County of Sonoma 2006 PPO Benefit Comparison for Medicare Retirees
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1 2006 PPO Benefit Comparison for Medicare Retirees PPO Plan County Plan Option Deductible Ranking Out-of-Pocket Maximum Ranking Lifetime Maximum Ranking Physician Service Ranking Sonoma Non-PERS $200/$400 6 $3,000/$6,000 8 $1,000,000 or $3,000,000 for $1 mil for $3 mil No PPO PERSCare None 1 None None 1 0% 1 Non-PERS $20/$70 $1,00/$,000 4 $1,000,000 Marin Non-PERS $0 4 $1,000/$3,000 1 $2,000, % out-ofnetwork in general. 0% after $ copay for routine physical. 90% of scheduled charges out-ofnetwork 8 Monterey PERSCare None 1 None None 1 0% 1 PERSCare None 1 None None 1 0% 1 Non-PERS, POS $20/$70 $1,00/$4,00 (HMO) or $2,000/$4,000 (PPO) or $3,000/$6,000 (non-network) 3 None for HMO, $2,000,000 for PPO and non-network 0% after $ copay (HMO)/0% after $2 copay (PPO)/80% out-of-network Santa Cruz PERSCare None 1 None None 1 0% 1 PERSCare None 1 None None 1 0% 1 Average $10/$300 $2,000/$4,000 $3,000,000 Comparison Average is better than Sonoma County Average is better than Sonoma County Average is better than Sonoma County 0% after $20 copay innetwork/80% out-of-network Average is generally better than Sonoma County All plans coordinate with Medicare payments. In most cases, Medicare is the primary plan. Ranking shows how each benefit provision compares. Ranking is based on a scale of 1 to, 1 being the highest benefit to plan members and being the lowest benefit. PPO Page 1 As of August 30, 2006
2 2006 PPO Benefit Comparison for Medicare Retirees County Plan Option Surgery Ranking Hospital Service Ranking Per Hospital Admission Copay Sonoma Non-PERS No PPO PPO Plan Ranking Prescription Drug Ranking None 1 $/$ 2 PERSCare 0% 1 0% 1 None 1 $/$1/$4 Non-PERS None 1 $/$ 1 Marin Non-PERS 90% of scheduled charges out-of-network 90% of scheduled charges out-of-network $20 for non-blue Cross facility $/$/$20 3 Monterey PERSCare 0% 1 0% 1 None 1 $/$1/$4 PERSCare 0% 1 0% 1 None 1 $/$1/$4 Non-PERS, POS 0% HMO/90% PPO/80% out-of-network 0% HMO/90% PPO/80% out-of-network None 1 $/$/$2 4 Santa Cruz PERSCare 0% 1 0% 1 None 1 $/$1/$4 PERSCare 0% 1 0% 1 None 1 $/$1/$4 Average 80% outof-network 6 80% out-ofnetwork Comparison Equivalent Equivalent Equivalent 6 None 1 $/$1/$30 6 Sonoma County is better than average All plans coordinate with Medicare payments. In most cases, Medicare is the primary plan. Ranking shows how each benefit provision compares. Ranking is based on a scale of 1 to, 1 being the highest benefit to plan members and being the lowest benefit. PPO Page 2 As of August 30, 2006
3 2006 Kaiser Benefit Comparison for Medicare Retirees County Plan Options Deductible Ranking Out-of-Pocket Maximum Kaiser Plan Ranking Lifetime Maximum Ranking Physician Service Coinsurance Sonoma 1 Non-PERS option None 1 $1,00/$3,000 1 None 1 0% after $0 (SEIU) or $ (others) copay 1 Non-PERS option None 1 $1,00/$3,000 1 None 1 0% after $ copay 1 Non-PERS option None 1 $1,00/$3,000 1 None 1 0% after $ copay Marin 3 Non-PERS options None 1 $1,00/$3,000 1 None 1 0% after $0 or $ or $1 copay Monterey 1 PERS option None 1 $1,00/$3,000 1 None 1 0% after $ copay 7 Ranking for $ copay for $ copay, for $1 copay 1 PERS option None 1 $1,00/$3,000 1 None 1 0% after $ copay 7 1 Non-PERS option None 1 $1,00/$3,000 1 None 1 0% after $ copay No Kaiser plan Santa Cruz 1 PERS option None 1 $1,00/$3,000 1 None 1 0% after $ copay 7 1 PERS option None 1 $1,00/$3,000 1 None 1 0% after $ copay 7 1 Non-PERS option None 1 $1,00/$3,000 1 None 1 0% after $ copay Average None 1 $1,00/$3,000 (imposed by Kaiser) Comparison (4) Equivalent Equivalent Equivalent 1 None 1 0% after $ copay Sonoma County is better than average All Kaiser plans shown on this exhibit are Medicare Advantage plans. Ranking shows how each benefit provision compares. Ranking is based on a scale of 1 to, 1 being the highest benefit to plan members and being the lowest benefit. (4) Kaiser Page 1 As of August 30, 2006
4 2006 Kaiser Benefit Comparison for Medicare Retirees County Plan Options Surgery Coinsurance Ranking Hospital Coinsurance Ranking Kaiser Plan Per Hospital Admission Copay Sonoma 1 Non-PERS option 0% 1 0% 1 None 1 Ranking Prescription Drug Ranking $0 (SEIU) or $/$ (others) 1 Non-PERS option 0% 1 0% 1 None 1 $/$ 4 1 Non-PERS option 0% 1 0% 1 None 1 $/$ 4 4 for $ copay Marin 3 Non-PERS options 0% 1 0% 1 None 1 $/$ or $/$ or $7/$7 4 for $/$, 6 for $7/$7 Monterey 1 PERS option 0% 1 0% 1 None 1 $/$1 1 PERS option 0% 1 0% 1 None 1 $/$1 1 Non-PERS option 0% 1 0% 1 None 1 $/$ 4 No Kaiser plan Santa Cruz 1 PERS option 0% 1 0% 1 None 1 $/$1 1 PERS option 0% 1 0% 1 None 1 $/$1 1 Non-PERS option 0% 1 0% 1 None 1 $/$ 6 Average 0% 1 0% 1 None 1 $/$ 6 Comparison Equivalent Equivalent Equivalent Sonoma County is better than average All Kaiser plans shown on this exhibit are Medicare Advantage plans. Ranking shows how each benefit provision compares. Ranking is based on a scale of 1 to, 1 being the highest benefit to plan members and being the lowest benefit. (4) Kaiser Page 2 As of August 30, 2006
5 2006 Other HMO Benefit Comparison for Medicare Retirees Other HMO Plans County Plan Options Deductible Ranking Out-of-Pocket Maximum Ranking Lifetime Maximum Ranking Physician Service Coinsurance Ranking Sonoma 1 PacifiCare option None 1 $1,000/$3,000 3 None 1 0% after $ copay 3 2 PacifiCare options (Medicare Advantage and Medicare Supplement) None 1 None None 1 0% after $0 or $ copay None 1 None None 1 0% after $ copay 6 3 for $ copay 2 County options and 1 Health Net option None 1 Plan A: none Plan B: $1,00/$3,000/$4,00 Health Net: $1,00/member for Plan A, 6 for Plan B, 7 for Health Net None 1 Plan A: 0% Plan B: 0% after $ copay Health Net: 0% 1 for Plan A, 3 for Plan B, 1 for Health Net Marin Monterey No other HMO None 1 None None 1 0% after $ copay 6 None 1 None None 1 0% after $ copay 6 Santa Cruz 2 Blue Shield HMO options, 1 Blue Shield out-of-state option, and 2 PacifiCare options BS OOS plan: $20/$00 Others: None for BS OOS, 1 for Others BS HMOs: $1,00/$3,000/$4,00 BS OOS: $1,000/$2,000 PacifiCare: None 6 for BS HMOs, 1 for BS OOS, for PacifiCare BS OOS: $6,000,000 Others: None for BS OOS, 1 for Others BS: 0% after $ PCP copay or $30 specialist copay BS OOS: 80% PacifiCare High: 0% after $ copay PacifiCare Low: 0% after $1 PCP copay or $2 specialist copay for BS, for BS OOS, 3 for PacifiCare High, for PacifiCare Low None 1 None None 1 0% after $ copay 6 None 1 None None 1 0% after $ copay 6 2 Health Net options None 1 $1,00/$3,000/$4,00 6 None 1 HN High: 0% HN Low: 0% after $ copay 1 for HN High, 3 for HN Low Average None 1 $1,00/$3,000/$4,00 6 None 1 0% after $ copay 6 Comparison Equivalent Sonoma County is better than average Equivalent Sonoma County is better than average Ranking shows how each benefit provision compares. Ranking is based on a scale of 1 to, 1 being the highest benefit to plan members and being the lowest benefit. Other HMO Page 1 As of August 30, 2006
6 2006 Other HMO Benefit Comparison for Medicare Retirees County Plan Options Surgery Coinsurance Ranking Hospital Coinsurance Ranking Per Hospital Admission Copay Ranking Prescription Drug Ranking Sonoma 1 PacifiCare option 0% 1 0% 1 None 1 $7/$14 2 PacifiCare options (Medicare Advantage and Medicare Supplement) Other HMO Plans 0% 1 0% 1 None 1 $ copay plan: $7/$14 for $ copay, $0 copay plan: $/$20 8 for $0 copay 0% 1 0% 1 None 1 $/$1/$4 6 2 County options and 1 Health Net option Plan A: 0% at Medical Center Plan B: 0% at Medical Center Health Net: 0% 8 for Plan A, 8 for Plan B, 1 for Health Net Plan A: 0% at Medical Center Plan B: 0% at Medical Center Health Net: 0% 8 for Plan A, 8 for Plan B, 1 for HN Plan A: None Plan B: $0/day Health Net: None 1 for Plan A, for Plan B, 1 for HN Plan A: no copay Plan B: $3/$3 Health Net: $/$ 1 for Plan A, 2 for Plan B, 3 for HN Marin Monterey No other HMO 0% 1 0% 1 None 1 $/$1/$4 6 0% 1 0% 1 None 1 $/$1/$4 6 Santa Cruz 2 Blue Shield HMO options, 1 Blue Shield out-of-state option, and 2 PacifiCare options BS: 0% BS OOS: 80% PacifiCare High: 0% PacifiCare Low: 0% after $20 copay/surgery 1 for BS, for BS OOS, 1 for PacifiCare High, 7 for PacifiCare Low BS High: 0% BS Low: 0% BS OOS: 80% PacifiCare High: 0% PacifiCare Low: 0% 1 for BS High, 1 for BS Low, for BS OOS, 1 for PacifiCare High, 1 for PacifiCare Low BS High: None BS Low: $20 BS OOS: None PacifiCare High: None PacifiCare Low: $00 1 for BS High, 7 for BS Low, 1 for BS OOS, 1 for P High, 9 for P Low BS: $/$20/$3 BS OOS: $/$ PacifiCare: $7/$14 0% 1 0% 1 None 1 $/$1/$4 6 0% 1 0% 1 None 1 $/$1/$4 6 2 Health Net options 0% 1 0% 1 None 1 $/$/$3 6 for BS, 4 for BS OOS, for PacifiCare Average 0% 1 0% 1 None 1 $/$/$3 6 Comparison Equivalent Equivalent Equivalent Sonoma County is better than average Ranking shows how each benefit provision compares. Ranking is based on a scale of 1 to, 1 being the highest benefit to plan members and being the lowest benefit. Other HMO Page 2 As of August 30, 2006
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