2015 Medical Rate Comparison

2015 Medical Rate Comparison

2015 Medical Rates with Employer Contribution Rate Member Monthly Cost HMO and PPO Plans Employee Only Employee + 1 Family CCPOA Medical Plan Member Contribution *Must be a CCPOA Member In SoCal? CCPOA Medical is a no-brainer! South Plan #2661 South Plan #2662 South Plan #2663 37.88 76.30 153.82 North Plan #2561 North Plan #2562 North Plan #2563 157.33 315.26 475.13 PERS Select (PPO) 94.22 186.44 239.37 PERS Choice (PPO) 116.45 230.90 297.17 PERS Care (PPO) 194.93 387.86 501.22 Blue Shield Access+ 194.16 386.32 499.22 Blue Shield Net Value (Limited Areas) 146.36 290.72 374.94 Kaiser 109.04 216.08 277.90 2015 State Contribution - Medical Plan* Employee = $524.00 Employee + 1 = $1050.00 Family = $1,368.00 *Subject to negotiations Dental Western Dental and CCPOA Primary $44.94 monthly premium for members Vision www.vsp.com $2.00 monthly* *Actual rate = $16.07 monthly. $8.64 State Contribution + Additional Negotiated Benefit/Trust contribution of $5.43 * State contribution rate as of 08/12/2014. Subject to change after printing.

2015 Medical Rates with CoBen 2015 Medical Rates (Before CoBen) HMO and PPO Plans Employee Only Employee + 1 Family CCPOA Medical Plan SoCal $561.88 $1,126.30 $1,521.82 NorCal $681.33 $1,365.26 $1,843.13 PERS Select (PPO) 618.22 1,236.44 1,607.37 PERS Choice (PPO) 640.45 1,280.90 1,665.17 PERS Care (PPO) 718.93 1,437.86 1,869.22 Blue Shield Access+ 718.16 1,436.32 1,867.22 Kaiser 633.04 1,266.08 1,645.90 2015 State Contribution - CoBen Medical Plan* Employee = $590.00 Employee + 1 = $1140.00 Family = $1,474.00 *Subject to negotiations Here s an Example of CoBen in action: CCPOA Medical Plan Dental Plan VSP Vision Plan Employee + 1 Southern California Member $1126.30 CCPOA Primary Dental Employee + 1 $79.00 VSP Vision Plan $8.64 Total Benefit Premium: $1213.94 - CoBen Allotment: Emp+1 $1,140.00 = Employee Contribution: $73.94 * State contribution rate as of 08/12/2014. Subject to change after printing.

2015 Retired Medical Rates with Employer Contribution Retired Members Fully Vested Rates HMO and PPO Plans Employee Only Employee + 1 Family CCPOA Medical Plan Member Contribution *Must be a CCPOA Member SoCal $0.00 $0.00 $0.00 NorCal $26.33 $119.26 $238.13 PERS Select (PPO) $0.00 $0.00 $0.00 PERS Choice (PPO) $0.00 $34.90 $60.17 PERS Care (PPO) $63.90 $191.86 $264.22 Blue Shield Access+ $63.16 $190.32 $262.22 Blue Shield Net Value (Limited Areas) $16.36 $94.72 $137.94 Kaiser $0.00 $20.08 $40.90 2015 State Contribution - Medical Plan* Employee = $655.00 Employee + 1 = $1,246.00 Family = $1,605.00 *Subject to negotiations Dental Retired Dental coverage is obtained through CalPERS Vision www.vsp.com The Trust offers different levels of coverage through VSP. See the website for complete details. STANDARD Plan Member + 1 Dependant = $13.19 monthly * State contribution rate as of 08/12/2014. Subject to change after printing.

2015 Retired Medicare Rates with Employer Contribution HMO and PPO Plans Employee Only Employee Plus 1 Family CCPOA Medical Plan Member Contribution *Must be a CCPOA Retired Member SoCal $0.00 $0.00 $0.00 NorCal $0.00 $0.00 $0.00 PERS Select (PPO) $0.00 $0.00 $0.00 PERS Choice (PPO) $0.00 $0.00 $0.00 PERS Care (PPO) $0.00 $0.00 $0.00 Blue Shield Access+ $0.00 $0.00 $0.00 Blue Shield Net Value (Limited Areas) $0.00 $0.00 $0.00 Kaiser $0.00 $0.00 $0.00 2015 State Contribution - Medical Plan* Employee = $655.00 Employee + 1 = $1,246.00 Family = $1,605.00 When you or your dependant reach age 65 or obtain Medicare, these are your rates. Does your family use both Basic and a Medicare Supplement? See next chart for more cost comparisons..

2015 Retired Rates Combination Plans with State Contribution 2015 State Contribution - Retired Retiree + 1 = $1,218.00 Family = $1,559.00 Combination Monthly Rate Employee in Supplemental Medicare & Dependant in Basic Employee in M 1 Dependent in B Employee in M 2+ Dependents in B Employee & 1 Dependent in M 1+ Dependents in B CCPOA Medical Plan Member Contribution *Must be a CCPOA Retired Member SoCal $0.00 $0.00 $0.00 NorCal 0.00 0.00 0.00 PERS Select (PPO) 0.00 0.00 0.00 PERS Choice (PPO) 0.00 0.00 0.00 PERS Care (PPO) 0.00 0.00 0.00 Blue Shield - Access+ 0.00 0.00 0.00 Blue Shield - Net Value 0.00 0.00 0.00 Kaiser 0.00 0.00 0.00 Combination Monthly Rate Employee in Supplemental Medicare & Dependant in Basic Employee in B 1 Dependent in M Employee in B 2+ Dependents in M Employee & 1 Dependent in B 1+ Dependents in M CCPOA Medical Plan Member Contribution *Must be a CCPOA Retired Member SoCal $0.00 $0.00 $0.00 NorCal 0.00 0.00 0.00 PERS Select (PPO) 0.00 0.00 0.00 PERS Choice (PPO) 0.00 0.00 0.00 PERS Care (PPO) 0.00 0.00 0.00 Blue Shield - Access+ 0.00 0.00 0.00 Blue Shield - Net Value 0.00 0.00 0.00 Kaiser 0.00 0.00 0.00

2015 VSP Plan Details PLAN MEMBER COST ADDITIONAL INFO VSP Active Rate VSP CoBen VSP RETIREE RATES $2.00 monthly $8.64 monthly State = $8.64 Supplemental/ Trust = $5.04; Total Plan = $16.07 State Basic Plan. CCPOA Supervisors get enhanced 2nd pair coverage at no cost Standard Plan Single = $9.20 Two Party = $13.19 Family = $23.54 Exam Plus Single = $2.41 Two Party = $3.34 Family = $5.75 Costco is now an Open Access provider. They have direct billing to VSP and a special benefit schedule. Shatter-proof lenses (polycarbonite) for children are now covered.

2015 CCPOA MEDICAL RATES AND COVERAGE MAPS

CCPOA Medical Plan Service Area Employee Only Employee + 1 Dependent Employee + Family $157.33 315.26 475.13 37.88 76.30 153.82 Facility City County Avenal State Prison Avenal Kings California Medical Facility Vacaville Solano California State Prison, Corcoran Corcoran Kings California State Prison, Sacramento Represa Sacramento California State Prison, Solano Vacaville Solano California Substance Abuse Treatment Facility Corcoran Kings Central California Women s Facility Chowchilla Madera Deuel Vocational Institution Tracy San Joaquin Folsom State Prison Represa Sacramento Pleasant Valley State Prison Coalinga Fresno San Quentin State Prison San Quentin Marin Valley State Prison for Women Chowchilla Madera California Health Care Facility Stockton San Joaquin California City Correctional Facility California City Kern California Correctional Institution Tehachapi Kern California Institution for Men Chino San Bernardino California Institution for Women Corona Riverside California Men s Colony San Luis Obispo San Luis Obispo California Rehabilitation Center Norco Riverside California State Prison, LA County Lancaster Los Angeles Calipatria State Prison Calipatria Imperial Centinela State Prison Imperial Imperial Chuckawalla Valley State Prison Blythe Riverside Ironwood State Prison Blythe Riverside Kern Valley State Prison Delano Kern North Kern State Prison Delano Kern R.J. Donovan Correctional Facility San Diego San Diego Wasco State Prison Wasco Kern California Correctional Center Susanville Lassen Correctional Training Facility Soledad Monterey High Desert State Prison Susanville Lassen Mule Creek State Prison Ione Amador Pelican Bay State Prison Cresent City Del Norte Salinas Valley State Prison Soledad Monterey Sierra Conservation Center Jamestown Tuolumne Youth Facility City County O.H. Close Youth Correctional Facility Stockton San Joaquin N.A. Chaderjian Youth Correctional Facility Stockton San Joaquin Ventura Youth Correctional Facility Ventura Ventura CCPOA Coverage Areas Partial NorCal Coverage SoCal = CCPOA Medical =

ce Area Anthem HMO Select Plan Service Area Employee Only Employee + 1 Dependent Employee + Family $115.45 $228.90 $294.57 Agenda Item Attachment 2, Page 1 2014 Proposed

Anthem HMO Traditional Plan Service Area ervice Area Employee Only Employee + 1 Dependent Employee + Family 203.34 404.68 523.08 Agenda Item Attachment 2, Page 2 2014 Proposed

Area BSC Access Plus Plan Service Area Employee Only Employee + 1 Dependent Employee + Family 194.16 386.32 499.22 Agenda Item Attachment 2, Page 3 2014 Proposed

a BSC Net Value Plan Service Area Employee Only Employee + 1 Dependent Employee + Family 146.36 290.72 3774.94 Agenda Item Attachment 2, Page 4 2014 Proposed

Health Net Salud y Mas Service Area rvice Area Employee Only Employee + 1 Dependent Employee + Family 11.97 21.94 25.52 Agenda Item Attachment 2, Page 5 2014 Proposed

Health Net Smart Care Service Area rvice Area Employee Only Employee + 1 Dependent Employee + Family 147.47 292.94 377.82 Agenda Item Attachment 2, Page 6 2014 Proposed

Kaiser Service Area Employee Only Employee + 1 Dependent Employee + Family 109.04 216.08 277.90 Agenda Item Attachment 2, Page 7 2014 Proposed

Sharp Service Area Employee Only Employee & 1 Dependent Employee & Family 62.38 122.76 156.59 Agenda Item Attachment 2, Page 8 2014 Proposed

United Service Area Employee Only Employee & 1 Dependent Employee & Family 118.40 234.80 302.24 Agenda Item Attachment 2, Page 9 2014 Proposed

2015 CCPOA Medical Rates Effective Date: 1/1/2015 12/31/2015 Active Member Out-Of-Pocket Cost PLAN Employee Only Employee + 1 Dependant Family Anthem Select HMO Anthem Traditional HMO $115.45 $228.90 $294.57 203.34 404.68 523.08 Blue Shield Access+ 194.16 386.32 499.22 Blue Shield NetValue 146.36 290.72 3774.94 CCPOA (North) $157.33 315.26 475.13 CCPOA (South) 37.88 76.30 153.82 Health Net Salud y Más 11.97 21.94 25.52 Health Net SmartCare 147.47 292.94 377.82 Kaiser (CA) 109.04 216.08 277.90 Sharp 62.38 122.76 156.59 UnitedHealthcare 118.40 234.80 302.24 PERS Select 94.22 186.44 239.37 PERS Choice 116.45 230.90 297.17 PERSCare 194.93 387.86 501.22 NO TOWERS? NO TRUST A C C E P T N O S U B S T I T U T E S