2015
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
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
Vision
www.vsp.com
$2.00 monthly*
*Actual rate = $16.07 monthly.
$8.64 State Contribution + Additional Negotiated Benefit/Trust contribution of $5.43
Dental
Western Dental and CCPOA Primary
$44.94 monthly
premium for members
*Subject to negotiations
* State contribution rate as of 08/12/2014. Subject to change after printing.
Here’s an Example of CoBen in action:
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
Medical Rates with CoBen
2015 State Contribution - CoBen Medical Plan*
Employee = $590.00 | Employee + 1 = $1140.00 | Family = $1,474.00
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
=
-
Contribution:
Employee
$73.94
CCPOA Medical Plan
Dental Plan
VSP Vision Plan
*Subject to negotiations
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
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
Dental
Retired Dental coverage is obtained through CalPERS
*Subject to negotiations
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
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 State Contribution - Medical Plan*
2015 Retired Rates
Combination Plans with State Contribution
Combination Monthly Rate
Employee in Supplemental Medicare &
Dependant in Basic
Employee in M
1 Dependent in B
2+ Dependents in B
Employee in M
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
2+ Dependents in M
Employee in B
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 State Contribution - Retired
2015
VSP Plan Details
PLAN
MEMBER COST
ADDITIONAL INFO
VSP Active Rate
$2.00 monthly
State = $8.64
Supplemental/ Trust = $5.04;
Total Plan = $16.07
VSP CoBen
$8.64 monthly
State Basic Plan. CCPOA Supervisors get
enhanced 2nd pair coverage at no cost
VSP RETIREE RATES
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.
2015
CCPOA
MEDICAL RATES
AND
CCPOA Coverage Areas
=
=
CCPOA Medical
Partial Coverage NorCal SoCalCCPOA Medical Plan Service Area
Employee Only
1 Dependent
Employee +
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
Network Access Analysis
Anthem HMO Select Service Area
California
June 17, 2013
Service Areas
Anthem Service Area (HMO
Select)
1 in. = 98.91 miles
2014 Proposed
© 2013 Quest Analytics, LLCAgenda Item 6a
Attachment 2, Page 1 of 9
Anthem HMO Select Plan Service Area
Employee Only
Employee + 1 Dependent
Employee + Family
Network Access Analysis
Anthem HMO Traditional Service Area
California
June 17, 2013
Service Areas
Anthem Service Area (HMO)
1 in. = 98.91 miles
2014 Proposed
© 2013 Quest Analytics, LLC
Agenda Item 6a
Attachment 2, Page 2 of 9
Anthem HMO Traditional Plan Service Area
Employee Only
Employee + 1 Dependent
Employee + Family
Network Access Analysis
BSC Access Plus Service Area
California
June 17, 2013
Service Areas
BSC Access Plus Service Area
1 in. = 98.91 miles
2014 Proposed
© 2013 Quest Analytics, LLC
Agenda Item 6a
Attachment 2, Page 3 of 9
BSC Access Plus Plan Service Area
Employee Only
Employee + 1 Dependent
Employee + Family
Network Access Analysis
BSC Net Value Service Area
California
June 17, 2013
Service Areas
BSC Net Value
1 in. = 98.91 miles
2014 Proposed
© 2013 Quest Analytics, LLCAgenda Item 6a
Attachment 2, Page 4 of 9
BSC Net Value Plan Service Area
Employee Only
Employee + 1 Dependent
Employee + Family
Network Access Analysis
Health Net Salud y Mas Service Area
California
June 17, 2013
Service Areas
Health Net Salud y Mas
1 in. = 98.91 miles
2014 Proposed
© 2013 Quest Analytics, LLC
Agenda Item 6a
Attachment 2, Page 5 of 9
Health Net Salud y Mas Service Area
Employee Only
Employee + 1 Dependent
Employee + Family
Network Access Analysis
Health Net Smart Care Service Area
California
June 17, 2013
Service Areas
Health Net SmartCare
1 in. = 98.91 miles
2014 Proposed
© 2013 Quest Analytics, LLC
Agenda Item 6a
Attachment 2, Page 6 of 9
Health Net Smart Care Service Area
Employee Only
Employee + 1 Dependent
Employee + Family
Network Access Analysis
Kaiser Service Area
California
June 17, 2013
Service Areas
Kaiser Service Area
1 in. = 98.91 miles
2014 Proposed
© 2013 Quest Analytics, LLC
Agenda Item 6a
Attachment 2, Page 7 of 9
Kaiser Service Area
Employee Only
Employee + 1 Dependent
Employee + Family
Network Access Analysis
Sharp Service Area
California
June 17, 2013
Service Areas
Sharp Service Area
1 in. = 98.91 miles
2014 Proposed
© 2013 Quest Analytics, LLC
Agenda Item 6a
Attachment 2, Page 8 of 9
Sharp Service Area
Employee Only
Employee & 1 Dependent
Employee & Family
Network Access Analysis
United Service Area
California
June 17, 2013
Service Areas
United Service Area
1 in. = 98.91 miles
2014 Proposed
© 2013 Quest Analytics, LLC
Agenda Item 6a
Attachment 2, Page 9 of 9
United Service Area
Employee Only
Employee & 1 Dependent
Employee & Family
NO TOWERS?
NO TRUST
A C C E P T N O S U B S T I T U T E S
