PLAN
YEAR PLAN DESIGN CHANGES
2001 Medical and Dental Bid
CIGNA: Replaced by Blue Cross of CA HMO & PPO: Added chiropractic benefits PPO: Added routine physical
PPO: Out-of-pocket maximum increased to $5,000
Dental PPO: Increased annual benefit max to $1,500/$1,250 2002 Kaiser: Rx copay increased from $7 to $10
Kaiser: Emergency room copay increased from $10 to $35 Pacificare: HMO- CA: Implemented 3-tier Rx copay Pacificare: HMO- AZ/NV: Implemented 2-tier Rx copay Blue Cross PPO: Increased Rx copay
2003 Blue Cross PPO: Implemented 3-tier Rx copay SecureHorizons CA: Implemented 3-tier Rx copay 2004 Added Caregiver benefit
Pacificare HMO: Dropped in OR, WA, CO, OK, and TX SecureHorizons CA changed to Standard Plan Design Emergency room copay increased from $20 to $50
Enhanced immunization, injectible drugs, vision and audiology benefits 2005 Medical and Dental Bid
Pacificare HMO- CA: Replaced by Blue Cross of CA SecureHorizons: Terminated from 5 non-CA states Added SCAN Healthplan
Kaiser: Office Visit Copay increased from $5 to $10 2006 Integrating Medicare Part D into all Sr. Plans
Wellpoint/Blue Cross PPO Dental increased annual in-network maximum from $1,500 to $2,000 2007 Office Visit Copay increases Blue Cross and Kaiser from $35 to $50 SCAN from $25 to $50
Secure Horizons had increased to $50 in 2004 Prescription Copays
Blue Cross
PPO Retail: Brand from $15 to $20, Non-formulary $25 to $45
PPO Mail Order Brand from $30 to $40, Non-formulary from $50 to $90
HMO Retail: Generic from $5 to $10, Brand from $10 to $20, Non-formulary $25 to $45
HMO Mail Order: Generic from $10 to $20, Brand from $20 to $40, Non-formulary from $50 to $90 Kaiser - retail/mail order
<65 Brand from $10 to $25 Sr. Advantage from $10 to $15 Secure Horizons
Retail: Generic from $5 to $10, Brand from $10 to $20, Non-formulary from $20 to $50 Mail Order: Generic from $10 to $20, Brand from $20 to $40, Non-formulary from $40 to $100 SCAN
Retail: Generic from $5 to $10, Brand from $10 to $20, Non-formulary N/A Mail Order: Generic from $10 to $20, Brand from $20 to $40, Non-formulary N/A 2008 No copay or benefit changes
BOARD Meeting: 4/27/21 Item IX-A
Attachment 5
Historical Benefit Changes 2001 through 2021
PLAN
YEAR PLAN DESIGN CHANGES
2009 Wellpoint/Blue Cross PPO Dental: Replaced by MetLife PPO Dental Secure Horizons: Annual Routine Physical copay from $15 to $0
SCAN service area increased: AZ-Maricopa Co., CA -Now in all parts of San Diego, Riverside, San Bernardino, Ventura and Kern Counties
MetLife Dental PPO added dental implants covered at 50% up to the annual maximum 2010 SCAN and SecureHorizons: Elimination of duplicate dental and vision benefits
All LACERS Medical Plans: Will comply with the Mental Health Parity Act. LACERS was not required to comply under the Act.
2011 Anthem: Decreased generic Anthem Rx copay from $10 and $20 (mail) to $5 and $10 (mail), increased Rx copay for brands/non-formularies from $20/$45 and $40/$90 (mail) to $25/$50 (mail) and $50/$100 (mail) in all plans; increased deductible from $500/$1,000 to $750/$1,500 and Office Visit and Urgent Care Visit copays from $15 to $20 in non-Medicare PPO and HMO; increased ER visit copay from $50 to $100 in non-Medicare HMO.
Kaiser non-Medicare Plan: Reduced Rx supply from 100-day to 30-day, increased Office Visit and Urgent Care Visit copay from $15 to $20; increased ER visit copay from $50 to $100.
2012 MetLife Dental PPO: Change to non-participating funding arrangement; Reduce capping of out-of-network UCR coverage from the 90th to the 70th percentile; Reduce out-of-out-of-network coverage of basic services from 80% to 70%; Extend crown replacement from five years to seven years VSP: Change from Signature Plan to Choice Plan (Member receives less discount for non-covered items)
Anthem Blue Cross Medicare Supplement Plan: Replace the Medicare Supplement Plan with the Medicare Advantage LPPO ($0 copays, no change in covered services, retiree support, CMS funding and oversight)
Kaiser Permanente Senior Advantage HMO: Medicare-covered preventive services will no longer have a $15 copay (covered 100%)
SCAN Medicare Advantage HMO: Medicare-covered eyewear will be covered at 100% up to the Medicare Allowance (current benefit: $75 allowance)
Evercare Solutions for Caregivers: Elimination of Plan
Anthem Blue Cross: modified its underwriting approach for the 2012 renewal from individual product underwriting (i.e., separate PPO and HMO underwriting) to whole case underwriting (i.e., combined PPO and HMO underwriting). This approach is intended to reduce wide annual variances in renewals of the individual plans
2013 No plan design changes Added Programs include:
UnitedHealthcare - Hi Healthinnovations Program (discounted hearing aid products and services)
MetLife - Web-based Dental Health Manager
VSP - Smart Data Management (data sharing program with medical plans) 2014 No plan design changes
Anthem Medicare Preferred (PPO) Plan: Replaced with Medicare Supplement plan, while retaining Silver Sneakers and Disease Management Programs
SCAN: Silver&Fit added (changed to SilverSneakers)
2015
VSP: Replaced with Anthem Blue View Vision for non-Kaiser Members. New progressive lens co-pay of $30. (co-pay would have also been part of VSP if contract renewed)
Metlife Dental PPO: Replaced with Delta Dental PPO; benefit change - 4 periodontal cleanings at no charge
SafeGuard Dental HMO: Replaced with DeltaCare USA® HMO
Historical Benefit Changes 2001 through 2021
2016
UnitedHealthCare - AZ, CA, NV: Diabetic Supplies - only one approved vendor. Change only affected 4 Members
Anthem HMO: Change Prescription Benefit copays and additional Specialty drug copay Retail: Generic from $5 to $10, Brand from $25 to $30, Non-formulary no change from $50; 20%
coinsurance for Speciality drugs up to $100
Mail Order: Generic from $10 to $20, Brand from $50 to $60, Non-formulary no change from $100;
20% coinsurance for Speciality drugs up to $100
2017 Anthem PPO: Change Prescription Benefit copays and additional Specialty drug copay Retail: Generic from $5 to $10, Brand from $25 to $30, Non-formulary no change from $50; 20%
coinsurance for Specialty drugs up to $100
Mail Order: Generic from $10 to $20, Brand from $50 to $60, Non-formulary no change from $100;
20% coinsurance for Speciality drugs up to $100
Kaiser Non-Medicare Plan: Change Prescription Benefit copays and additional Specialty drug copay
Retail: Generic from $10 to $15, Brand from $25 to $35
Mail Order: Generic from $20 to $30, Brand from $50 to $70, Speciality drugs up to $100 Kaiser Permanente Senior Advantage HMO: Silver & Fit program added
2018 No plan design changes
2019 Anthem HMO and PPO: SilverSneakers added
2020 All Plans: Accupuncture benefit added/expanded in all plans
All Medicare Plans: Prescription Drug Catastrophic Coverage Added
2021 KPSA: Added transportation benefit - 24 one-way trips up to 50 miles each/year
UHC: Added transportation benefit - 30 one-way trips up to 50 miles each/year; Added meal delivery benefit - 3 meals/day for up to four weeks post discharge from hospital; Solutions for Caregivers was dissolved by UHC.
KP HMO: Added Active and Fit fitness program benefit Anthem PPO and Med Sup: Removed lifetime maximums
BOARD Meeting: 4/27/21 Item IX-A
Attachment 6