Small group and CalChoice benefit comparison

Transcription

1 Small group and CalChoice benefit comparison effective July 1, 2015 We believe in choice. A guide to choosing the right plan for your business US health plan 1

2 San Diegans choose Sharp Health Plan With a range of plans and provider networks, we have the right plan to meet your unique small business needs. Sharp Health Plan is your first choice for access to high-quality, affordable health care for a healthy San Diego workforce. Local focus As the only San Diego-based commercial health plan, all of our services, from account management to customer care, are provided locally. Award-winning care Sharp Health Plan is a subsidiary of Sharp HealthCare, a recipient of the 2007 Malcolm Baldrige National Quality Award, the nation s highest presidential honor for quality and organizational performance excellence. Customizable With a multitude of plan designs, four provider networks and a broad range of pricing options, you have the ability to tailor your plan design to your business needs.

3 Additional benefits included with every plan We know that excellent health care is not enough; it must also be easy to access. The convenience of Sharp Health Plan extends beyond San Diego and beyond standard business hours. All Sharp Health Plan members receive these value-added benefits. 1 Assist America Assist America connects Sharp Health Plan members to doctors, hospitals, pharmacies and other services when faced with a medical emergency while traveling 100 miles or more away from home, or out of the country. Sharp Nurse Connection We offer after-hours nurse advice telephone service for Sharp Health Plan members. When you have a health question or concern after regular business hours, a single phone call puts you in touch with a registered nurse. MinuteClinic Get care for minor illnesses, injuries and more through MinuteClinic, the medical clinic in select CVS/pharmacy stores in San Diego and across the nation. 2 Best Health Best Health is one of only eight health plan wellness programs to be accredited nationally. The program provides Sharp Health Plan members with a variety of resources from meal plans to exercise routines to one-on-one personalized health coaching. 1 Based on the 2014 California Assessment of Healthcare Providers and Systems (CAHPS ) results, Sharp Health Plan received an overall summary rating of 86% satisfaction compared to the statewide average of 76%. For customer service, Sharp Health Plan received a 90% satisfaction rating and the statewide average was not reported. The source for data contained in this publication is Quality Compass 2014 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 2014 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). 2 A $40 copay will apply to most services except flu shots, which have a copay of $10.

4 Provider Networks Sharp Health Plan offers four provider networks to offer flexibility while delivering high-quality health services: Choice, Value, Performance and Premier. 2,200+ Doctors 13 Hospitals 6 Medical Groups Supplemental benefits available with every plan All plans include pediatric vision and dental benefits for members up to age 19. A portfolio of dental HMO and PPO plans, provided through Premier Access Dental, is also available. Chiropractic services American Specialty Health (ASH) Plans AC34 B $5 per visit / 40 visits per year $10 per visit / 30 visits per year D $10 per visit / 20 visits per year Acupuncture services American Specialty Health (ASH) Plans AC23 $15 per visit / 20 visits per year AC17 $10 per visit / 20 visits per year AC21 $15 per visit / 15 visits per year AC15 $10 per visit / 15 visits per year AC19 $15 per visit / 12 visits per year AC13 $10 per visit / 12 visits per year Chiropractic + acupuncture services American Specialty Health (ASH) Plans AC33 $15 per visit / 20 visits per year AC25 $10 per visit / 12 visits per year AC31 $15 per visit / 15 visits per year AC04 $10 per visit / 20 visits per year AC29 $15 per visit / 12 visits per year AC03 $10 per visit / 40 visits per year AC27 $10 per visit / 15 visits per year AC02 $5 per visit / 40 visits per year Vision services Vision Service Plan (VSP) Advantage $10 per visit / Eye exam: 1 every 12 months / Frames: 1 every 24 months / Lenses: 1 every 12 months Assisted Reproductive Technologies (ART) For employers with 20+ employees SHPA Z 2015 SHC Art C Copayments equal to 50% coinsurance of covered infertility services Questions? Call (858) or , us at customer.service@sharp.com, or visit sharphealthplan.com. Like us on Facebook facebook.com/sharphealthplan ¹ Based on NCQA s Private Health Insurance Rankings

5 Benefits comparison Small group Platinum 90 plans effective July 1, 2015 Sharp 0 / 10 / 100 Sharp 0 / 15 / 250 Sharp 0 / 20 / 500 Sharp 0 / 20 /1000 c Sharp 0 /20 /10% c Sharp 0/ 20 / 250 Calendar year deductible (per individual/per family, applies only to those covered benefits indicated) None None None None None None Calendar year deductible for covered drugs (per member, applies only to those covered drugs indicated) None None None None None None Lifetime maximums n/a n/a n/a n/a n/a n/a Annual out-of-pocket maximum, including deductible (per individual/per family) 1 $2,000 1 / $4,000 1 $2,000 1 / $4,000 1 $2,000 1 / $4,000 1 $2,000 1 / $4,000 1 $4,000 1 / $8,000 1 $4,000 1 / $8,000 1 Primary Care Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $10 $15 $20 $20 $20 $20 Specialist Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $10 $15 $30 $40 $40 $40 Preventive care services (per visit) 2 $0 2 $0 2 $0 2 $0 2 $0 $0 2 Prenatal and postpartum office visits (per visit) $10 $15 $30 $40 $0 2 $0 2 Allergy injections (per visit) $10 $10 $10 $10 $20 $20 Allergy testing (per visit) $10 $15 $30 $40 $40 $40 Outpatient surgery $100 / procedure $250 / procedure $500 / procedure $500 / procedure 10% coinsurance 3 $250 / procedure Radiology, pathology, hemodialysis, etc. (per visit) $0 $0 $0 $0 $40 $40 Advanced radiology (including MRI, CT Scan, PET Scan, MRA, MRS, MUGA, SPECT) $100 / procedure $100 / procedure $100 / procedure $100 / procedure 10% coinsurance 3 $150 / procedure Physical, occupational and speech therapy (per visit) $10 $15 $30 $40 $20 $20 Hospitalization Inpatient $100 / day (3-day max) $250 / day (3-day max) $500 / day (3-day max) $1,000 / admission 10% coinsurance 3 $250 / day (5-day max) Emergency room (per visit, waived if admitted for inpatient hospital stay) $100 $100 $100 $150 $150 $150 Urgent care (per visit) $10 $ 15 $30 $40 $40 $40 Ambulance (in connection with hospital admission or emergency services) $100 $100 $100 $150 $150 $150 Drugs administered in a practitioner s office, hospital or outpatient facility 8 $0 $0 $0 $0 $0 $0 Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 30-day supply) 8 $10 / $20 / $40 $15 / $35 / $50 $19 / $35 / $70 $15 / $35 / $50 $5 / $15 / $25 / 10% $5 / $15 / $25 / 10% Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 90-day supply by mail order) 8 $20 / $40 / $80 $30 / $70 / $100 $38 / $70 / $140 $30 / $70 / $100 $10 / $30 / $50 / 10% $10 / $30 / $50 / 10% Generic Formulary and prescribed over-the-counter contraceptives for women 8 $0 $0 $0 $0 $0 $0 Durable medical equipment 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 10% coinsurance 3 10% coinsurance 3 Diabetics supplies 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 10% coinsurance 3 10% coinsurance 3 Prosthetics, orthotics (per visit) $10 $15 $30 $30 $40 $40 Mental health hospitalization Inpatient $100 / day (3-day max) $250 / day (3-day max) $500 / day (3-day max) $1,000 / admission 10% coinsurance 3 $250 / day (5-day max) Mental health Outpatient (per visit) $10 $15 $30 $40 $20 $20 Home-based applied behavioral analysis (per visit, for treatment of pervasive developmental disorder or autism) $10 $15 $30 $40 10% coinsurance 3 $20 Chemical dependency hospitalization Inpatient $100 / day (3-day max) $250 / day (3-day max) $500 / day (3-day max) $1,000 / admission 10% coinsurance 3 $250 /day (5-day max) Chemical dependency Outpatient (per visit) $10 $15 $30 $40 $20 $20 Emergency services for acute drug or alcohol detoxification (per visit) $100 $100 $100 $150 $150 $150 Skilled nursing facility services (100 days per benefit period) $100 / day (3-day max) $200 / day (3-day max) $200 / day (3-day max) $200 / admission 10% coinsurance 3 $150 / day (5-day max) Home health services (per visit, 100 visits per calendar year) $10 $15 $30 $40 10% coinsurance 3 $20 Hospice care Inpatient $100 / day (3-day max) $250 / day (3-day max) $500/ day (3-day max) $200 / admission $0 / admission $0 / admission Hospice care Outpatient (per visit) $0 $0 $0 $0 $0 $0

6 Benefits comparison Small group Gold 80 plans effective July 1, 2015 Sharp 0/30/1000 A Sharp 0/30/1000 B Sharp 0/40/1000 Sharp 1000/30/30% c Sharp 0/30/20% c Sharp 0/30/600 Calendar year deductible (per individual/per family, applies only to those covered benefits indicated) None None None $1,000 6 / $2,000 6 None None Calendar year deductible for covered drugs (per member, applies only to those covered drugs indicated) None None $150 $150 None None Lifetime maximums n/a n/a n/a n/a n/a n/a Annual out-of-pocket maximum, including deductible (per individual/per family) 1 $5,000 1 / $10,000 1 $5,000 1 / $10,000 1 $5,000 1 / $10,000 1 $3,400 1 / $6,800 1 $6,250 1 / $12,500 1 $6,250 1 / $12,500 1 Primary Care Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $30 $30 $40 $30 $30 $30 Specialist Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $60 $50 $40 $30 $50 $50 Preventive care services (per visit) 2 $0 2 $0 2 $0 2 $0 2 $0 2 $0 2 Prenatal and postpartum office visits (per visit) $60 $50 $40 $30 $0 $0 Allergy injections (per visit) $10 $10 $10 $10 $30 $30 Allergy testing (per visit) $60 $50 $40 $30 $50 $50 Outpatient surgery $500 / procedure $750 / procedure $750 / procedure 30% coinsurance 3,5 20% coinsurance 3 $600 / procedure Radiology, pathology, hemodialysis, etc. (per visit) $0 $0 $0 $0 $50 $50 Advanced radiology (including MRI, CT Scan, PET Scan, MRA, MRS, MUGA, SPECT) $150 / procedure $150 / procedure $150 / procedure $100 / procedure 20% coinsurance 3 $250 / procedure Physical, occupational and speech therapy (per visit) $60 $50 $40 $30 $30 $30 Hospitalization Inpatient $1,000 / admission $1,000 / day $1,000 / day 30% coinsurance 3,5 20% coinsurance 3 $600 / day (5-day max) Emergency room (per visit, waived if admitted for inpatient hospital stay) $100 $100 $150 $150 5 $250 $250 Urgent care (per visit) $60 $ 50 $40 $30 $60 $60 Ambulance (in connection with hospital admission or emergency services) $100 $100 $100 $100 5 $250 $250 Drugs administered in a practitioner s office, hospital or outpatient facility 8 $0 $0 $0 $0 $0 $0 Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 30-day supply) 8 $19 / $35 / $70 $19 / $35 / $70 $19 / $35 5 / $70 5 $19 / $35 5 / $70 5 $15 /$50/ $70 / 20% $15 / $50 / $70 / 20% Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 90-day supply by mail order) 8 $38 / $70 / $140 $38 / $70 / $140 $38 / $70 5 / $140 5 $38 / $70 5 / $140 5 $30 / $100 / $140 / 20% $30 / $100 / $140 /20% Generic Formulary and prescribed over-the-counter contraceptives for women 8 $0 $0 $0 $0 $0 $0 Durable medical equipment 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3,5 20% coinsurance 3 20% coinsurance 3 Diabetics supplies 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 Prosthetics, orthotics (per visit) $40 $30 $40 $30 $50 $50 Mental health hospitalization Inpatient $1,000 / admission $1,000 / day $1,000 / day 30% coinsurance 3,5 20% coinsurance 3 $600 / day (5-day max) Mental health Outpatient (per visit) $60 $50 $40 $30 $30 $30 Home-based applied behavioral analysis (per visit, for treatment of pervasive developmental disorder or autism) $40 $40 $40 $40 20% coinsurance 3 $30 Chemical dependency hospitalization Inpatient $1,000 / admission $1,000 / day $1,000 / day 30% coinsurance 3,5 20% coinsurance 3 $600 / day (5-day max) Chemical dependency Outpatient (per visit) $60 $50 $40 $30 $30 $30 Emergency services for acute drug or alcohol detoxification (per visit) $100 $100 $150 $150 5 $250 $250 Skilled nursing facility services (100 days per benefit period) $150 / admission $150 / admission $150 / day 30% coinsurance 3,5 20% coinsurance 3 $300 /day (5-day max) Home health services (per visit, 100 visits per calendar year) $40 $40 $40 $40 20% coinsurance 3 $30 Hospice care Inpatient $150 / admission $150 / admission $150 / day 30% coinsurance 3,5 $0 / admission $0 / admission Hospice care Outpatient (per visit) $0 $0 $0 $40 $0 $0

7 Benefits comparison Small group Silver 70 plans effective July 1, 2015 Sharp 1750 / 40 / 40% c Sharp 1500 / 45 / 20% A c Sharp 1500 / 45 / 20% B c Sharp HSA*1500 / 20% / 20% Calendar year deductible (per individual/per family, applies only to those covered benefits indicated) $1,750 6 / $3,500 6 $1,500 6 / $3,000 6 $1,500 6 / $3,000 6 $1,500 4 / $3,000 4 Integrated Calendar year deductible for covered drugs (per member, applies only to those covered drugs indicated) $150 $500 / $1,000 $500 / $1,000 Integrated Lifetime maximums n/a n/a n/a n/a Annual out-of-pocket maximum, including deductible (per individual/per family) 1 $5,750 1 / $11,500 1 $6,250 1 / $12,500 1 $6,250 1 / $12,500 1 $6,250 1 / $12,500 1 Primary Care Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $40 $45 $45 20% coinsurance 3,5 Specialist Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $40 $65 $65 20% coinsurance 3,5 Preventive care services (per visit) 2 $0 2 $0 $0 $0 Prenatal and postpartum office visits (per visit) $40 $0 $0 $0 Allergy injections (per visit) $10 $45 $45 20% coinsurance 3,5 Allergy testing (per visit) $40 $65 $65 20% coinsurance 3,5 Outpatient surgery 40% coinsurance 3,5 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3,5 Radiology, pathology, hemodialysis, etc. (per visit) $0 $65 $65 20% coinsurance 3,5 Advanced radiology (including MRI, CT Scan, PET Scan, MRA, MRS, MUGA, SPECT) $100 / procedure 20% coinsurance 3,5 $250 / procedure 20% coinsurance 3,5 Physical, occupational and speech therapy (per visit) $40 $45 $45 20% coinsurance 3,5 Hospitalization Inpatient 40% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 Emergency room (per visit, waived if admitted for inpatient hospital stay) $150 5 $250 5 $ % coinsurance 3,5 Urgent care (per visit) $40 $90 $90 20% coinsurance 3,5 Ambulance (in connection with hospital admission or emergency services) $150 5 $250 5 $ % coinsurance 3,5 Drugs administered in a practitioner s office, hospital or outpatient facility 8 $0 $0 $0 $0 Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 30-day supply) 8 $19 / $35 5 / $70 5 $15 / $50 5 / $70 5 / 20% 5 $15 / $50 5 / $70 5 / 20% 5 20% 5 / 20% 5 / 20% 5 / 20% 5 Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 90-day supply by mail order) 8 $38 / $70 5 / $140 5 $30 / $100 5 / $140 5 / 20% 5 $30 / $100 5 / $140 5 / 20% 5 20% 5 / 20% 5 / 20% 5 / 20% 5 Generic Formulary and prescribed over-the-counter contraceptives for women 8 $0 $0 $0 $0 Durable medical equipment 50% coinsurance 3,5 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3,5 Diabetics supplies 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3,5 Prosthetics, orthotics (per visit) $40 $65 $65 20% coinsurance 3,5 Mental health hospitalization Inpatient 40% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 Mental health Outpatient (per visit) $40 $45 $45 20% coinsurance 3,5 Home-based applied behavioral analysis (per visit, for treatment of pervasive developmental disorder or autism) $ % coinsurance 3 $45 20% coinsurance 3,5 Chemical dependency hospitalization Inpatient 40% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 Chemical dependency Outpatient (per visit) $40 $45 $45 20% coinsurance 3,5 Emergency services for acute drug or alcohol detoxification (per visit) $150 5 $250 5 $ % coinsurance 3,5 Skilled nursing facility services (100 days per benefit period) 40% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 Home health services (per visit, 100 visits per calendar year) $40 20% coinsurance 3 $45 20% coinsurance 3,5 Hospice care Inpatient 40% coinsurance 3,5 $0 / admission $0 / admission $0 / admission Hospice care Outpatient (per visit) $40 $0 $0 $0

8 Small group Bronze 60 plans effective July 1, 2015 c Sharp 5000 / 60 / 30% c Sharp HSA* 4500 / 40% / 40% Benefits comparison Calendar year deductible (per individual/per family, applies only to those covered benefits indicated) $5,000 6 / $10,000 6 Integrated $4,500 4 / $9,000 4 Integrated Calendar year deductible for covered drugs (per member, applies only to those covered drugs indicated) Integrated Integrated Lifetime maximums n/a n/a Annual out-of-pocket maximum, including deductible (per individual/per family) 1 $6,250 1 / $12,500 1 $6,250 1 / $12,500 1 Primary Care Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $60 5,7 40% coinsurance 3,5 Specialist Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $ % coinsurance 3,5 Preventive care services (per visit) 2 $0 $0 Prenatal and postpartum office visits (per visit) $0 $0 Allergy injections (per visit) $ % coinsurance 3,5 Allergy testing (per visit) $ % coinsurance 3,5 Outpatient surgery 30% coinsurance 3,5 40% coinsurance 3,5 Radiology, pathology, hemodialysis, etc. (per visit) 30% coinsurance 3,5 40% coinsurance 3,5 Advanced radiology (including MRI, CT Scan, PET Scan, MRA, MRS, MUGA, SPECT) 30% coinsurance 3,5 40% coinsurance 3,5 Physical, occupational and speech therapy (per visit) $ % coinsurance 3,5 Hospitalization Inpatient 30% coinsurance 3,5 40% coinsurance 3,5 Emergency room (per visit, waived if admitted for inpatient hospital stay) $ % coinsurance 3,5 Urgent care (per visit) $120 5,7 40% coinsurance 3,5 Ambulance (in connection with hospital admission or emergency services) $ % coinsurance 3,5 Drugs administered in a practitioner s office, hospital or outpatient facility 8 $0 $0 Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 30-day supply) 8 $15 5 / $50 5 / $75 5 / 30% 5 40% 5 / 40% 5 / 40% 5 / 40% 5 Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 90-day supply by mail order) 8 $30 5 / $100 5 / $150 5 / 30% 5 40% 5 / 40% 5 / 40% 5 / 40% 5 Generic Formulary and prescribed over-the-counter contraceptives for women 8 $0 $0 Durable medical equipment 30% coinsurance 3,5 40% coinsurance 3,5 Diabetics supplies 30% coinsurance 3,5 40% coinsurance 3,5 Prosthetics, orthotics (per visit) $ % coinsurance 3,5 Mental health hospitalization Inpatient 30% coinsurance 3,5 40% coinsurance 3,5 Mental health Outpatient (per visit) $60 5,7 40% coinsurance 3,5 Home-based applied behavioral analysis (per visit, for treatment of pervasive developmental disorder or autism) 30% coinsurance 3,5 40% coinsurance 3,5 Chemical dependency hospitalization Inpatient 30% coinsurance 3,5 40% coinsurance 3,5 Chemical dependency Outpatient (per visit) $60 5,7 40% coinsurance 3,5 Emergency services for acute drug or alcohol detoxification (per visit) $ % coinsurance 3,5 Skilled nursing facility services (100 days per benefit period) 30% coinsurance 3,5 40% coinsurance 3,5 Home health services (per visit, 100 visits per calendar year) 30% coinsurance 3,5 40% coinsurance 3,5 Hospice care Inpatient $0 / admission $0 / admission 5 Hospice care Outpatient (per visit) $0 $0

9 Benefits comparison CalChoice Platinum plans effective July 1, 2015 CalChoice 90 HMO Premier 0 / 15 / 400 CalChoice 90 HMO Performance 0 / 15 / 15% Calendar year deductible (per individual/per family, applies only to those covered benefits indicated) None None Calendar year deductible for covered drugs (per member, applies only to those covered drugs indicated) None None Lifetime maximums None None Annual out-of-pocket maximum, including deductible (per individual/per family) 1 $3,500 / $7,000 $3,000 / $6,000 Primary Care Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $15 $15 Specialist Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $20 $30 Preventive care services (per visit) 2 $0 $0 Prenatal and postpartum office visits (per visit) $20 $30 Allergy injections (per visit) $15 $15 Allergy testing (per visit) $20 $30 Outpatient surgery 20% coinsurance 3 15% coinsurance 3 Radiology, pathology, hemodialysis, etc. (per visit) $0 $0 Advanced radiology (including MRI, CT Scan, PET Scan, MRA, MRS, MUGA, SPECT) $150 / procedure $100 / procedure Physical, occupational and speech therapy (per visit) $20 $30 Hospitalization Inpatient $400 / admission 15% coinsurance 3 Emergency room (per visit, waived if admitted for inpatient hospital stay) $150 15% coinsurance 3 Urgent care (per visit) $20 $30 Ambulance (in connection with hospital admission or emergency services) $100 15% coinsurance 3 Drugs administered in a practitioner s office, hospital or outpatient facility 7 $0 $0 Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 30-day supply) 7 $10 / $25 / $50 $10 / $25 / $50 Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 90-day supply by mail order) 7 $20 / $50 / $100 $20 / $50 / $100 Generic Formulary and prescribed over-the-counter contraceptives for women 7 $0 $0 Durable medical equipment 50% coinsurance 3 50% coinsurance 3 Diabetics supplies 20% coinsurance 3 20% coinsurance 3 Prosthetics, orthotics (per visit) $20 $30 Mental health hospitalization Inpatient $400 / admission 15% coinsurance 3 Mental health Outpatient (per visit) $20 $30 Home-based applied behavioral analysis (per visit, for treatment of pervasive developmental disorder or autism) $20 $30 Chemical dependency hospitalization Inpatient $400 / admission 15% coinsurance 3 Chemical dependency Outpatient (per visit) $20 $30 Emergency services for acute drug or alcohol detoxification (per visit) $150 15% coinsurance 3 Skilled nursing facility services (100 days per benefit period) $200 / admission 15% coinsurance 3 Home health services (per visit, 100 visits per calendar year) $20 $30 Hospice care Inpatient $0 $0 Hospice care Outpatient (per visit) $0 $0

10 Benefits comparison CalChoice Gold plans effective July 1, 2015 CalChoice 80 HMO Performance 0 / 20 / 25% CalChoice 80 HMO Premier 0 / 25 / 450 Calendar year deductible (per individual/per family, applies only to those covered benefits indicated) None $0 Calendar year deductible for covered drugs (per member, applies only to those covered drugs indicated) $150 / $300 $150 / $300 Lifetime maximums None None Annual out-of-pocket maximum, including deductible (per individual/per family) 1 $6,350 / $12,700 $6,350 / $12,700 Primary Care Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $20 $25 Specialist Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $45 $60 Preventive care services 2 (per visit) $0 $0 Prenatal and postpartum office visits (per visit) $45 $60 Allergy injections (per visit) $20 $25 Allergy testing (per visit) $45 $60 Outpatient surgery 25% coinsurance 3 25% coinsurance 3 Radiology, pathology, hemodialysis, etc. (per visit) $0 $60 Advanced radiology (including MRI, CT Scan, PET Scan, MRA, MRS, MUGA, SPECT) $175 / procedure $175 / procedure Physical, occupational and speech therapy (per visit) $45 $60 Hospitalization Inpatient 25% coinsurance 3 $450 / day (5-day max) Emergency room (per visit, waived if admitted for inpatient hospital stay) 25% coinsurance 3 $200 Urgent care (per visit) $45 $60 Ambulance (in connection with hospital admission or emergency services) 25% coinsurance 3 $150 Drugs administered in a practitioner s office, hospital or outpatient facility 7 $0 $0 Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 30-day supply) 7 $19 / $35 5 / $70 5 $19 / $35 5 / $70 5 Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 90-day supply by mail order) 7 $38 / $70 5 / $140 5 $38 / $70 5 / $140 5 Generic Formulary and prescribed over-the-counter contraceptives for women 7 $0 $0 Durable medical equipment 50% coinsurance 3 50% coinsurance 3 Diabetics supplies 20% coinsurance 3 20% coinsurance 3 Prosthetics, orthotics (per visit) $45 $60 Mental health hospitalization Inpatient 25% coinsurance 3 $450 / day (5-day max) Mental health Outpatient (per visit) $45 $60 Home-based applied behavioral analysis (per visit, for treatment of pervasive developmental disorder or autism) $45 $60 Chemical dependency hospitalization Inpatient 25% coinsurance 3 $450 / day (5-day max) Chemical dependency Outpatient (per visit) $45 $60 Emergency services for acute drug or alcohol detoxification (per visit) 25% coinsurance 3 $200 Skilled nursing facility services (100 days per benefit period) 25% coinsurance 3 $200 / day Home health services (per visit, 100 visits per calendar year) $45 $60 Hospice care Inpatient $0 $0 Hospice care Outpatient (per visit) $0 $0

11 CalChoice Silver plans effective July 1, 2015 CalChoice 70 HMO Premier 1800 / 30 / 750 CalChoice 70 HMO Performance 1800 / 35 / 30% Benefits comparison Calendar year deductible (per individual/per family, applies only to those covered benefits indicated) $1,800 / $3,600 6 $1,800 / $3,600 6 Calendar year deductible for covered drugs (per member, applies only to those covered drugs indicated) $200 / $400 $200 / $400 Lifetime maximums None None Annual out-of-pocket maximum, including deductible (per individual/per family) 1 $6,000 / $12,000 $6,250 / $12,500 Primary Care Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $30 $35 Specialist Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $60 $70 Preventive care services (per visit) 2 $0 $0 Prenatal and postpartum office visits (per visit) $60 $70 Allergy injections (per visit) $60 $35 Allergy testing (per visit) $60 $70 Outpatient surgery 30% coinsurance 3,5 30% coinsurance 3,5 Radiology, pathology, hemodialysis, etc. (per visit) $60 5 $30 5 Advanced radiology (including MRI, CT Scan, PET Scan, MRA, MRS, MUGA, SPECT) $250 / procedure 5 $300 / procedure 5 Physical, occupational and speech therapy (per visit) $50 $50 Hospitalization Inpatient $750 / day 5 30% coinsurance 3,5 Emergency room (per visit, waived if admitted for inpatient hospital stay) $ % coinsurance 3,5 Urgent care (per visit) $60 $70 Ambulance (in connection with hospital admission or emergency services) $250 30% coinsurance 3,5 Drugs administered in a practitioner s office, hospital or outpatient facility 7 $0 $0 Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 30-day supply) 7 $19 / $50 5 / $80 5 $19 / $50 5 / $100 5 Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 90-day supply by mail order) 7 $38 / $100 5 / $160 5 $38 / $100 5 / $200 5 Generic Formulary and prescribed over-the-counter contraceptives for women 7 $0 $0 Durable medical equipment 50% coinsurance 3,5 50% coinsurance 3,5 Diabetics supplies 20% coinsurance 3,5 20% coinsurance 3,5 Prosthetics, orthotics (per visit) $60 $70 Mental health hospitalization Inpatient $750 / day 5 30% coinsurance 3,5 Mental health Outpatient (per visit) $60 $70 Home-based applied behavioral analysis (per visit, for treatment of pervasive developmental disorder or autism) $60 $70 Chemical dependency hospitalization Inpatient $750 / day 5 30% coinsurance 3,5 Chemical dependency Outpatient (per visit) $60 $70 Emergency services for acute drug or alcohol detoxification (per visit) $ % coinsurance 3,5 Skilled nursing facility services (100 days per benefit period) $200 / day 5 30% coinsurance 3,5 Home health services (per visit, 100 visits per calendar year) $60 $70 Hospice care Inpatient $0 $0 Hospice care Outpatient (per visit) $0 $0

12 Benefits comparison CalChoice Bronze plans effective July 1, 2015 CalChoice 60 HMO Premier 2000 / 60 / 1500 CalChoice 60 HSA Performance 3750 / 40 / 40% CalChoice Sharp HSA Premier 4500 / 40 / 40% Calendar year deductible (per individual/per family, applies only to those covered benefits indicated) $2,000 / $4,000 6 $3,750 / $7,500 4 $4,500 4 / $9,000 4 Integrated Calendar year deductible for covered drugs (per member, applies only to those covered drugs indicated) Integrated with Medical Deductible Integrated with Medical Deductible Integrated Lifetime maximums None None Unlimited Annual out-of-pocket maximum, including deductible (per individual/per family) 1 $6,350 / $12,700 $6,350 / $12,700 $6,250 / $12,500 1 Primary Care Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $ % coinsurance 3,5 40% coinsurance 3,5 Specialist Physician office visit for consultation, treatment, diagnostic testing, etc. (per visit) $ % coinsurance 3,5 40% coinsurance 3,5 Preventive care services (per visit) 2 $0 $0 $0 Prenatal and postpartum office visits (per visit) $ % coinsurance 3,5 $0 5 Allergy injections (per visit) $ % coinsurance 3,5 40% coinsurance 3,5 Allergy testing (per visit) $ % coinsurance 3,5 40% coinsurance 3,5 Outpatient surgery 40% coinsurance 3,5 40% coinsurance 3,5 40% coinsurance 3,5 Radiology, pathology, hemodialysis, etc. (per visit) $ % coinsurance 3,5 40% coinsurance 3,5 Advanced radiology (including MRI, CT Scan, PET Scan, MRA, MRS, MUGA, SPECT) $400 / procedure 5 40% coinsurance 3,5 40% coinsurance 3,5 Physical, occupational and speech therapy (per visit) $ % coinsurance 3,5 40% coinsurance 3,5 Hospitalization Inpatient $1,500 / day (3-day max) 5 40% coinsurance 3,5 40% coinsurance 3,5 Emergency room (per visit, waived if admitted for inpatient hospital stay) $ % coinsurance 3,5 40% coinsurance 3,5 Urgent care (per visit) $ % coinsurance 3,5 40% coinsurance 3,5 Ambulance (in connection with hospital admission or emergency services) $ % coinsurance 3,5 40% coinsurance 3,5 Drugs administered in a practitioner s office, hospital or outpatient facility 7 $0 $0 $0 Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 30-day supply) 7 $19 / $60 5 / $ % 5 / 40% 5 / 40% 5 40% 5 / 40% 5 / 40% 5 / 40% 5 Generic Formulary / Brand Formulary / Non-Formulary / Specialty Formulary (medications up to a 90-day supply by mail order) 7 $38 / $120 5 / $ % 5 / 40% 5 / 40% 5 40% 5 / 40% 5 / 40% 5 / 40% 5 Generic Formulary and prescribed over-the-counter contraceptives for women 7 $0 $0 $0 Durable medical equipment 50% coinsurance 3,5 50% coinsurance 3,5 40% coinsurance 3,5 Diabetics supplies 20% coinsurance 3,5 20% coinsurance 3,5 40% coinsurance 3,5 Prosthetics, orthotics (per visit) $ % coinsurance 3,5 40% coinsurance 3,5 Mental health hospitalization Inpatient $1,500 / day (3-day max) 5 40% coinsurance 3,5 40% coinsurance 3,5 Mental health Outpatient (per visit) $ % coinsurance 3,5 40% coinsurance 3,5 Home-based applied behavioral analysis (per visit, for treatment of pervasive developmental disorder or autism) $ % coinsurance 3,5 40% coinsurance 3,5 Chemical dependency hospitalization Inpatient $1,500 / day (3-day max) 5 40% coinsurance 3,5 40% coinsurance 3,5 Chemical dependency Outpatient (per visit) $ % coinsurance 3,5 40% coinsurance 3,5 Emergency services for acute drug or alcohol detoxification (per visit) $ % coinsurance 3,5 40% coinsurance 3,5 Skilled nursing facility services (100 days per benefit period) $200 / day 5 40% coinsurance 3,5 40% coinsurance 3,5 Home health services (per visit, 100 visits per calendar year) $ % coinsurance 3,5 40% coinsurance 3,5 Hospice care Inpatient $0 / admission $0 / admission 5 $0 / admission 5 Hospice care Outpatient (per visit) $0 $0 5 $0 5

13 Footnotes c These plan designs are also available on Covered California. 1 Copayments and deductibles for supplemental benefits (Assisted Reproductive Technologies, Chiropractic Services, Adult Vision) do not apply to the annual out of pocket maximum. 2 Includes preventive services with rating of A or B from the US Preventive Services Task Force; immunizations for children, adolescents and adults recommended by the Centers for Disease Control and Prevention; and preventive care and screenings supported by the Health Resources and Services Administration for infants, children, adolescents and women. If preventive care is received at the time of other services, the applicable copayment for such services other than preventive care may apply. 3 Of contracted rates. 4 In high deductible health plans (HDHPs) linked to Health Savings Accounts (HSAs), each individual in a family plan must meet an amount of either $2,600 or the individual deductible, whichever is higher, until the family deductible is met. 5 Deductible applies. 6 Individuals enrolled in a family plan will reach the annual deductible maximum if the Member meets the individual deductible maximum amount or if any combination of enrolled family members meets the family deductible maximum amount, whichever comes first. 7 Deductible applies after the first 3 non-preventive visits. 8 Member cost-share will not exceed $200 per individual prescription of up to a 30-day supply of covered oral anti-cancer drug. * Sharp Health Plan provides integrated HSA Plans with our preferred partner, HealthEquity. Please refer to HSA eligibility requirements when considering these plans. Members may elect to open an HSA account in conjunction with an HDHP HSA compatible plan. Back to Plans Small group Platinum 90 plans Small group Gold 80 plans Small group Silver 70 plans Small group Bronze 60 plans CalChoice Platinum plans CalChoice Gold plans CalChoice Silver plans CalChoice Bronze plans