST %AC•TANIEN•TO MONTESERE?NO WINTERS 1,A1.0 AIM) 11'11ODI AND www.clill)et..q.(!,.I.gov SANTA CLARA SARA•TOCIA V11RA COUNTY: siINNYVAI.r; Misting Current as of: 4/1/1999 CaIPERS [�L CALIFORNIA CITIES PARTNERS IN MEETING THE HEALTH CARE CHALLENGE PARTICIPATING CI'T'IES Iu:tzN COUNTY: LOS ANGLLIES MON'110:IueY RIVERSIDE C0IlN'I'Y: CalPERS REALTFI PROGRAM CALIFORNIA CITY COUN'T'Y: COUN'T'Y: c:AL.INIENA ALAMEDA COUNTY: RLDGECREST MAYWOOD CARMM,-nY=riIE SIEA CANTON LAKE MONROVIA DELRI',Y OAKS CATIA DRALCi't'Y ALAMEDA KINGS COUNTY: MONTEI3ELLO GONGALLS CORONA ALBANY DUBLIN AV[.,NAI. MONTEREY PARK KING CITY INDIAN Wl{I.I.S EMERYVILLE NORWALK MAIUNA MONTLREY INDR) LAKE ELSINORE FREMONT LAKE COUNTY' PALMDALE PACIFIC GROVEMOIt1iN0 VALLEY HAYWARD LAKtEPORT PARAMOUNT SAND CITY MURRII rA NEWARK PASADENA OAKLAND LOS ANGELES PICO RIVERA NAPA COUNTY: SPRINGS PIEDMONT • COUNTY: POMONA NAPA ERRINORCo PIiRlt18 AGOURA IIILLS RANCHO PALOS VERDES YOUNTVILLE, TOWN OF "rEM1ECULA AMADOR COUNTY: AIAIANBRA ROLLING IIILLS JACKSON ARCADIA ROSEMEAD NEVADA COUNTY: SACRAMENTO SUTTER CREEK ARTESIA SAN DIMAS GRASS VALLEY COUNTY: AVALON SAN FERNANDO FOl'90m BUTTE COUNTY: AZUSA SAN GABRIEL ,sc)n•I BIGGS BALDWIN PARK SAN MARINA ORANGE COUNTY: PARADISE, TOWN OF BOLI. SANTA CLARITA BREA SAN BENITO BELLFLOWER SANTA FL SPRINGS BUENA PARK COUNTY: COLUSA COUNTY: BEVERLY IIILLS SANTA MONICA COSTA MESA IIOLLISTL•'R COLUSA BURBANK SIL:RRA MADRE CYPJWSS WILLIAMS CALABASAS SICNALHILL DANA POINT SAN BERNARDINO CARSON CERRITOS SOUT I EL MONTE SOUTH GATT: FOUNTAIN VALLEY COUNTY: CONTRA COSTA COUNTY: CLAREMONT SOUTII PASADENA FULLL RTON BARSTOW ANTIOCH COMMERCE TEMPLE CITY GARDEN GROVE CHINO BRENTWOOD COMPTON THOUSAND OAKS LA HABRA CHINO MILLS CLAYTON COVINA TORRANCE LA PALMA COLTON CONCORD CONCORD CUDAHY WEST COVINA LAGUNA NIGUEL HESPIERIA TOWN OF DANVIL E CULVER CITY WEST HOLLYWOOD LOS ALAMITOS IIIGHLAND DIAMOND BAR WESTLAKE VILLAGE MISSION VIEJO LOMA LINDA ARTCZ MARTINEZ DUARTE NEWPORT BEACH ONTARIO I; PINORICHMOND EL MONTE MARIN COUNTY: ORANGE ANDS RIA LLTOO EL SEGUNDO BELVEDERE SAN CLEMENT!✓ RIA SAN PABLO GLENDORA COR"L'L•' MADERA,'1'OWN OF SAN'T'A ANA SAN 13l Y-NIN )INO IIAW'f1IOItNE LARKSPUR LARKSPNOVAT SISAL BEAC11 'I'WI;N'I'Y-NINE PALMS FRESNO COUNTY: HIDDEN HILLS STANTON UPLAND REEDLEY HUNTINGTON PARK DOSS, TOWN Or TUSTIN YUCAIPA INGLEWOOD SAN ANSELMO, TOWN OF WESTMINIS7•ER YUCCA VALLEY, TOWN OF GLENN COUNTY: IRWINDALE SAN RAFAEL YORBA LINDA ORLAND LA CANADA- TIBURON, TOWN OF PLACER COUNTY: SAN DIEGO COUNTY: WILLOWS FLINTILIDGL LA IIABRA HEIGIITS MENDOCINO LINCOLN CARLSBAD HUMBOLDT Cutj:L41Y:[.AIvuRADA COUNTY: LOOMts,TOWN OF CORONADO BLUE LAKE ROI EL C AJON LA PUENTE UKIAH ROSEVIL LE ENCINITEVLTAS INYO COUNTY' LAKL•'WOOD IMPERIAL BLACH MRCED COUNTY: E, LA MESA BISHOPLAWNDALIE LOMI"1'A A WATER RIVERSIDE LL•'MON GROVE LYNWOOD LOS BANOS COUNTY; OCEANSIDE M,AIABUBI,1'"t'IitE SAN MARCOS X-IANIIA'TTAN BEACH SOLANA BE ACI I SAN JOAQUIN SANTA CRUZ COUNTY: ...COUNTY: LATHROP ` CAPITOLA MAN.TECA SANTA CRUZ C1PEIS TRACY _......: , SHASTA COUNTY SAN LUIS OBISPO SHASTA LAKE COUNTY: CALIFORNIA... MORRO BAY: SISKIYOU COUNTY:: PISMO BEACH ETNA CITIES SAN LUIS OBISPO FORT JONES, TOWN OF SAN MATEEO SOLANO COUNTY: COUNTY: AMERICAN CANYON ATHERRTON, TOWN OF DIXON BELMONT FAIRFIELD BRISBANE RIO VISTA BURLINGAME VACAVILLE COLMA, TOWN OF VALLEJO DALY CITY HALF MOON. BAY SONOMACO.UNTY: HILLSBOROUGH, PETALUMA TOWN OF SANTA ROSH MENLO PARK MILLBRAE STANISLAUS . PACIFICA COUNTY: REDWOOD CITY MODESTO SAN CARLOS SAN MATEO -SUTTER COUNTY: Y s WOODSIDE, TOWN OF LIVE. OAK w+' YUBA CITY SANTA BARBARA . COUNTY: �. � TULARE COUNTY: Ca1PERLI'S BUELLTON FARMERS'VILLE CARPINTERIA, r GUADALUPE VENTURA COUNTY: SANTA MARIA MOORPARK . California Public SOLVANG OJAI OXNARU Employees' Retirement SANTA CLARA PORT HUENEME " System COUNTY: SANTA PAULA CUPERTINO THOUSAND OAKS GILROY PU61IC Agency LOS ALTOS"HILLS, YOLO COUNTY': Information/Marketing OWN F DAVIS (9110 65$4233 LOS GATOS. WEST SACTAMENTO. P TOWILAL. WOODLAND PARTNERS".'""': ► SANTA CLARA rwww.calpers ca.gav SARATOGA YUBA COi:1NTY .' . IN SUNNYVALE MARYsvILL>r Listing Current "s of:.... . 4/1/1999 AL A CSA : IJLN� n �: PARTICIPATING CITIES KERN COUNTY: LOS ANGELES MONTEREY RIVERSIDE COUNTY: CAPERS HEALTH PROGRAM CALIFORNIACITY COUNTY: COUNTY, CALIMESA ALAMEDA COUNTY: RIDGECREST MAYWOOD CARMEL-BY-THE-SEA CANYON LAKE ALAMEDA MONROVIA DEL REY OAKS CATHEDRAL CITY ALBANY KINGS COUNTY: MONTEBELLO GONZALES CORONA DUBLIN AVENAL MONTEREY PARK KING CITY INDIAN WELLS EMERYVILLE NORWALK MARINA INDIO FREMONT LAKE COUNTY: PALMDALE MONTEREY LAKE ELSINORE HAYWARD LAKEPORT. PARAMOUNT PACIFIC GROVE MORENO VALLEY NEWARK PASADENA SANE) CITY MURRIETA OAKLAND LOS ANGELES PICA RIVERA NAPA COUNTY: NORCO PALM SPRINGS PIEDMONT COUNTY: POMONA NAPA PERRIS AMADOR COUNTY: AGOURA HILLS RANCHO PALOS VERDES YOUNTVILLE, TOWN OF TEMECULA ALHANBRA ROLLING HILLS JACKSON ARTESI A A NEVADA COUNTY: SACRAMENTO SUTTER CREEK AVALON SAN DI SAN S AVALON FERN SAN FERNANDO GRASS VALLEY COUNTY: BUTTE COUNTY- AZUSA SAN GABRIEL FOLSOM BIGGS BALDWIN PARK SAN MARINO ORANGE COUNTY: PARADISE, TOWN OF BELL SANTA CLARITA BREA SAN BENITO BELLFLOWER SANTA FE SPRINGS BUENA PARK COUNTY: COLUSA COUNTY: BEVERLY HILLS SANTA MONICA COSTA MESA HOLLISTER COLUSA BURBANK SIERRA MADRE CYPRESS WILLIAMS CALABASAS SIGNAL HILL DANA POINT SAN BERNARDINO CARSON SOUTH EL MONTE CONTRA COSTA COUNTY: CERRITOS SOUTH GATE FOUNTAIN VALLEY- COUNTY: ANTIOCH CLAREMONT SOUTH PASADENA FULLERTON BARSTOW BRENTWOOD COMMERCE TEMPLE CITY GARDEN GROVE CHINO CLAYTON COMPTON THOUSAND OAKS LA HABRA CHINO HILLS CONCORD CON ORD CO COVINA TORRANCE LA PALMA COLTON CUDAHY WEST COVINA LAGUNANIOUEL HESPERIA TOWN OF CULVER CITY WEST HOLLYWOOD LOS ALAMITOS HIGHLAND HERCULES DIAMOND BAR WESTLAKE VILLAGE MISSION VIEJO LAMA LINDA MARTINEZ MARTIDUARTE NEWPORT BEACH ONTARIO RICHMOND EL MONCE MARIN COUNTY: ORANGE REDLANDS SAN PABLO EL SEGUNDO BELVEDERE SAN CLEMENTE RIALTO GLENDORA CORTE MADERA, TOWN OF SANTA ANA SAN BERNARDINO FRESNO COUNTY: HAWTHORNE LARKSPUR SEAL BEACH TWENTY-NINE PALMS HIDDEN HILLS NOVATO STANTON UPLAND REEDLEY HUNTINGTON PARK ROSS, TOWN OF TUSTIN YUCAIPA INGLEWOOD SAN ANSELMO, TOWN OF WESTMINISTER YUCCA VALLEY, TOWN OF GLENN COUNTY: IRWINDALE SAN RAFAEL YORBALINDA ORLAND LA CANADA- TIBURON, TOWN OF WILLOWS FLINTRIDGE PLACER COUNTY: SAN DIEGO COUNTY: LA HABRA HEIGHTS MENDOCINO LINCOLN CARLSBAD HUMBOLDT COUNTY: COUNTY: LOOMIS, TOWN OF CORONADO BLUE LAKE LA MIRADA ROCKLIN EL CAJON L.A PUENTE UKIAH ROSEVILLE ENCINITAS INYO COUNTY: LAKEWOOD IMPERIAL BEACH LAWNDALE MERCED COUNTY: LA MESA BISHOP LOMITA ATWATER RIVERSIDE LEMON GROVE LYNWOOD LOS BANOS COUNTY; OCEANSIDE MALIBU BLYTHE SAN MARCOS MANHATTAN BEACH SOLANA BEACH Program. information 2000 C li of-Illd i)LIE)IlC I_I11�1�f)\'CC's' \l'�ll'l`Illl'll� \'ct.l'I[1 CaIPERS Health Program Information { 'What's New for 2000+ ........................................ 2 CAPERS Health Program Features ........................... 3 I 2000 Basic Plan Premiums ................................... 4 f 2000 Supplement & Managed Medicare Premiums ........... S 2000 PERSCare & PERS Choice Benefit Summaries F(Basic Plans) .................................................. 6 { CAPERS 2000 HMO Basic Health Plan Benefit Summary ............................................. 7 Visit ourweb site at www.calpers.ca.ov Nonm(alPERS Agencies Welcome! for additional information What's New for 20001 Benefit Changes The CalPERS Board approved coverage of the treatment of sexual dysfunction, including Viagra® and other drugs prescribed for sexual dysfunction at the standard prescription drug copayments. New Health Plan Additions Universal Care will join the CalPERS Health Program effective January 1, 2000. Uniusraal Care has been operating in Southern California since 1985 and has approximately 212,000 enrollees in their service area of Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, and Ventura counties. PacifiCare Heakh ,Systems, Inc. will offer out-of-state coverage to Ca1PERS members in select zip codes of Arizona and Nevada effective January 1, 2000. PacifiCare of Arizona and PacifiCare of Nevada are an extension of our commitment to provide members entranced customer service and improve member satisfaction. New Rates For contract year 2000, the Basic HMO plan premiums represent an average of 9.7 percent incresase. Considering the high coats of prescription drugs and inflation, WRERSbelieves that this increase is reasonable, at the same time delivering a stable and secure product! 02• PEZSCare and PERS Choice basic plan premiums have increased an average of 7.9 percent. New Practices CJPERS continues to implement Nev Practices to simplify our husiriess rules. The CalPERS Health Partner Inquiry System (CH PIS) is available to contracting Pubtic Agency employers to review their employees and retirees' health enrollment status. There is no cost to tb►e employer except the equipment and software to access the inquiry system. It' ,Simple to do Business with Ca1PERS' ColPERS Health Program Features ■ Stability, Flexibility & Choice i Participation by Individual Employee Groups ■ No Utilization or Actuarial Review for New Agencies ■ No Exclusions for Pre-existing Conditions During Initial & Open Enrollments • No Waiting Period ■ Program Premium Rates & Benefits are the Same for All Contracting Agencies ■ Individual Choice Between PPO, HMO or Association Plane ■ Preferred_. Provider Organization (PPO) Plans: • CAPERS self-funded plans • Administered by Blue Cross of California • Self referral • Open -formulary prescriptions • Nationwide & worldwide coverage t Health Maintenance Organization (HMO) Plans: • Standardized benefits • Out -of -State coverage available on some plans ■ Association Plan: • Peace Officers Research Association of California (PORAL) Police and Fire Health Plan ■ Dependent Coverage for Children: Covers up to age 23 (unmarried) • Natural, step, or adopted child • Do not need to be a student nor reside with enrollee Economically -dependent child coverage available III Lifetime Health Coverage for Disabled Children ■ Lifetime Health Coverage for Eligible Retirees ■ Toll -Free Customer Service (800) 232-3345 •3• 2000 Basic Monthly Premiums PPOs PERSCare PERS Choice 296.00 592.00 1 770.00 176.00 352.00 458.00 HMOs Aetna U.S. Healthcare 178.63 357.26 464.46 Blue Shield Access+ HMO 184.56 369.12 479.87 CIGNA 172.37 344.76 448.48 Health Net 180.64 361.27 469.67 HP of the Redwoods 183.40 366.79 476.83 Kaiser Foundation 184.06 368.12 478.56 Lifeguard 196.31 390.61 507.81 Maxicare 166.0Q 332.00 431.60 PacifiCare of California 174.52 349.04 453.73 PacifiCare of Arizona 302.36 604.72 786.15 PacifiCare of Nevada 294.52 589.05 765.76 Universal Care 161.49 322.98 419.87 ASSOCIATION 464.43 Kaiser Foundation` 98.18 PORAC Police and Fire 294.54 `Senior Advantage' Health Plan 210.00 410.00 549.00 • 4 • 2000 s nadd or Managed Medicare Monthly Prams "Managed Medicare Plans • 5j • PPOs PERSCare 225.00 450.00 675.00 PERS Choice 214.00 1 428.00 642.00 HMOs Aetna U.S. Healthcare 104.67 209.34 314.01 'Goren Medicare' Blue Shield Access+ HMO 208.82 417.64 626.46 CIGNA" 75.00 150.00 225.00 'Health Care for Seniors' Health Net` 125.35 250.70 376.05 'Seniority Plus' HP of the Redwoods 154.81. 309.62 464.43 Kaiser Foundation` 98.18 196.36 294.54 `Senior Advantage' Lifeguard 161.82 323.63 485.45 Maxicare 148.62 297.24 445.86 PacifiCare of California' 99.05 198.10 297.15 'Secure Horizons' PacifiCare of Arizona' 75.00 150.00 225.00 `Secure Horizons' PacifiCare of Nevada' 87.40 174.80 349.42 `Secure Horizons' Universal Care 103.66 207.31 310.97 ASSOCIATION PORAC Police and Fire Health Plan 198.00 396.00 594.00 "Managed Medicare Plans • 5j • Comparison of PERSCare and PERS Choice Plans Basic Plan 2000 Contract Year * Irepor oo: The maximum annual copayment opOies onfy'd services are received hi3m a Prefaced Provider, or t you live and receive covered services outside of a Preferred Provider area. M covered services axe received from nogFeferred Providers, whether referred by a Preferred Plandder or not (there is no implied contract), there is no maximum copayment responshitity. ** The plm wdyes the dedeufihfe regeirmrerrt IN gess servicest This is only a summary of benefits offered by PERSCare and PERS Choice. Please see the Evidence of Coverage booklets for the exact terms of coverage. *69 CalPERS HMO Basic Health Plan Benefit Summary 2000 Contract Year Your Cost PERS Choice Your Cost Premiums PERSCute 'No Charge 1 Party $296 Services $176 Non -PPO PPO Non -PPO 2 Party $592 $352 10%- 40%` ` Family $770 $458 $5 Well Baby Care Calendar Year DeducAle Inpatient Hospital Visits (Office/hospital visit) 10% 40% Member 40% $250 no charge" $250 Family 40% $500 no charge" $500 Maximum Annual copayment Member 40% $2,000 10% $3,000 Family 40% $4,000 20% $6,000 Lifetime Maximum Benefit Per Member 20% none 10% $2,000,000 * Irepor oo: The maximum annual copayment opOies onfy'd services are received hi3m a Prefaced Provider, or t you live and receive covered services outside of a Preferred Provider area. M covered services axe received from nogFeferred Providers, whether referred by a Preferred Plandder or not (there is no implied contract), there is no maximum copayment responshitity. ** The plm wdyes the dedeufihfe regeirmrerrt IN gess servicest This is only a summary of benefits offered by PERSCare and PERS Choice. Please see the Evidence of Coverage booklets for the exact terms of coverage. *69 CalPERS HMO Basic Health Plan Benefit Summary 2000 Contract Year Services WPERS HMOs Hospital PERSCare 'No Charge PERS Choice No Charge Services PPO Non -PPO PPO Non -PPO $5 Hearing Exam/ est Hospital 10%- 40%` ` 20% 40% Physician Services $5 Well Baby Care $5 Inpatient Hospital Visits (Office/hospital visit) 10% 40% $10 copay" 40% Immunization/Well-Baby Care no charge" 40% no charge` ` 40% Periodic Health Exams no charge" 40% nocharge" 40% Diagnostic X-ray and lab 10% 40% 20%. 40% Ambulance 20% 20% 20% 20% Emergency Care Services 10% 10% 20% 20% Chiropractic Services 10% 40% 20% 40% Acupuncture Services 10% 40% 20% 40% Mental Health Limited to short-term therapy for a period No charge for inpatient visits at a hospital not exceeding 60 consecutive calendar days or skilled nursing facility. $5/visit for Inpatient 10% 40% 20% 40% Outpatient 10% 40% 2046 40% Home Health Care 10% 40% 20% 40% Hearing Aid Benefit 10% 40% 20% 40% $1,000 Max. every 36 mon," $1,000 Max. every 36 months Prescription Drugs Retail Pharmacy Program $5 generic/$10 brand naxn4e $5 generic/$10 brand name. . Mail Service Program $5 generic or brand name $5 generic or brand name 24 Hour Nurseline YES YES * Irepor oo: The maximum annual copayment opOies onfy'd services are received hi3m a Prefaced Provider, or t you live and receive covered services outside of a Preferred Provider area. M covered services axe received from nogFeferred Providers, whether referred by a Preferred Plandder or not (there is no implied contract), there is no maximum copayment responshitity. ** The plm wdyes the dedeufihfe regeirmrerrt IN gess servicest This is only a summary of benefits offered by PERSCare and PERS Choice. Please see the Evidence of Coverage booklets for the exact terms of coverage. *69 CalPERS HMO Basic Health Plan Benefit Summary 2000 Contract Year Importm>r This is only a summary of benefits offered. Pease see the Evidence of (overage booklets far the exact terms of coverage. •7• Services WPERS HMOs Hospital Inpatient 'No Charge Outpatient No Charge Physician Care Office Visits $5 Allergy Test/Treat $5 Hearing Exam/ est $5 Immunizationa/Inoculations $5 Gynecological Exam $5 Periodic Health Exam $5 Well Baby Care $5 Inpatient Hospital Visits No Charge Surgery/Anestbesia No Charge Eye Refraction $10 Age limit varies by plan Diagnostic x-ray and lab No Charge Outpatient Durable Medical Equipment No Charge Includes Orthotics and Prosthetics Prescription Drugs $5/30 day $5/90 day mail Infertility Testing & Treatment 50% of charges Ambulance No Charge Emergency Care Varies by plan Mental Health - Inpatient No charge up to 30 days per calendar year Outpatient $20 per visit/20 visits per calendar year Substance Abuse Inpatient No Charge Outpatient $5 per visit/20 visits per calendar year Home Health No Charge Skilled Nursing Care No Charge up to 100 clays per calendar year Speech/Physical/Occupational Therapy Limited to short-term therapy for a period No charge for inpatient visits at a hospital not exceeding 60 consecutive calendar days or skilled nursing facility. $5/visit for per condition following the date of the first outpatient and home visite. therapy session. Applies to each therapy. Long-term rehabilitation is not covered. Hospice No Charge Chiropractic Varies by plan $5 per visit /20 visits per calendar year Blood & Blond Products No Charge Hearing Aid Denefit $1,000 Max. every 36 months Importm>r This is only a summary of benefits offered. Pease see the Evidence of (overage booklets far the exact terms of coverage. •7• Nates: 08* We're ready to show you what CalPERS can do for your agency and your employees. We'll be in your area soon, so let us explain how you, together with Ca1PERS, can meet—and beat—the health care challenge! For more information or to set up an appointment, please complete and return this card or contact C.'aIPERS PAhc Agency Information/Marketing at (916) 658-1233. ❑ Please send me CAPERS Health Program information. ❑ Please call me to schedule a presentation. r Name Agency .................... Adese City State ZIP } Phone FAX Place Postage Here California Public Employees' Retirement System Health Benefit Services Division Public .agency Information/Marketing P.O. Box 942714 Sacramento, CA 94229-2714 A- C.hf,.-ni. Public Employees' Retirement System Public Agency Information/Marketing (916) 658-1233 Website: www.calpers.ca.gov A*%�, CAPERS Health Benefits Program Presented by — Karla Purcell CaIPERS BACKGROUND +0 ^7—>r a 6 38 years providing health benefits — since 1962 :- In 1967 legislation was passed to allow public agencies to join the program HEALTH BENEFITS MEMBERSHIP Over "1.2" million lives covered > Over 1,200 contracting Public Agencies > 104 school districts Largest risk pool in California NEGOTIATIONS Negotiations start January for the following new year Health plan contracts are signed by CalPERS Health Committee Board in April Circular letters are sent to contracting Agencies by May/June ENROLLMENT AND CONTRACTING PROCEDURES Agency needs to adopt a resolution: > Agency as a "whole"; or > 8y recognized employee group — including your "elected officials" > Effective Date: ist of any given month Adopted resolution must be received by the 101h of the month for the effective date to be the first of the following month ➢ Initially there is a new agency enrollment > Open enrollment is held every year from September 1st through October 15th > Contracts are on a calendar year basis — January 1st through December 315t EMPLOYER COSTS > Employer Contribution: Z Equal contribution: :- Unequal contribution: ➢ Administrative Cost: Contingency Reserve Fund: $16 minimum for active and retired employees $1 minimum per month for retiree's with annual increases of 5% of the active employee's contribution Maximum 2% - Currently 0.5% (half of one percent since 1988) Maximum 4% - Currently 0.0% since 1985 (OVER) BILLING PROCEDURES Monthly Itemized bill CalPERS Agencies — will include the total premium for enrolled active employees and only the agency contribution amount for enrolled retirees + administrative fee Non CalPERS Agencies — will include the full premium for active and retired employees + administrative fee Agencies issue a single payment to CalPERS. CalPERS disburses payment to each carrier COBRA billing administered by carrier, employee pays carrier direct EMPLOYEE ELIGIBILITY > Program must be offered to ALL eligible "active" and "retired" employees: ➢ Active: Timebase of half-time or more; Tenure of more than 6 months ➢ Retired: PERS/SIRS membership; receive a monthly allowance; and separate/retire within 120 days (can not defer retirement) Must offer program to "past" retirees After initial Effective date: Be enrolled in a PERS plan at the time of separation before retiring Deductions: From PERS or STRS check FAMILY MEMBER ELIGIBILITY ➢ Dependents: Unmarried up to age "23" (natural, step, or adopted) Extended Dependent Children Coverage Domestic Partner Coverage ➢ Survivor: May continue PERS health plan coverage if receiving spouse's retirement warrant. ➢ No dual coverage and split enrollments HEALTH PLAN COVERAGE ➢ PPO's or Preferred Provider Organizations ➢ Traditional fee for service or indemnity plan with deductibles and co -pays ➢ Self -referral to any Blue Cross doctor (including specialists and acupuncture) ➢ Non formulary prescriptions with $5.00 co -pay for generic and $10.00 for name brand ➢ World Wide coverage provided ➢ HMO's or Health Maintenance Organizations ➢ You chose a Primary Care Physician (PSP) ➢ PCP coordinates all your care including referrals to any specialists ➢ Prescriptions are $5.00 co -pay with HMO formulary for prescriptions PROGRAM FEATURES ➢ No utilization or actuarial review for new agencies ➢ ALL premiums and benefits are the SAME for all agencies ➢ No waiting periods ➢ Cannot be denied coverage for pre-eAsting conditions ➢ Coordination with employer to conduct health fair and enrollment training ➢ ALL eligible ACTIVE and RETIREES participate in open enrollments ➢ Customer Service/Member Advocacy (800) 237-3345 CaIPERS CaIPERS CaIPERS CaIPERS CaIPERS Available Health Plans For 2000: SAN_JOAQUIN COUNTY.- Aetna OUNTY: Aetna U.S. Healthcare Blue Shield Access+ HMO Health Net Kaiser Lifeguard Maxicare Pacificare PERSCare PERS Choice HMO Availability is geographically restricted by Residence Zip Code PERS Care & PERS Choice offer World Wide Coverage www.calpers.ca.gov