Small Group Benefit Comparison

Transcription

1 Small Group Benefit Comparison effective January 1, 2016 A guide to choosing the right plan for your business

2 San Diegans choose Sharp Health Plan With a range of solutions 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 local, not-for-profit commercial health plan, we not only serve the people of San Diego we are the people of San Diego. When you join Sharp Health Plan, you ll have care options close to where you live and work. Award-winning care You ll receive award-winning care from our nationally recognized doctors, medical groups and hospitals. We are also the highest-rated health plan 1 in California, and the highest-rated health plan for customer satisfaction 2 among reporting California health plans. 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 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 standard business hours. All Sharp Health Plan members receive the following value added benefits: Best Health Best Health is one of only 10 health plan wellness programs to be nationally accredited. 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. Sharp Nurse Connection We offer an 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 As the walk-in medical clinic located inside select CVS/pharmacy stores, MinuteClinic provides convenient access to basic care, without an appointment. 3 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. 1 The source for this data is Quality Compass 2015 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 2015 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). Sharp Health Plan achieved the following summary ratings: an 81.8 for Rating of the Health Plan compared to the state average of 71.1; an 84.2 for Rating of Health Care compared to the state average of 76.7; an 85.6 for Rating of Personal Doctor compared to the state average of 82.3; an 80.1 for Rating of Health Promotion and Education compared to the state average of Based on the National Committee for Quality Assurance (NCQA) Private Health Insurance Plan Ratings Sharp Health Plan achieved the following summary scores: 4 out of 5 rating for Customer Satisfaction, the only plan in California to do so, and a 4 out of 5 rating overall placing Sharp Health Plan in the top third of health plans nationally. 3 A $40 copay will apply to most services except flu shots, which have a $10 copay.

4 Small group Platinum 90 plans effective January 1, 2016 Deductibles Calendar year deductible (per individual/per family) (applies only to those covered benefits indicated) Calendar year deductible (per member) for covered brand-name drugs (formulary and non-formulary) Maximums There are no lifetime maximums for this plan Annual Out of Pocket Maximum, including deductible (per individual/per family) Professional Services (per visit) Primary Care Physician office visit for consultation, treatment, diagnostic testing, etc. Specialist Physician office visit for consultation, treatment, diagnostic testing, etc. Preventive services² Prenatal and postpartum office visits Allergy injections Allergy testing Outpatient Services Outpatient surgery Radiology services (x-rays and diagnostic imaging) Advanced radiology (including MRI, CT Scan, PET Scan, MRA, MRS, MUGA, SPECT) Physical, occupational and speech therapy Hospitalization Services Inpatient Emergency/Urgent Care Services Emergency room (waived if admitted for inpatient hospital stay) Urgent care Ambulance Services Ambulance in connection with hospital admission or emergency services Prescription Drug Coverage Drugs administered in a practitioner s office, hospital or outpatient facility Generic Formulary / Brand Formulary / Non-Formulary medications up to a 30-day supply Generic Formulary / Brand Formulary / Non-Formulary / Medications up to a 90-day supply by mail order Generic Formulary and prescribed over-the-counter contraceptives for women Durable Medical Equipment Durable medical equipment Diabetics supplies Prosthetics, orthotics Mental Health Services Inpatient Outpatient Home-based applied behavioral analysis for treatment of pervasive developmental disorder or autism Chemical Dependency Services Inpatient Outpatient Emergency services for acute drug or alcohol detoxification Other Skilled nursing facility services (maximum of 100 days per benefit period) Home health services (maximum of 100 visits per calendar year) Hospice care - inpatient Hospice care - outpatient 1 Copayments and deductibles for supplemental benefits (Assisted Reproductive Technologies, Chiropractic Services, Adult Vision) do not apply to the annual out of pocket maximum.

5 Sharp Platinum 90 0 / 10 / 200 Sharp Platinum 90 0 / 15 / 250 Sharp Platinum 90 0 / 20 / 250 Sharp Platinum 90 0 / 20 / 300 Sharp Platinum 90 0 / 20 / 500 A Sharp Platinum 90 0 / 20 / 500 B Sharp Platinum 90 0/20/1000 A Sharp Platinum 90 0/20/1000 B None None None None None None None None None None None None None None None None N / A N / A N / A N / A N / A N / A N / A N / A $3,000 1 / $6,000 1 $2,900 1 / $5,800 1 $2,500 1 / $5,000 1 $3,000 1 / $6,000 1 $2,000 1 / $4,000 1 $3,000 1 / $6,000 1 $2,000 1 / $4,000 1 $3,000 1 / $6,000 1 $10 $15 $20 $20 $20 $20 $20 $20 $20 $15 $20 $30 $30 $30 $40 $30 $0 $0 $0 $0 $0 $0 $0 $0 $20 $15 $20 $30 $30 $30 $40 $30 $10 $15 $20 $20 $20 $20 $20 $20 $20 $15 $20 $30 $30 $30 $40 $30 $100 / procedure $250 / procedure $125 / procedure $300 / procedure $500 / procedure $250 / procedure $500 / procedure $500 / procedure $0 $0 $40 $0 $0 $40 $0 $0 $100 $100 $150 $100 $100 $150 $100 $100 $20 $15 $20 $30 $30 $30 $40 $30 $300 / day (3-day max) $250 / day (3-day max) $250 / admission $300 / day (3-day max) $500 / day (3-day max) $500 / admission $1,000 / admission $1,000 / admission $100 $100 $100 $100 $100 $100 $150 $100 $10 $20 $20 $30 $30 $30 $40 $30 $100 $100 $100 $100 $100 $100 $150 $100 $0 $0 $0 $0 $0 $0 $0 $0 $15 / $35 / $50 $15 / $35 / $50 $10 / $25 / $50 $19 / $35 / $70 $19 / $35 / $70 $10/ $25 / $50 $15 / $35 / $50 $15 / $35 / $50 $30 / $70 / $100 $30 / $70 / $100 $20 / $50 / $100 $38 / $70 / $140 $38 / $70 / $140 $20 / $50 / $100 $30 / $70 / $100 $30 / $70 / $100 $0 $0 $0 $0 $0 $0 $0 $0 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 $20 $15 $20 $30 $30 $30 $40 $30 $200 / day (3-day max) $250 / day (3-day max) $250 / admission $300 / day (3-day max) $500 / day (3-day max) $500 / admission $1,000 / admission $1,000 / admission $20 / visit $15 / visit $20 / visit $30 / visit $30 / visit $30 / visit $40 / visit $30 / visit $20 / visit $15 / visit $20 / visit $30 / visit $30 / visit $30 / visit $40 / visit $30 / visit $200 / day (3-day max) $250 / day (3-day max) $250 / admission $300 / day (3-day max) $500 / day (3-day max) $500 / admission $1,000 / admission $1,000 / admission $20 / visit $15 / visit $20 / visit $30 / visit $30 / visit $30 / visit $40 / visit $30 / visit $100 / visit $100 / visit $20 / visit $30 / visit $100 / visit $100 / visit $150 / visit $100 / visit $100 / day (3-day max) $200 / day (3-day max) $150 / day (5-day max) $200 / day (3-day max) $200 / day (3-day max) $150 / day (5-day max) $200 / admission $200 / admission $20 / visit $15 / visit $20 / visit $30 / visit $30 / visit $30 / visit $40 / visit $30 / visit $100 / day (3-day max) $250 / day (3-day max) $200 / day admission $500 / day (3-day max) $500 / day (3-day max) $200 / admission $200 / admission $200 / admission $0 $0 $0 $0 $0 $0 $0 $0 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.

6 Small group Gold 80 / Silver 70 plans effective January 1, 2016 Deductibles Calendar year deductible (per individual/per family) (applies only to those covered benefits indicated) Calendar year deductible (per member) for covered brand-name drugs (formulary and non-formulary) Maximums There are no lifetime maximums for this plan Annual Out of Pocket Maximum, including deductible (per individual/per family) Professional Services (per visit) Primary Care Physician office visit for consultation, treatment, diagnostic testing, etc. Specialist Physician office visit for consultation, treatment, diagnostic testing, etc. Preventive services² Prenatal and postpartum office visits Allergy injections Allergy testing Outpatient Services Outpatient surgery Radiology services (x-rays and diagnostic imaging) Advanced radiology (including MRI, CT Scan, PET Scan, MRA, MRS, MUGA, SPECT) Physical, occupational and speech therapy Hospitalization Services Inpatient Emergency/Urgent Care Services Emergency room (waived if admitted for inpatient hospital stay) Urgent care Ambulance Services Ambulance in connection with hospital admission or emergency services Prescription Drug Coverage Drugs administered in a practitioner s office, hospital or outpatient facility Generic Formulary / Brand Formulary / Non-Formulary medications up to a 30-day supply Generic Formulary / Brand Formulary / Non-Formulary / Medications up to a 90-day supply by mail order Generic Formulary and prescribed over-the-counter contraceptives for women Durable Medical Equipment Durable medical equipment Diabetics supplies Prosthetics, orthotics Mental Health Services Inpatient Outpatient Home-based applied behavioral analysis for treatment of pervasive developmental disorder or autism Chemical Dependency Services Inpatient Outpatient Emergency services for acute drug or alcohol detoxification Other Skilled nursing facility services (maximum of 100 days per benefit period) Home health services (maximum of 100 visits per calendar year) Hospice care - inpatient Hospice care - outpatient 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.

7 Sharp Gold 80 0 / 30 / 30% Sharp Gold 80 0 / 40 / 40% Sharp Gold 80 0 / 30 / 1000 A Sharp Gold 80 0 / 30 / 1000 B Sharp Gold 80 0 / 40 / 1000 Sharp Gold / 30 / 30% Sharp Silver / 40 / 40% None None None None None $1,000 5 / $2,000 5 $1,750 5 / $3,500 5 None None None None $150 $150 $150 N / A N / A N / A N / A N / A N / A N / A $4,500 1 / $9,000 1 $4,500 1 / $9,000 1 $6,250 1 / $12,500 1 $5,000 1 / $10,000 1 $5,000 1 / $10,000 1 $3,400 1 / $6,800 1 $5,750 1 / $11,500 1 $30 $40 $30 $30 $40 $30 $40 $30 $40 $70 $60 $60 $30 $40 $0 $0 $0 $0 $0 $0 $0 $30 $40 $70 $60 $60 $30 $40 $30 $40 $30 $30 $40 $30 $40 $30 $40 $70 $60 $60 $30 $40 30% coinsurance 3 40% coinsurance 3 $600 / procedure $750 / procedure $750 / procedure 30% coinsurance 3,4 40% coinsurance 3,4 $50 $50 $70 $60 $50 $0 $40 30% coinsurance 3 $150 $175 $150 $150 $100 $100 $30 $40 $70 $60 $60 $30 $40 30% coinsurance 3 40% coinsurance 3 $1,000 / admission $1,000 / day $1,000 / day 30% coinsurance 3,4 40% coinsurance 3,4 $100 $100 $200 $200 $200 $150 4 $150 4 $30 $40 $70 $60 $40 $30 $40 $100 $100 $100 $100 $100 $100 4 $150 4 $0 $0 $0 $0 $0 $0 $0 $15 / $50 / $70 $19 / $35 / $70 $19 / $35 / $70 $19 / $35 $19 / $35 4 / $70 4 $19 / $35 4 / $70 4 $19 / $35 4 / $70 4 $30 / $100 / $140 $38 / $70 / $140 $38 / $70 / $140 $38 / $70 / $140 $38 / $70 4 / $140 4 $38 / $70 4 / $140 4 $38 / $70 4 / $140 4 $0 $0 $0 $0 $0 $0 $0 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3,4 50% coinsurance 3,4 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3 $30 $40 $70 $60 $60 $30 $40 30% coinsurance 3 40% coinsurance 3 $1,000 / admission $1,000 / day $1,000 / day 30% coinsurance 3,4 40% coinsurance 3,4 $30 / visit $40 / visit $70 / visit $60 / visit $60 / visit $30 / visit $40 / visit $30 / visit $40 / visit $70 / visit $60 / visit $60 / visit $30 / visit 4 $40 / visit 4 30% coinsurance 3 40% coinsurance 3 $1,000 / admission $1,000 / day $1,000 / day 30% coinsurance 3,4 40% coinsurance 3,4 $30 / visit $40 / visit $70 / visit $60 / visit $60 / visit $30 / visit $40 / visit $100 / visit $100 / visit $200 / visit $200 / visit $200 / visit $150 / visit 4 $150 / visit 4 30% coinsurance 3 $150 / day $175 / admission $150 / admission $150 / day 30% coinsurance 3,4 40% coinsurance 3,4 $30 / visit $40 / visit $70 / visit $60 / visit $60 / visit $30 / visit 4 $40 / visit $150 / day $150 / day $150 / admission $150 / admission $150 / day 30% coinsurance 3,4 40% coinsurance 3,4 $0 $0 $0 $0 $0 $0 $0 4 Deductible applies. 5 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.

8 Covered CA Platinum 90 / Gold 80 plans effective January 1, 2016 Deductibles Calendar year deductible (per individual/per family) (applies only to those covered benefits indicated) Calendar year deductible (per member) for covered brand-name drugs (formulary and non-formulary) Maximums There are no lifetime maximums for this plan Annual Out of Pocket Maximum, including deductible (per individual/per family) Professional Services (per visit) Primary Care Physician office visit for consultation, treatment, diagnostic testing, etc. Specialist Physician office visit for consultation, treatment, diagnostic testing, etc. Preventive services² Prenatal and postpartum office visits Allergy injections Allergy testing Outpatient Services Outpatient facility / physician Radiology services (x-rays and diagnostic imaging) Advanced radiology (including MRI, CT Scan, PET Scan, MRA, MRS, MUGA, SPECT) Physical, occupational and speech therapy Hospitalization Services Inpatient facility / physician Emergency/Urgent Care Services Emergency room facility / physician (waived if admitted for inpatient hospital stay) Urgent care Ambulance Services Ambulance in connection with hospital admission or emergency services Prescription Drug Coverage Drugs administered in a practitioner s office, hospital or outpatient facility Tier 1 / Tier 2 / Tier 3 / Tier 4 medications up to a 30-day supply Tier 1 / Tier 2 / Tier 3 medications up to a 90-day supply by mail order Generic Formulary and prescribed over-the-counter contraceptives for women Durable Medical Equipment Durable medical equipment Diabetics supplies Prosthetics, orthotics Mental Health Services Inpatient facility / physician Outpatient Home-based applied behavioral analysis for treatment of pervasive developmental disorder or autism Chemical Dependency Services Inpatient facility / physician Outpatient Emergency services for acute drug or alcohol detoxification inpatient facility / physician Other Skilled nursing facility services (maximum of 100 days per benefit period) Home health services (maximum of 100 visits per calendar year) Hospice care - inpatient Hospice care - outpatient 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.

9 Sharp Platinum 90 Sharp Platinum 90 Sharp Gold 80 Sharp Gold 80 0 / 20 /10% (Network 2) 5 0 / 20 / 250 (Network 1) 6 0 / 35 / 20% (Network 2) 5 0 / 35 / 600 (Network 1) 6 None None None None None None None None N / A N / A N / A N / A $4,000 1 / $8,000 1 $4,000 1 / $8,000 1 $6,200 1 / $12,400 1 $6,200 1 / $12,400 1 $20 $20 $35 $35 $40 $40 $55 $55 $0 $0 $0 $0 $0 $0 $0 $0 $20 $20 $35 $35 $40 $40 $55 $55 10% coinsurance 3 /10% coinsurance 3 $250 per procedure / $40 per visit 20% coinsurance 3 / 20% coinsurance 3 $600 per procedure / $55 $40 / visit $40 / visit $50 / visit $50 / visit 10% coinsurance 3 $150 / procedure 20% coinsurance 3 $250 / procedure $20 / visit $20 / visit $35 / visit $35 / visit 10% coinsurance 3 /10% coinsurance 3 $250 per day (5-day max) / $40 20% coinsurance 3 / 20% coninsurance 3 $600 per day (5-day max) / $55 per visit $150 per visit / 10% coinsurance 3 $150 per visit / $0 $250 per visit / 20% 3 $250 per visit / $0 $40 $40 $60 $60 $150 $150 $250 $250 $0 $0 $0 $0 $5 / $15 / $25 / 10% 4 $5 / $15 / $25 / 10% 4 $15 / $50 / $70 / 20% 4 $15 / $50 / $70 / 20% 4 $10 / $30 / $50 $10 / $30 / $50 $30 / $100 / $140 $30 / $100 / $140 $0 $0 $0 $0 10% coinsurance 3 10% coinsurance 3 20% coinsurance 3 20% coinsurance 3 10% coinsurance 3 10% coinsurance 3 20% coinsurance 3 20% coinsurance 3 10% coinsurance 3 10% coinsurance 3 20% coinsurance 3 20% coinsurance 3 10% coinsurance 3 /10% coinsurance 3 $250 per day (5-day max) / $40 per visit 20% coinsurance 3 / 20% coinsurance 3 $600 per day (5-day max) / $55 per visit $20 / visit $20 / visit $35 / visit $35 / visit $20 / visit $20 / visit 20% coinsurance 3 $30 / visit 10% coinsurance 3 /10% coinsurance 3 $250 per day (5-day max) / $40 per visit 20% coinsurance 3 /20% coinsurance 3 $600 per day (5-day max) / $55 per visit $20 / visit $20 / visit $35 / visit $35 / visit $150 per visit / $0 $150 per visit / $0 20% coinsurance 3 / 20% coinsurance 3 $250 per visit / $0 10% coinsurance 3 $150 / day (5-day max) 20% coinsurance 3 $300 / day (5-day max) 10% coinsurance 3 $20 / visit 20% coinsurance 3 $30 / visit $0 / admission $0 / admission $0 / admission $0 / admission $0 $0 $0 $0 3 Of contracted rates. 4 Up to $250 per 30-day supply. 5 Network 2 is the Performance Network. 6 Network 1 is the Premier Network.

10 Covered CA Silver 70 / Bronze 60 plans effective January 1, 2016 Deductibles Calendar year deductible (per individual/per family) (applies only to those covered benefits indicated) Calendar year deductible (per member) for covered brand-name drugs (formulary and non-formulary) Maximums There are no lifetime maximums for this plan Annual Out of Pocket Maximum, including deductible (per individual/per family) Professional Services (per visit) Primary Care Physician office visit for consultation, treatment, diagnostic testing, etc. Specialist Physician office visit for consultation, treatment, diagnostic testing, etc. Preventive services² Prenatal and postpartum office visits Allergy injections Allergy testing Outpatient Services Outpatient facility / physician Radiology services (x-rays and diagnostic imaging) Advanced radiology (including MRI, CT Scan, PET Scan, MRA, MRS, MUGA, SPECT) Physical, occupational and speech therapy Hospitalization Services Inpatient facility / physician Emergency/Urgent Care Services Emergency room facility / physician (waived if admitted for inpatient hospital stay) Urgent care Ambulance Services Ambulance in connection with hospital admission or emergency services Prescription Drug Coverage (suggested coverage; other supplemental drug coverage available) Drugs administered in a practitioner s office, hospital or outpatient facility Tier 1 / Tier 2 / Tier 3 / Tier 4 medications up to a 30-day supply Tier 1 / Tier 2 / Tier 3 medications up to a 90-day supply by mail order Generic Formulary and prescribed over-the-counter contraceptives for women Durable Medical Equipment Durable medical equipment Diabetics supplies Prosthetics, orthotics Mental Health Services Inpatient facility / physician Outpatient Home-based applied behavioral analysis for treatment of pervasive developmental disorder or autism Chemical Dependency Services Inpatient facility / physician Outpatient Emergency services for acute drug or alcohol detoxification inpatient facility / physician Other Skilled nursing facility services (maximum of 100 days per benefit period) Home health services (maximum of 100 visits per calendar year) Hospice care - inpatient Hospice care - outpatient 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.

11 Sharp Silver / 45 / 20% A (Network 2) 10 Sharp Silver / 45 / 20% B (Network 1) 11 Sharp Silver 70 HSA 2000 / 20% / 20% (Network 1) 11 Sharp Bronze / 70 / 100% (Network 2) 10 Sharp Bronze 60 HSA 4500 / 40% / 40% (Network 1) 11 $1,500 6 / $3,000 6 $1,500 6 / $3,000 6 $2,000 4 / $4,000 4 Integrated $6,000 6 / $12,000 6 Integrated $4,500 4 / $9,000 4 Integrated $250 / $500 $250 / $500 Integrated $500 / $1,000 Integrated N / A N / A N / A N / A N / A $6,500 1 / $13,000 1 $6,500 1 / $13,000 1 $6,250 1 / $12,500 1 $6,500 1 / $13,000 1 $6,500 1 / $13,000 1 $45 $45 20% coinsurance 3,5 $70 5,7 40% coinsurance 3,5 $70 $70 20% coinsurance 3,5 $90 5,7 40% coinsurance 3,5 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $45 $45 20% coinsurance 3,5 $ % coinsurance 3,5 $70 $70 20% coinsurance 3,5 $ % coinsurance 3,5 20% coinsurance 3 / 20% coinsurance 3 20% coinsurance 3 / 20% coinsurance 3 20% coinsurance 3,5 / 20% coinsurance 3,5 100% coinsurance 3,5 / 100% coinsurance 3,5 40% coinsurance 3,5 / 40% coinsurance 3,5 $65 / visit $65 / visit 20% coinsurance 3,5 100% coinsurance 3,5 40% coinsurance 3,5 20% coinsurance 3,5 $250 / procedure 20% coinsurance 3,5 100% coinsurance 3,5 40% coinsurance 3,5 $45 / visit $45 / visit 20% coinsurance 3,5 $70 / visit 5 40% coinsurance 3,5 20% coinsurance 3,5 / 20% coinsurance 3,5 20% coinsurance 3,5 / 20% coinsurance 3,5 20% coinsurance 3,5 / 20% coinsurance 3,5 100% coinsurance 3,5 / 100% coinsurance 3,5 40% coinsurance 3,5 / 40% coinsurance 3,5 $250 per visit 5 / $50 per visit 5 $250 per visit 5 / $50 per visit 5 20% coinsurance 3,5 / 20% coinsurance 3,5 100% coinsurance 3,5 / 100% coinsurance 3,5 40% coinsurance 3,5 / 40% coinsurance 3,5 $90 $90 20% coinsurance 3,5 $120 5,7 40% coinsurance 3,5 $250 5 $ % coinsurance 3,5 100% coinsurance 3,5 40% coinsurance 3,5 $0 $0 $0 $0 $0 $15 / $55 5 / $75 5 / 20% 5,8 $15 / $55 5 / $75 5 / 20% 5,8 20% 5 / 20% 5 / 20% 5 / 20% 5 100% 5,9 / 100% 5,9 / 100% 5,9 / 100% 5,9 40% 5 / 40% 5 / 40% 5 / 40% 5 $30 / $110 5 / $150 5 $30 / $110 5 / $ % 5 / 20% 5 / 20% 5 100% 5,9 / 100% 5,9 / 100% 5,9 40% 5 / 40% 5 / 40% 5 $0 $0 $0 $0 $0 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3,5 100% coinsurance 3,5 40% coinsurance 3,5 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3,5 100% coinsurance 3,5 40% coinsurance 3,5 20% coinsurance 3 20% coinsurance 3 20% coinsurance 3,5 100% coinsurance 3,5 40% coinsurance 3,5 20% coinsurance 3,5 / 20% coinsurance 3,5 20% coinsurance 3,5 / 20% coinsurance 3,5 20% coinsurance 3,5 / 20% coinsurance 3,5 100% coinsurance 3,5 / 100% coinsurance 3,5 40% coinsurance 3,5 / 40% coinsurance 3,5 $45 / visit $45 / visit 20% coinsurance 3,5 $70 / visit 5,7 40% coinsurance 3,5 20% coinsurance 3 $45 / visit 20% coinsurance 3,5 $70 / visit 5 40% coinsurance 3,5 20% coinsurance 3,5 / 20% coinsurance 3,5 20% coinsurance 3,5 / 20% coinsurance 3,5 20% coinsurance 3,5 / 20% coinsurance 3,5 100% coinsurance 3,5 / 100% coinsurance 3,5 40% coinsurance 3,5 / 40% coinsurance 3,5 $45 / visit $45 / visit 20% coinsurance 3,5 $70 / visit 5,7 40% coinsurance 3,5 $250 per visit 5 / $50 per visit 5 $250 per visit 5 / $50 per visit 5 20% coinsurance 3,5 / 20% coinsurance 3,5 100% coinsurance 3,5 / 100% coinsurance 3,5 40% coinsurance 3,5 / 40% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 20% coinsurance 3,5 100% coinsurance 3,5 40% coinsurance 3,5 20% coinsurance 3 $45 / visit 20% coinsurance 3,5 100% coinsurance 3,5 40% coinsurance 3,5 $0 / admission $0 / admission $0 / admission 5 $0 / admission $0 / admission 5 $0 $0 $0 5 $0 $0 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 three non-preventive visits. 8 Up to $250 per 30-day supply after pharmacy deductible. 9 Member cost share after dedutible will not exceed $500 per 30-day supply. 10 Network 2 is the Performance Network. 11 Network is the Premier Network.

12 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 Art C Copayments equal to 50% coinsurance of covered infertility services

13 79 76 North Valley 2 76 Oceanside Tri-City Carlsbad 78 Vista Mira Costa Ocean Hills San Marcos 74 Twin Oaks H Escondido Valley Center 7 H 8 Valley View Provider Networks Sharp Health Plan offers four provider networks for flexibility while delivering high-quality health services: Choice, Value, Performance and Premier. Leucadia Encinitas Solana Beach Del Mar Del Mar Heights Rancho Santa Fe North City 56 Rancho Bernardo Carmel Mountain Sabre Springs H 9 Poway Ramona Rosemont 67 San Diego County Estate 2,200+ Doctors La Jolla Mira Mesa Miramar 52 Santee Alpine 13 Hospitals 6 Medical Groups 52 Coronado H 6 H 11H H 163 Linda Mission Vista Valley Grossmont University Heights La Mesa Ocean Beach Lemon Grove Loma Portal Spring Valley Encanto Chula Vista (Imperial Beach) (San Ysidro) National City H H H Bonita H El Cajon Lakeside 52 Rolling Hills Ranch Eastlake Vistas 56 Jamacha (Otay Mesa) Crest

14 Provider Network Comparison At Sharp Health Plan, we offer four provider networks to deliver cost-effective solutions to meet the unique needs of every employer. With access to more than 2,240 Physicians, we have an option that s right for you. 1 Network 1 - Premier Network 2 - Performance Network 3 - Value Network 4 - Choice A high-performing, select network and our most affordable option. An affordable network in San Diego County offering more choice for people living in the North County area. A large network of medical professionals devoted to giving you the best possible care and value. Our largest network, offering the most choice and convenience. Physician Networks Sharp Rees-Stealy () Carmel Valley Chula Vista Del Mar Downtown San Diego El Cajon Frost Street Genesee Kearny Villa La Mesa/La Mesa West Mira Mesa Mt. Helix Otay Ranch Point Loma Rancho Bernardo San Carlos San Diego Scripps Ranch Sorrento Mesa Sharp Community Medical Group (SCMG) Alpine Chula Vista Clairemont Coronado Downtown San Diego East San Diego El Cajon Imperial Beach SCMG Continued Kearny Mesa La Mesa Lakeside Mira Mesa National City Point Loma San Carlos Santee Tierrasanta University City Sharp Community Medical Group (SCMG) Inland North Escondido Poway SCMG Graybill Carlsbad Escondido Fallbrook Oceanside San Marcos Temecula Vista SCMG Arch Health Partners Escondido Poway Ramona San Marcos 1 Coverage area includes but is not limited to the locations in this document. Premier is a preferred premium rate provider network and is available in select ZIP codes throughout San Diego County. To see if your business qualifies for this provider network, please contact your Sharp Health Plan Account Manager.

15 Children s Physicians Medical Group Carlsbad Chula Vista Clairemont Del Mar Downtown San Diego Eastlake East San Diego El Cajon Encinitas Escondido Fallbrook Hillcrest La Jolla La Mesa Linda Vista Mira Mesa National City Oceanside Poway Pt. Loma Rancho Bernardo San Marcos Scripps Ranch Sorrento Valley Temecula University City Valley Center Vista Greater Tri-Cities IPA Carlsbad Oceanside Vista Primary Care Associates Medical Group Carlsbad Encinitas Oceanside San Marcos Solana Beach Vista Hospital Networks Sharp Chula Vista Medical Center Sharp Coronado Hospital Sharp Grossmont Hospital Sharp Mary Birch Hospital for Women & Newborns Sharp Memorial Hospital Sharp Mesa Vista Hospital Palomar Downtown Palomar Medical Center Pomerado Hospital Rady Children s Hospital Tri-City Medical Center Inland Valley Medical Center Rancho Springs Medical Center Pharmacies Albertsons Sav-on Pharmacy Costco Pharmacy CVS/pharmacy Independent Neighborhood Pharmacies Ralphs Pharmacy Rite Aid Pharmacy Sharp Rees-Stealy Pharmacy Target Pharmacy Vons Pharmacy Walgreens Pharmacy Walmart Pharmacy Wellpartner (Mail order pharmacy) Participating physicians are subject to change; for the most current information, please visit sharphealthplan.com. Independent Physician Network More than 227 Primary Care Providers and 435 Specialists are independently contracted.

16 Consider us your personal health care assistant (858) or a.m. 6 p.m., Monday through Friday customer.service@sharp.com sharphealthplan.com