If you decide not to make changes to your benefits, no action is required.

HEALTH PLAN DEFINITIONS

• Health Maintenance Organization (HMO):  This type of plan is designed to reduce out-of-pocket expenses, with no deductible and a minimal co-payment.   All services must be received from contracting physicians and hospitals.
• Preferred Provider Organization (PPO)/Indemnity – This plan requires that a deductible be met before the plan benefits are payable (90% - 80% depending upon which PPO is selected).  Similar to HMO’s, the PPO Indemnity plan contracts with specific doctors and hospitals in certain areas.   The plan pays higher benefits when utilizing a participating provider (BLUE CROSS) than a non-participating provider.  Under a PPO/Indemnity plan, there is no geographic restriction.  Blue Cross Administers both PPOs.   MEDCO  is the pharmacy benefit manager for both PPOs.

Blue Shield Access+ (HMO) and Blue Shield NetValue (HMO)    1-800-334-5847   

Kaiser (HMO)  1-800-464-4000  

PERSCare (PPO), PERSChoice (PPO) and PERS Select (PPO)  1-877-737-7776 
(Blue Cross administers the PPO plans)  

The 2010 Health Benefits Summary  and 2010 Health Benefits Program Guide  will assist you making health plan choices during the Open Enrollment Period.

Medical ID cards: The health plans will make every effort to ensure members who change health plans receive their new identification cards before January 1, 2010.  If you change plans and do not receive new cards by the above date, do not continue to use your prior plan after December 31, 2009.  To resolve this problem, contact your new health plan and inquire about the issuance of cards.  Delta Dental does not issue dental cards; please refer to your group number for dental care.

HMO CO-PAYMENTS/ OFFICE VISITS AND URGENT CARE CHANGES: 

• Office co-payments will be waived for preventive care office visits including periodic health exams, Maternity care, well baby visits, allergy testing and treatment,
  immunizations, hearing evaluations and pre/post natal care.  Please Note:  Kaiser will continue to charge a co-payment for allergy testing and treatment.
• Other office visits co-payments $15.
• Co-payments for urgent care visits will be $15.
• Out-of-pocket maximum will be $1,500 for individual and $3,000 for family. Pharmacy is excluded.

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