RETIRED LABORERS HEALTH AND WELFARE PLAN - COMPARISON OF BENEFITS - EFFECTIVE SEPTEMBER 1, 2015 LABORERS

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "RETIRED LABORERS HEALTH AND WELFARE PLAN - COMPARISON OF BENEFITS - EFFECTIVE SEPTEMBER 1, 2015 LABORERS"

Transcription

1 When You Can Change Plans Type of Plan Geographical Area Covered Choice of Physicians Specialized Care: In-Network Outside Network Out-of-Area Care Claim Forms Annual Deductible RETIRED HEALTH AND WELFARE PLAN - COMPARISON OF BENEFITS - EFFECTIVE SEPTEMBER 1, 2015 You are free to change plans twice in a calendar year. You and your dependents must be enrolled in the same Plan that is, you may not enroll in the and your dependents enroll in. To change medical plans, request a Retired Plan Application Form from the Fund Office, your Local Union or go to our website, to print or order the form. The Plan provides traditional, fee-for-service medical benefits and offers higher coverage Care is provided through physicians or when you use Anthem Blue Cross providers. medical staff at a facility For Medicare eligible individuals, the Plan will Care is provided through physicians or located in the member's service area. pay 100% of the Medicare eligible individual s medical staff at a facility Medicare will not pay for or provide Part A (Hospitalization) deductible and/or located in the member's service area. benefits for services received outside the coinsurance; 100% of the Medicare eligible Kaiser s Medicare Program. individual s responsibility under Part B provided the expenses are covered under the Plan. Expenses incurred outside the United States and its Territories are covered if due to Emergency You must reside within Kaiser Service Area. Services. If the expense is covered, normal benefits will apply. Unlimited. Use of Anthem Blue Cross physicians result in lower out-of-pocket expenses. You select any specialist. You select any specialist. Out of network benefits apply to treatment anywhere in the United States, its territories and possessions. Services outside United States may be covered if due to emergency. None. $150 per individual, maximum of $450 per family per Plan Year. Does not apply to Inpatient Hospital, Physical Exam and Prescription Drug benefits. Deductible amount applied in December, January and February will be carried forward to following Plan Year. Each member may use any Physician. Self-referral to specialists such as optometry, chemical dependency, psychiatry, and OB/Gyn. Your physician refers you to other specialists. An outside specialist requires specific referral from your Plan Physician. Cost Sharing is consistent with Plan coverage required for services if provided by a Plan Provider or referred by a Physician. Cost Sharing for Emergency Care, Post-Stabilization Care, and Out-of-Area Urgent Care from a Non Plan Provider is the Cost Sharing for a plan provider and subject to authorization. Required from non- providers for emergency, out-of-area urgent care and post stabilization care. None. Page 1 of 6

2 Annual Benefit Maximum Inpatient Hospital Medical/Surgery Mental Health $750,000 per person, $2,000 reinstatement per None. Some restrictions apply. $1,500 maximum out-of-pocket per individual up to $3,000 Plan Year. Does not apply to Prescription Drug. per family per year. Not subject to Deductible. 100% for all covered benefits and services at 100% for all covered benefits and services at Anthem Blue Cross Hospital: 85% of 1st medical facilities. medical facilities. $10,000 and 100% thereafter of negotiated rates. Non- Anthem Blue Cross Hospital: 65% of 1st $10,000 and 100% thereafter of allowed charges. Exception: For emergencies and members residing outside California 85%) Total Hip or Knee Replacement Surgery Same as Medical/Surgery above but not to exceed $30,000 Maximum Plan Allowance. Skilled Nursing Facility/ECF 100% when authorized by a Plan physician. 100% for up to 100 days per benefit period when authorized by a Plan physician. Alcohol and Substance Abuse Utilization Review Outpatient Hospital Care Emergency Room Hospital Ambulatory Surgery Center Home Health Care Hospice Care Automatic part of Plan procedures. Required for most hospital stay. Non-PPO elective admissions only - 20% penalty of first $10,000 of allowed charges for non-compliance. Anthem Blue Cross - 90% of negotiated rates. Non-Anthem Blue Cross 90% of allowed charges. Anthem Blue Cross - 90% of negotiated rate after a $25 copayment. Non-Anthem Blue Cross - 90% of allowed charges after a $50 copayment. Copayment waived under certain circumstances. Anthem Blue Cross - 90% of negotiated rates. Non-Anthem Blue Cross - $500 max per day. 100% for detoxification and rehabilitation services when authorized by a Plan physician. Automatic part of Plan procedures. $10 copayment per visit for most outpatient services. $50 copayment per visit. Waived if admitted. 100% for detoxification and rehabilitation services when authorized by a Plan physician. 100% at a medical facility, subject to a $10 copayment. 90% of covered charges - only upon referral by 100% when authorized by a Plan physician for part-time intermittent care. Case Management. 90% of covered charges - only upon referral by 100% when selected as alternative to traditional services and authorized by a Plan physician. Case Management. Page 2 of 6

3 Ambulance Physician Fees: Office Visits Electronic/On-line Medical Evaluation 100% per trip 75% of Allowed Charge*, less $20 copayment per visit. Not subject to Deductible. Member must use a physician through LiveHealth Online Service. 100% of allowed charge after $10 copayment per visit. 100% after $10 copayment per visit. N/A 100% after $10 copayment per visit. N/A Surgery Inpatient - 100%. Outpatient - 100% after a $10 copayment. Inpatient - 100%. Outpatient - 100% after a $10 copayment. Physical Exam Not subject to Deductible and Physician Office Visit copayment. Retirees and spouse: $300 maximum per Plan Year; children older than 2 years old: $200 maximum per Plan Year. 100% after a $10 copayment. 100% after a $10 copayment. Emergency Room Physician Immunizations Inoculations Outpatient Substance Abuse Treatment Mental Health Outpatient Lab Test, X-Ray, MRI, CT Scan Chiropractic Benefits Physical Therapy Durable Medical Equipment Hearing Aids Device Dental Care Inclusive with hospital charges see Emergency Room Hospital. 100%. Individual Therapy: 100% after $10 copayment per visit. Group Therapy: 100% after $5 copayment per visit. Inclusive with hospital charges see Emergency Room Hospital. 75% of Allowed Individual Therapy: 100% after $10 copayment per visit. Charge*, less $20 copayment per visit. Group Therapy: 100% after $5 copayment per visit. 100%. $10 copayment visit for manual manipulation $40 per visit up to 20 visits per Plan Year. Not covered. or subluxation of the spine as diagnosed by x- X-rays limited to $100 per Plan Year. ray and prescribed by a Plan physician. 100% after a $10 copayment per visit. 100% when prescribed by a Plan physician and in accordance with Health Plan DME Formulary guidelines. No hardware appliances are covered. $1,200 maximum per ear/device per 36 months. Only testing or exam is covered. Two optional dental benefits, Delta Dental and Delta Care USA, are available at an additional monthly cost of $85 for Delta Dental or $52 for Delta Care USA whether you enroll in the or Kaiser. See the enclosed Comparison of Dental Plans. You must pay for this coverage for a minimum of 6 months. You are allowed to change dental plans every March 1. Page 3 of 6

4 Vision Care Optional vision benefit is available provided through Anthem Blue Cross Blue View Vision network for an additional monthly cost of $11. You must pay for this coverage for a minimum of 6 months. Frequency: Exam, lenses & frames 12 months Copays: $10 exam, $15 lenses, $0 frames, $0 contacts Max Allowance: $145 frames, $120 contacts Refer to Group Number OptumRx benefits provided through Fund. Kaiser provides for an eye exam only at 100% after a $10 copayment per exam. Optional vision benefit is available provided through Anthem Blue Cross Blue View Vision network for an additional monthly cost of $11. You must pay for this coverage for a minimum of 6 months. See Direct Payment Plan for benefits. Senior Advantage provides up to $150 eyewear allowance every 24 months. Optional vision benefit is available provided through Anthem Blue Cross Blue View Vision network for an additional monthly cost of $11. You must pay for this coverage for a minimum of 6 months. See Direct Payment Plan for benefits. Prescription Drugs Toll-Free Numbers Page 4 of 6 Retail Participant pays copayment per prescription below. 30 day supply maximum per prescription: Generic - $10 Formulary Brand Name - $20 Non-Formulary Brand Name - $30 Mail Order Participant pays copayment per prescription below. 90 day supply maximum per prescription: Generic - $20 Formulary Brand Name - $40 Non-Formulary Brand Name - $60 Mail Order is mandatory for maintenance drugs after 3 fills. Maximum - $20,000 per calendar year combined retail and mail order. If a generic equivalent is available and you or Physician prefer brand name, you will pay for the difference in cost between generic and brand name Participant pays copayment per prescription below at pharmacies; 100 day supply of generic or medically necessary prescribed brand name drugs in accordance with Health Plan Formulary guidelines. No maximum. Copayment: Generic - $5 Brand Name - $ (English) (Spanish) Refer to Group Number when calling. Participant pays copayment per prescription below for covered drugs in accordance with Health Plan Formulary guidelines. No maximum. At a Kaiser Pharmacy - Participant pays copayment per prescription below. 30 day supply maximum per prescription: Generic - $5 Brand Name - $10 Mail Order - Participant pays copayment per prescription below. 100 day supply maximum per prescription: Generic - $10 Brand Name - $20 *Allowed Charge 75% of the negotiated rate for Anthem Blue Cross providers or 75% of allowed charge for non-anthem Blue Cross providers. This Comparison of Benefits is intended only as a summary of the benefits provided by each Plan. All exclusions and limitations of benefit coverage have not been included and may vary slightly from Plan to Plan. The contents of this comparison are not to be construed or accepted as a substitute for the provisions of the Retired Laborers s Rules and Regulations or s contract.

5 Laborers Health and Welfare Trust Fund for Northern California 220 Campus Lane * Fairfield, California Telephone: (707) Toll-Free: (800) Website: TO: ALL RETIRED AND THEIR ELIGIBLE DEPENDENTS COVERED UNDER THE RETIRED PLAN EFFECTIVE SEPTEMBER 1, 2015 The Trust Fund offers Retired Participants and their eligible dependents a choice between two health plans: Laborers a Health Maintenance Organization (HMO) You and your eligible dependents may elect coverage under the Laborers or. Kaiser provides benefits at either no cost to you or with limited copayments; however, Kaiser limits your choice of physicians and facilities. The Laborers provides traditional fee-for-service benefits and you may use any physician or hospital you wish, however, using an Anthem Blue Cross Prudent Buyer Plan provider may lower your out-of-pocket costs. The Comparison of Benefits is designed to help you choose a medical plan that suits your entire family s health care needs. We urge you to review the Comparisons and accompanying Retired Plan Rate Sheet before selecting a plan. You are allowed to change your plan no more than twice per calendar year. Whether you select the Laborers or a, you must complete a Laborers Retired Plan Application Form. However, you must also complete a Senior Advantage (KPSA) election form if you have Medicare and chose. All forms that require completion must be mailed to the Trust Fund Office at the above address do not mail any of the forms directly to. NOTIFY TRUST FUND OFFICE OF ANY CHANGE IN DEPENDENT STATUS Whether you enroll in the Laborers or, you must notify the Trust Fund Office of any change in dependent status by completing a new Enrollment Form and submitting the required documents along with it. For example, if you want to add a dependent, such as a spouse, complete a new Enrollment Form and submit the appropriate document as requested on the form. If you want to delete a dependent, you must also submit a new Enrollment Form. If you fail to notify the Trust Fund Office of a change in dependent status, it may delay payment of claims. Enrollment Forms are available through your Local Union, the Trust Funds web site or by calling the Trust Fund Office at the above telephone number. If you need more information or have any questions concerning this insert, please do not hesitate to contact the Trust Fund Office. The staff will be happy to assist you. AUGUST 21, 2015 Page 5 of 6 Sincerely, BOARD OF TRUSTEES

6 HEALTH AND WELFARE TRUST FUND FOR NORTHERN CALIFORNIA RETIRED PLAN RATE SHEET MONTHLY SELF-PAYMENT RATES EFFECTIVE MARCH 1, 2015 If you earned less than 10 Years of Credited Service, you are under age 55, or you are a former Special Plan employee, your premium is 100% of the rate specified below. If you meet one of the following criteria, you will pay either 50% or 75% of the specified amount below: 50% - You are age 55 or over (age 55 means the month following your 55 th birthday) and earned 25 Years of Credited Service, or Regardless of age and Years of Credited Service, you were approved a Disability Pension based on a Social Security Disability Award, or Regardless of Years of Credited Service, you are age 70 (age 70 means the month following your 70 th birthday). 75% - You are age 55 or over and earned Years of Credited Service. NOTE: The rates below DO NOT include the cost of coverage for dental and/or vision benefits. If you have elected dental and/or vision coverage, these benefits will be provided at an additional monthly cost of $85.00 for Delta Dental or $52.00 for Delta Care USA and $11.00 for vision, or $96.00 for both Delta Dental and vision or $63.00 for both Delta Care USA and vision. TYPE OF COVERAGE DIRECT PAYMENT PLAN KAISER PERMANENTE (Non-Medicare Eligible) One Medicare $ NOT AVAILABLE $ Two Medicare $ NOT AVAILABLE $ KAISER PERMANENTE SENIOR ADVANTAGE ( Medicare-Risk Program) One Non-Medicare $ $1, NOT AVAILABLE Two Non-Medicare $1, $2, NOT AVAILABLE One Medicare and One Non-Medicare $1, $1, $1, One Medicare and Two Non-Medicare $1, $2, $2, Family (3 or more) $1, ALL family members are Non-Medicare. $2, ALL family members are Non-Medicare. $ per Medicare eligible family member. Non-Medicare family members may enroll in Kaiser Non-Medicare Plan. If your family mix is different from above or your type of coverage is not shown, call the Fund Office for the specific rates. Rev. 7/3/2015 Page 6 of 6

KAISER PERMANENTE PLAN (Non-Medicare Eligible)

KAISER PERMANENTE PLAN (Non-Medicare Eligible) CEMENT MASONS HEALTH AND WELFARE TRUST FUND FOR NORTHERN CALIFORNIA RETIRED CEMENT MASONS AND THEIR ELIGIBLE DEPENDENTS EFFECTIVE JANUARY 1, 2015 GENERAL When You Can Change Plans Type of Plan, Service

More information

When You Can Change Plans. Care is provided through physicians or medical staff at a Kaiser Permanente facility located in the member's service area.

When You Can Change Plans. Care is provided through physicians or medical staff at a Kaiser Permanente facility located in the member's service area. CEMENT MASONS HEALTH AND WELFARE TRUST FUND ACTIVE CEMENT MASONS AND THEIR ELIGIBLE DEPENDENTS EFFECTIVE FEBRUARY 1, 2013 PLAN FEATURES DIRECT PAYMENT PLAN KAISER PERMANENTE When You Can Change Plans Type

More information

OPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVES and EARLY RETIREES

OPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVES and EARLY RETIREES PPO Kaiser Permanente For Non-PPO Providers Employee Premium None None None None None Explanation of s and Options Available to You If you choose a doctor who is not contracted with Anthem Blue Cross the

More information

OPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVE and RETIRED PARTICIPANTS

OPERATING ENGINEERS HEALTH & WELFARE FUND BENEFIT PLANS SUMMARY COMPARISON FOR ACTIVE and RETIRED PARTICIPANTS Employee Premium None None None None None Explanation of Plans and Options Available to You Deductible Annual Out-of-Pocket Calendar Year (Applicable to members who reside in California & Nevada Only.)

More information

Carpenters Health & Welfare Trust Fund for California Retiree Plan Comparison

Carpenters Health & Welfare Trust Fund for California Retiree Plan Comparison Carpenters Health & Welfare Trust Fund for California Retiree Plan Comparison Information Needed: Eligibility, Benefits, COBRA or Disability Claims: Indemnity Medical Plan Indemnity Hearing Aid Benefit

More information

California Ironworkers Field Welfare Plan 1/1/2014 Open Enrollment Benefit Plan Comparison Non-Medicare Retired Participants Residing in Nevada

California Ironworkers Field Welfare Plan 1/1/2014 Open Enrollment Benefit Plan Comparison Non-Medicare Retired Participants Residing in Nevada Non- Choice of Providers Calendar Year Deductible *The Fund s Calendar Year Deductible is never waived. However, some services are not subject to the Deductible. If you live in Nevada, your network of

More information

Fee-for-Service. Medicare Supplemental Retiree Health Plans

Fee-for-Service. Medicare Supplemental Retiree Health Plans Sheet Metal Workers Health Plan of Southern California, Arizona & Nevada April 2011 Summary Comparison Of Benefits Available under the Fee-for-Service and Medicare Supplemental Retiree Health Plans Important:

More information

RETIREE OPEN ENROLLMENT 2014

RETIREE OPEN ENROLLMENT 2014 RETIREE OPEN ENROLLMENT 2014 The month of August 2014 is open enrollment for eligible retirees to switch from one retiree health plan to another. Open enrollment is also the time when you are allowed to

More information

Health Plans Comparison Chart

Health Plans Comparison Chart Health Plans Comparison Chart PPO Deductible Coinsurance (Plan pays) Annual Out-of-Pocket Maximum (Medical) (all medical s, deductibles and coinsurance for covered services will apply. Once limit is met,

More information

Los Rios Community College District KAISER PERMANENTE

Los Rios Community College District KAISER PERMANENTE Los Rios Community College District KAISER PERMANENTE GROUP # 602838: Early Retiree DHMO Plan (under age 65 or over 65 w/o Medicare A & B) Senior Advantage (age 65+ with Medicare A & B) In order to continue

More information

S c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/14-6/30/15

S c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/14-6/30/15 S c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/14-6/30/15 This information sheet is for reference only. Please refer to Evidence of Coverage requirements, limitations

More information

S c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/15-6/30/16

S c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/15-6/30/16 S c h o o l s I n s u r a n c e G r o u p Health Net Plan Comparison Fiscal Year 7/1/15-6/30/16 This information sheet is for reference only. Please refer to Evidence of Coverage requirements, limitations

More information

Summary of Benefits and Coverage What this Plan Covers & What it Costs

Summary of Benefits and Coverage What this Plan Covers & What it Costs This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the plan document at www.mpiphp.org or by calling 1-855-275-4674. Important Questions Answers

More information

BAKERSFIELD CITY SCHOOL DISTRICT

BAKERSFIELD CITY SCHOOL DISTRICT BAKERSFIELD CITY SCHOOL DISTRICT INSURANCE PLANS for RETIREES 2015-2016 GENERAL INFORMATION About DISTRICT Plans for Retirees And INDIVIDUAL Retiree Plans, SISC Sponsored Retirees of the Bakersfield City

More information

2016 Retiree Open Enrollment Benefits Briefing Non Medicare

2016 Retiree Open Enrollment Benefits Briefing Non Medicare 2016 Retiree Open Enrollment Benefits Briefing Non Medicare October 28: Bankhead Theater, Livermore October 29: The Grand Theater, Tracy LLNL-PRES-678554 This work was performed under the auspices of the

More information

Operating Engineers Public Employees Health and Welfare Trust Fund Plan D vs PERS CHOICE and PERS SELECT PPO Plan

Operating Engineers Public Employees Health and Welfare Trust Fund Plan D vs PERS CHOICE and PERS SELECT PPO Plan Calendar Year Deductible $500 Individual / $1,000 Family per calendar year Does not apply to PPO physician office visits, PPO preventive care or hospital emergency room charges for an emergency medical

More information

ROCHESTER INSTITUTE OF TECHNOLOGY 2014 Medical Benefits Comparison Chart Medicare-Eligible Retirees in the Rochester Area

ROCHESTER INSTITUTE OF TECHNOLOGY 2014 Medical Benefits Comparison Chart Medicare-Eligible Retirees in the Rochester Area Contacting the Carrier Voice: (877) 883-9577 TTY: (585) 454-2845 Website: Voice: (800) 665-7924 TTY: (800) 252-2452 Website: www.excellusbcbs.com www.mvphealthcare.com Deductible Carry Over None None Deductible,

More information

Medical Benefits Analysis

Medical Benefits Analysis Medical Benefits Analysis (Active and Retired Under Age 65) Insurance Plan Health Net 5KF Kaiser Maximum Lifetime Benefit Deductible Maximum Out-of-Pocket Hospitalization Outpatient Surgery Emergency Room

More information

Kraft Foods Group, Inc. Retiree Medical and Prescription Plan Summary High Deductible Health Plan

Kraft Foods Group, Inc. Retiree Medical and Prescription Plan Summary High Deductible Health Plan General Provisions Deductible (eligible medical and prescription drug expenses apply to the deductible) Kraft Foods Group, Inc. Retiree Medical and Prescription Plan Summary Care can be obtained in-network

More information

Benefits At A Glance Plan C

Benefits At A Glance Plan C Benefits At A Glance Plan C HIGHLIGHTS OF WELFARE FUND BENEFITS WELFARE FUND BENEFITS IN BRIEF Medical and Hospital Benefits Empire BlueCross BlueShield Plan C-1 Empire BlueCross BlueShield Plan C-2 All

More information

Your Plan: Anthem Silver HMO 1500/30%/6550 Your Network: California Care HMO

Your Plan: Anthem Silver HMO 1500/30%/6550 Your Network: California Care HMO Your Plan: Anthem Silver HMO 1500/30%/6550 Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does

More information

Summary of Benefits and Coverage What this Plan Covers & What it Costs - 2015

Summary of Benefits and Coverage What this Plan Covers & What it Costs - 2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the plan document at www.mpiphp.org or by calling 1-855-275-4674. Important Questions Answers

More information

Pace University CIGNA Medical Detailed Benefit Summaries July 1, 2015 - June 30, 2016

Pace University CIGNA Medical Detailed Benefit Summaries July 1, 2015 - June 30, 2016 Consumer Core HDHP In Net $50 (ONLY APPLICABLE TO THOSE Network Core $25 ALREADY ENROLLED) Network Choice Fund In Network In Network In Network Deductible $1,300/$2,600 (Cumulative) N/A N/A Coinsurance

More information

[2015] SUMMARY OF BENEFITS H1189_2015SB

[2015] SUMMARY OF BENEFITS H1189_2015SB [2015] SUMMARY OF BENEFITS H1189_2015SB Section I You have choices in your health care One choice is to get your Medicare benefits through Original Medicare (fee-for-service Medicare). Original Medicare

More information

Carpenters Health & Welfare Trust Fund for California

Carpenters Health & Welfare Trust Fund for California Carpenters Health & Welfare Trust Fund for California Comparison for Plan B & Flat Rate Benefits Information Needed: Eligibility, Benefits, COBRA, Disability, or Life and Accidental Death and Dismemberment

More information

Independent Health s Medicare Passport Advantage (PPO)

Independent Health s Medicare Passport Advantage (PPO) Independent Health s Medicare Passport Advantage (PPO) (a Medicare Advantage Preferred Provider Organization Option (PPO) offered by INDEPENDENT HEALTH BENEFITS CORPORATION with a Medicare contract) Summary

More information

Summary of Benefits Community Advantage (HMO)

Summary of Benefits Community Advantage (HMO) Summary of Benefits Community Advantage (HMO) January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list

More information

State Retiree Medicare Advantage Plans

State Retiree Medicare Advantage Plans State Retiree Medicare Advantage Plans October/November 2015 Copyright 2013 by The Segal Group, Inc. All rights reserved. Your 2016 Retiree Benefits www.cms.illinois.gov/thetrail 2 Eligibility Who is Required

More information

LEGACY PLAN Medical In-Ntwk Out-of-Ntwk

LEGACY PLAN Medical In-Ntwk Out-of-Ntwk Preventive Services Age, gender and frequency criteria Adult physical/immunizations Well child visits/immunizations Screenings 0 Co-Insurance (after deductible) Out-of-Pocket Maximums Office Visit (copays)

More information

Arizona State Retirement System Plan Benefit Information for Medicare Eligible Members

Arizona State Retirement System Plan Benefit Information for Medicare Eligible Members Arizona State Retirement System Plan Benefit Information for Medicare Eligible Members Benefits Effective January 1, 2012 UHAZ12HM3349753_000 H0303_110818_013543 Summary of the UnitedHealthcare plans

More information

Medical Plan Comparison - Retirees Age 65 or Over

Medical Plan Comparison - Retirees Age 65 or Over * Plan Type Medicare Cost Plan with Prescription Coordinates with Medicare and includes Medicare prescription drug program Medicare Cost Plan with Prescription Medicare Advantage Plan with Prescription

More information

Health Alliance Plan. Coverage Period: 01/01/2014-12/31/2014. document at www.hap.org or by calling 1-800-759-3436.

Health Alliance Plan. Coverage Period: 01/01/2014-12/31/2014. document at www.hap.org or by calling 1-800-759-3436. Health Alliance Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2014-12/31/2014 Coverage for: Individual Family Plan Type: HMO This is only a summary.

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: Anthem BlueCross BlueShield Blue Access PPO Option D58 / Rx Option 8 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 12/01/2013-11/30/2014 Coverage For: Individual/Family

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: HealthKeepers Anthem HealthKeepers 20 POS / $10/$20/$35/20% Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2015-12/31/2015 Coverage For: Individual/Family

More information

BRYN MAWR COLLEGE MEDICAL INSURANCE BENEFITS COMPARISON EFFECTIVE NOVEMBER 1, 2009

BRYN MAWR COLLEGE MEDICAL INSURANCE BENEFITS COMPARISON EFFECTIVE NOVEMBER 1, 2009 BENEFITS Description of Plan Annual Deductible (January - December) - Individual - Family PERSONAL CHOICE PPO BRYN MAWR COLLEGE KEYSTONE HEALTH PLAN EAST KEYSTONE POS Provides comprehensive health Provides

More information

Northeastern University 2015 Medical Benefits

Northeastern University 2015 Medical Benefits Northeastern University 2015 Medical Benefits Northeastern s 2015 Open Enrollment Effective Date: January 1, 2015 2015 Medical Plan Options Blue Choice New England Core POS Plan New Plan Blue Choice New

More information

2013 IBM Health Benefit Comparison Charts

2013 IBM Health Benefit Comparison Charts 203 IBM Health Benefit Comparison Charts for IBM Active Employees These Health Benefit Comparison Charts provide a summary overview of the coverage available for medical services, mental health/substance

More information

HEALTH CARE DENTAL CARE

HEALTH CARE DENTAL CARE UNIVERSITY OF DAYTON MEDICARE SUPPLEMENT PLAN OPEN ENROLLMENT HEALTH CARE DENTAL CARE 2016 Office of Human Resources 300 College Park Dayton, OH 45469-1614 Phone 937-229-2541 Fax 937-229-2009 O65 1 Health

More information

Health Insurance Matrix 01/01/16-12/31/16

Health Insurance Matrix 01/01/16-12/31/16 Employee Contributions Family Monthly : $121.20 Bi-Weekly : $60.60 Monthly : $290.53 Bi-Weekly : $145.26 Monthly : $431.53 Bi-Weekly : $215.76 Monthly : $743.77 Bi-Weekly : $371.88 Employee Contributions

More information

MAYFLOWER MUNICIPAL HEALTH GROUP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PPO REVIEW OF BENEFITS

MAYFLOWER MUNICIPAL HEALTH GROUP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PPO REVIEW OF BENEFITS Fiscal Year 2015 2016 MAYFLOWER MUNICIPAL HEALTH GROUP ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PPO REVIEW OF S ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

More information

Medical Plan Comparison - Retirees Age 65 or Over

Medical Plan Comparison - Retirees Age 65 or Over l Plan Comparison - Retirees Age 65 or Over Program Name U of M Retiree Plan with Group reblue SM Rx Group Platinum Blue SM Plan C withgroup reblue SM Rx Freedom Plan & Retiree National Choice Freedom

More information

2015 Medical Plan Options Comparison of Benefit Coverages

2015 Medical Plan Options Comparison of Benefit Coverages Member services 1-866-641-1689 1-866-641-1689 1-866-641-1689 1-866-641-1689 1-866-641-1689 1-800-464-4000 Web site www.anthem.com/ca/llns/ www.anthem.com/ca/llns/ www.anthem.com/ca/llns/ www.anthem.com/ca/llns/

More information

2015 IBM Health Benefit Comparison Charts for IBM Active Employees

2015 IBM Health Benefit Comparison Charts for IBM Active Employees 2015 IBM Health Benefit Comparison Charts for IBM Active Employees These Health Benefit Comparison Charts provide a summary overview of the coverage available for medical, mental health/substance care

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3952 Y0041_H3952_KS_15_18734 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how

More information

Napa County. Medicare Advantage Plans. (Medicare Part C Plans) Compliments of HICAP. (Health Insurance Counseling and Advocacy Program)

Napa County. Medicare Advantage Plans. (Medicare Part C Plans) Compliments of HICAP. (Health Insurance Counseling and Advocacy Program) 2015 Napa County Medicare Advantage Plans (Medicare Part C Plans) HICAP Volunteer Counselors are available to help compare health plans in an objective and unbiased manner. They can help consumers understand

More information

Benefit Coverage Chart & Rates

Benefit Coverage Chart & Rates Benefit Coverage Chart & Rates Effective July 1, 2014- June 30, 2015 PPO Medical Coverage by Category The following coverages are included with the PPO plan: o Prescription o Vision Additional Benefits

More information

January 1, 2015 December 31, 2015 Summary of Benefits. Advantra (HMO) H3928-001 80.06.360.1-LA1

January 1, 2015 December 31, 2015 Summary of Benefits. Advantra (HMO) H3928-001 80.06.360.1-LA1 January, 205 December 3, 205 Summary of Benefits H3928-00 80.06.360.-LA Y0022_205_H3928_00_LA Accepted 9/204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of what we

More information

Your Plan: Anthem Bronze PPO 5500/30%/6450 w/hsa Your Network: Prudent Buyer PPO

Your Plan: Anthem Bronze PPO 5500/30%/6450 w/hsa Your Network: Prudent Buyer PPO Your Plan: Anthem Bronze PPO 5500/30%/6450 w/hsa Your Network: Prudent Buyer PPO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does

More information

January 1, 2015 December 31, 2015 Summary of Benefits. Altius Advantra (HMO) H8649-003 80.06.361.1-UTWY A

January 1, 2015 December 31, 2015 Summary of Benefits. Altius Advantra (HMO) H8649-003 80.06.361.1-UTWY A January, 205 December 3, 205 Summary of Benefits H8649-003 80.06.36.-UTWY A Y0022_205_H8649_003_UT_WYa Accepted /204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.summit-inc.net or www.yctrust.net or by calling Summit

More information

StudentBlue University of Nebraska

StudentBlue University of Nebraska Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family Plan Type: PPO What is the overall deductible? This is only a summary. If you want more details about

More information

Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?

Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services? This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020. Important Questions

More information

Cost Sharing Definitions

Cost Sharing Definitions SU Pro ( and ) Annual Deductible 1 Coinsurance Cost Sharing Definitions $200 per individual with a maximum of $400 for a family 5% of allowable amount for inpatient hospitalization - or - 50% of allowable

More information

You can see the specialist you choose without permission from this plan.

You can see the specialist you choose without permission from this plan. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsil.com or by calling 1-866-826-0913. Important Questions

More information

STATE OF IOWA HEALTH INSURANCE PLAN COMPARISON EFFECTIVE JANUARY 1, 2016

STATE OF IOWA HEALTH INSURANCE PLAN COMPARISON EFFECTIVE JANUARY 1, 2016 This comparison is only a summary of benefits. Benefits will be administered as described in each plan s Summary of Benefits & Coverage. For further details, refer to those documents or call Wellmark Blue

More information

PLUMBERS LOCAL 24 WELFARE FUND

PLUMBERS LOCAL 24 WELFARE FUND PLUMBERS LOCAL 24 WELFARE FUND Quick Reference Guide for JOURNEYMEN Effective January 1, 2015 Important Notice: This is an outline of the principal plan provisions of the Plumbers Local 24 Welfare Plan

More information

Benefit Coverage Chart & Rates Effective July 1, 2014 June 30, 2015

Benefit Coverage Chart & Rates Effective July 1, 2014 June 30, 2015 Benefit Coverage Chart & Rates Effective PPO Medical Coverage by Category The following coverages are included with the PPO plan: o Prescription o Vision Additional Benefits o Dental o Dental & Orthodontia

More information

NATIONAL HEALTH & WELFARE FUND PLAN C

NATIONAL HEALTH & WELFARE FUND PLAN C H E A LT H A N N U I T Y I O N V A C AT P E N S I O N NATIONAL HEALTH & WELFARE FUND PLAN C BENEFITS AT A GLANCE Introduction The IATSE National Health & Welfare Fund was set up to provide health care

More information

Service AvMed Cigna Leon Cares Humana HMO Humana PPO UnitedHealthcare. Out-of- Network

Service AvMed Cigna Leon Cares Humana HMO Humana PPO UnitedHealthcare. Out-of- Network 2016 Medicare Advantage Plans Comparison Chart This comparison chart is a side-by-side representation of services offered through the AvMed, Cigna, UHC, and Humana Medicare Advantage Plans for both in-network

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: Anthem BlueCross Premier HMO 20 / $10/$25/$45/20% Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2014-12/31/2014 Coverage For: Individual/Family Plan Type:

More information

$25 copay. One routine GYN visit and pap smear per 365 days. Direct access to participating providers.

$25 copay. One routine GYN visit and pap smear per 365 days. Direct access to participating providers. HMO-1 Primary Care Physician Visits Office Hours After-Hours/Home Specialty Care Office Visits Diagnostic OP Lab/X Ray Testing (at facility) with PCP referral. Diagnostic OP Lab/X Ray Testing (at specialist)

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3909 Y0041_H3909_PC_15_18889 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how

More information

2016 Summary of Benefits

2016 Summary of Benefits 2016 Summary of Benefits Health Net Violet Option 3 (PPO) Douglas and Josephine counties, OR Benefits effective January 1, 2016 H5520 Health Net Life Insurance Company H5520_2016_0202 CMS Accepted 09162015

More information

HEALTH PLAN COMPARISON

HEALTH PLAN COMPARISON City of San José HEALTH PLAN COMPARISON For Employees Represented by AEA, AMSP, CAMP, CEO, IAFF, IBEW, MEF and OE#3 SERVICE Kaiser Permanente Blue Shield HMO QUESTIONS ABOUT PLAN DESIGN AND PROVIDER NETWORKS

More information

Healthy Benefits HMO 6850.0

Healthy Benefits HMO 6850.0 Coverage Period: Beginning on or after 1/1/2016 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at https://www.capbluecross.com/sbcsia

More information

HEALTHSPAN MEDICARE HEALTH PLAN

HEALTHSPAN MEDICARE HEALTH PLAN This is an advertisement. HealthSpan Medicare Advantage for Federal Members (HMO) YOUR GUIDE TO CHOOSING A HEALTHSPAN MEDICARE HEALTH PLAN INCREASE YOUR COVERAGE without increasing your FEHB premium. MAKE

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.gpatpa.com or by calling 915-887-3420. Important Questions

More information

Anthem Blue Cross Life and Health Insurance Company University of Southern California Custom Premier PPO 400/20%/20%

Anthem Blue Cross Life and Health Insurance Company University of Southern California Custom Premier PPO 400/20%/20% Anthem Blue Cross Life and Health Insurance Company University of Southern California Custom Premier 400/20%/20% Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period:

More information

Kaiser Permanente: Platinum 90 HMO

Kaiser Permanente: Platinum 90 HMO Kaiser Permanente: Platinum 90 HMO Coverage Period: Beginning on or after 01/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family Plan Type: HMO

More information

Anthem Blue Cross Life and Health Insurance Company University of California San Francisco Custom Premier PPO 200/20 (200/20/80/60)

Anthem Blue Cross Life and Health Insurance Company University of California San Francisco Custom Premier PPO 200/20 (200/20/80/60) Anthem Blue Cross Life and Health Insurance Company University of California San Francisco Custom Premier PPO 200/20 (200/20/80/60) Summary of Benefits and Coverage: What this Plan Covers & What it Costs

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at https://eoc.anthem.com/eocdps/aso or by calling 1-888-650-4047.

More information

PLAN DESIGN AND BENEFITS POS Open Access Plan 1944

PLAN DESIGN AND BENEFITS POS Open Access Plan 1944 PLAN FEATURES PARTICIPATING Deductible (per calendar year) $3,000 Individual $9,000 Family $4,000 Individual $12,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being

More information

HNE Premier 1 (HMO) and HNE Premier 2 (HMO)

HNE Premier 1 (HMO) and HNE Premier 2 (HMO) 2016 Medicare Advantage Summary of Benefits HNE Premier 1 (HMO) and HNE Premier 2 (HMO) January 1, 2016 - December 31, 2016 H8578_2016_429 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2016 SECTION I

More information

Aetna Medicare Advantage HMO SHBP Summary of Benefits and Coverage: What this Plan Covers & What it Costs

Aetna Medicare Advantage HMO SHBP Summary of Benefits and Coverage: What this Plan Covers & What it Costs This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.state.nj.us/treasury/pensions/health-benefits.shtml or

More information

VIP HMO MEDICARE PLAN 2014 Summary of Benefits For Medicare-Eligible Retirees Residing in Manhattan, Brooklyn, Bronx, Staten Island & Queens

VIP HMO MEDICARE PLAN 2014 Summary of Benefits For Medicare-Eligible Retirees Residing in Manhattan, Brooklyn, Bronx, Staten Island & Queens 214 Summary of Benefits PROFESSIONAL SERVICES PCP office visits Specialist office visits Annual physical exam/preventive care Physical, Speech & Occupational Therapy Flu & Pneumonia Vaccinations Diagnostic

More information

SCAN Health Plan. 2015 Summary of Benefits

SCAN Health Plan. 2015 Summary of Benefits SCAN Health Plan 2015 Summary of Benefits Y0057_SCAN_8713_2014F File & Use Accepted 09032014 SCAN Classic (HMO) (a Medicare Advantage Health Maintenance Organization (HMO) offered by SCAN Health Plan with

More information

Medicare & UC Medical Benefits

Medicare & UC Medical Benefits Medicare & UC Medical Benefits UCSB Health Care Facilitator Program Laura Morgan 893-4201 UC Retirement Administration Service Center (RASC) 1-800-888-8267 This presentation is intended for communication

More information

$500 Individual / $1,500 Family Does not apply to preventive care and pharmacy

$500 Individual / $1,500 Family Does not apply to preventive care and pharmacy This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.mhhealthplan.org or by calling 1-713-338-6535 or 1-888-642-5040.

More information

Your Guide to Choosing a Kaiser Permanente Medicare Health Plan

Your Guide to Choosing a Kaiser Permanente Medicare Health Plan This is an advertisement. Kaiser Permanente Senior Advantage for Federal Members (HMO) Your Guide to Choosing a Kaiser Permanente Medicare Health Plan INCREASE YOUR COVERAGE without increasing your FEHB

More information

Schedule of Benefits Summary. Health Plan. Out-of-network Provider

Schedule of Benefits Summary. Health Plan. Out-of-network Provider Schedule of Benefits Summary University Name: University of Nebraska - Student Plan Health Plan : 2014/2015 Academic Year (see attached) Payment for Services Covered Services are reimbursed based on the

More information

2015 Summary of Benefits

2015 Summary of Benefits 2015 Summary of Benefits Plans 003 and 004 H6298_14_027 accepted Summary of Benefits January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn t list

More information

Essentials Rx 15 (HMO) Plan offered by PacificSource Medicare. Annual Notice of Changes for 2014

Essentials Rx 15 (HMO) Plan offered by PacificSource Medicare. Annual Notice of Changes for 2014 Essentials Rx 15 (HMO) Plan offered by PacificSource Medicare Annual Notice of Changes for 2014 You are currently enrolled as a member of Essentials Rx 15 (HMO) Plan. Next year, there will be some changes

More information

Gateway Health Medicare Assured RubySM (HMO SNP) $6,700 out-of-pocket limit for Medicare-covered services. No No No No. Days 1-6: $0 or $225 copay per

Gateway Health Medicare Assured RubySM (HMO SNP) $6,700 out-of-pocket limit for Medicare-covered services. No No No No. Days 1-6: $0 or $225 copay per Assured RubySM (HMO Premium $0 monthly plan $0 - $33.90 monthly plan Assured GoldSM (HMO $12.40 - $46.30 monthly plan $43.90 - $77.80 monthly plan In Network Maximum Out-of-Pocket $3,400 out-of-pocket

More information

This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan

This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.kaiserpermanente.org or by calling 1-800-464-4000. Important

More information

National Benefit Fund

National Benefit Fund 1199SEIU National Benefit Fund June 2015 SUMMARY PLAN DESCRIPTION Section VI Retiree Health Benefits A. Retiree Health Benefits B. Using Your Benefits Wisely C. If You Retire at or after Age 65 and Live

More information

Small group and CalChoice benefit comparison

Small group and CalChoice benefit comparison 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 San Diegans choose Sharp Health Plan With

More information

2015 WPEG Coinsurance Plan Coverage Period: 1/1/2015-12/31/2015

2015 WPEG Coinsurance Plan Coverage Period: 1/1/2015-12/31/2015 2015 WPEG Coinsurance Plan Coverage Period: 1/1/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs This is only a summary. If you want more detail about your coverage

More information

Cabrillo College Retiree Benefits and Medicare Frequently Asked Questions

Cabrillo College Retiree Benefits and Medicare Frequently Asked Questions Cabrillo College Retiree Benefits and Medicare Frequently Asked Questions Table of Contents What is Medicare?... 3 What are the different parts of Medicare?... 4 What does Medicare help cover Part A?...

More information

: Western University of Health Sciences (Oregon)

: Western University of Health Sciences (Oregon) : Western University of Health Sciences (Oregon) All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest Coverage Period: March 1, 2015-February 29, 2016 Summary of Benefits

More information

$0 See the chart starting on page 2 for your costs for services this plan covers.

$0 See the chart starting on page 2 for your costs for services this plan covers. Group Health Options, Inc.: Options Idaho Group Conversion Coverage Period: 7/1/2012 1/1/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Group Conversion Plan

More information

Benefit Summary - A, G, C, E, Y, J and M

Benefit Summary - A, G, C, E, Y, J and M Benefit Summary - A, G, C, E, Y, J and M Benefit Year: Calendar Year Payment for Services Deductible Individual $600 $1,200 Family (Embedded*) $1,200 $2,400 Coinsurance (the percentage amount the Covered

More information

$0. See the chart starting on page 2 for your costs for services this plan covers.

$0. See the chart starting on page 2 for your costs for services this plan covers. Access+ HMO Facility Coinsurance 15-20% Coverage Period: Beginning On or After 01/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Family Plan

More information

Quick Guide 2016. Peoples Health Choices 65 #14 (HMO) Jefferson, Orleans and Plaquemines parishes

Quick Guide 2016. Peoples Health Choices 65 #14 (HMO) Jefferson, Orleans and Plaquemines parishes Quick Guide 2016 $0 mium* Plan Pre Peoples Health Choices 65 #14 (HMO) Jefferson, Orleans and Plaquemines parishes *You must continue to pay your Medicare Part B premium. H1961_PH16C65S1QG Accepted Thank

More information

What is the overall deductible? Are there other deductibles for specific services?

What is the overall deductible? Are there other deductibles for specific services? This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/cuhealthplan or by calling 1-800-735-6072.

More information

Tribute. 2015 Summary of Benefits. Health Plan of Oklahoma. Tribute Health Plan of Oklahoma HMO SNP

Tribute. 2015 Summary of Benefits. Health Plan of Oklahoma. Tribute Health Plan of Oklahoma HMO SNP Tribute Health Plan of Oklahoma Tribute Health Plan of Oklahoma HMO SNP 2015 Summary of Benefits This booklet gives you a summary of what we cover and what you pay. It doesn t list every service that we

More information

Laborers Funds Administrative Office of Northern California, Inc.

Laborers Funds Administrative Office of Northern California, Inc. Date: April 24, 2015 Laborers Funds Administrative Office of Northern California, Inc. 220 Campus Lane, Fairfield, CA 94534-1498 Telephone: 707 864 2800 or 800 244 4530 Important Information Regarding

More information

Medical Plan - Healthfund

Medical Plan - Healthfund 18 Medical Plan - Healthfund Oklahoma City Community College Effective Date: 07-01-2010 Aetna HealthFund Open Choice (PPO) - Oklahoma PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY -

More information

Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?

Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services? : VIVA HEALTH Access Plan Coverage Period: 01/01/2015 12/31/2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document

More information

Group Health Cooperative: Gold

Group Health Cooperative: Gold Group Health Cooperative: Gold Coverage Period: 1/1/2016 to 1/1/2017 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Group Plan Type: HMO This is only a summary. If

More information