Medical Plan Comparison Chart
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BLUE SHIELD EPO (Exclusive Provider Organization)
Under the EPO plan, the network of contracted physicians and hospitals are known as Preferred Providers. Under an EPO plan, you do not have an assigned Primary Care Physician (PCP). You are allowed to access medical services from any Blue Shield in-network PPO physician, specialist or facility without having to obtain a referral. All covered services, except for Emergency Care, must be provided by a Preferred Provider. The EPO plan does not provide out-of-network benefits.
2016 EPO PLAN INFORMATION
2015 EPO PLAN INFORMATION
- 2015 EPO Enrollment Guide
- 2015 EPO Low Summary of Benefits & Coverage
- 2105 EPO Low Option Benefit Summary
- 2015 EPO Low Option Pharmacy
- 2015 EPO High Summary of Benefits & Coverage
- 2105 EPO High Option Benefit Summary
- 2015 EPO High Option Pharmacy
BLUE SHIELD PPO (Preferred Provider Organization)
THIS PLAN IS NOT AVAILABLE IN 2016
The PPO plan is designed to provide choice, two levels of service, and flexibility. Participants may go directly to any physician without a referral and have a choice of using preferred (PPO/in-network) or non-preferred (non-PPO/out-of-network) providers. Generally, there are annual deductibles to meet before benefits apply. Participants are also responsible for a certain percentage of the charges (co-insurance), and the plan pays the balance up to the agreed upon amount.
2015 PPO PLAN INFORMATION
- 2105 PPO Enrollment Guide
- 2015 PPO Summary of Benefits & Coverage
- 2015 PPO Benefit Summary
- 2015 PPO Pharmacy
BLUE SHIELD HDHP (High Deductible Health Plan)
The HDHP provides choice and two levels of service; in-network and out-of-network. The HDHP uses the Blue Shield national PPO networks so you have a choice of using in-network preferred providers or any out-of-network physician that you choose. There are no copayments; only co-insurance with coverage for in-network providers at a higher benefit level and lower cost to you. This plan has a higher annual deductible that must be met before it begins to pay the appropriate co-insurance amount.
An HSA (Health Savings Account) is available to you if you are enrolled in a HDHP. An H.S.A. account allows you to contribute using pre-tax dollars and the funds roll over and accumulate year to year if not spent. H.S.A. funds can be used to pay any qualified medical expenses. This type of health savings account is owned by you and is portable. If you decide to terminate the HDHP, you will no longer be able to deposit new funds into the H.S.A. account, but funds already in the H.S.A. will remain available for your use.
2016 HDHP PLAN INFORMATION
2015 HDHP PLAN INFORMATION
- BLUE SHIELD HDHP OPTION
- 2105 HDHP Enrollment Guide
- 2015 HDHP Summary of Benefits & Coverage
- 2015 HDHP Benefit Summary
A Health Saving Account (HSA) is available only to employees who participate in the Blue Shield High Deductible Health Plan (HDHP). A HSA is like a IRA for healthcare. It is a tax-advantaged personal savings or investment account that you can use to save and pay for qualified health expenses, now or in the future. Paired with a qualified high deductible health plan (HDHP), an HSA is a powerful financial tool that empowers you to be more actively involved in your healthcare decisions.
An HSA allows you to:
- Save toward medical expenses (including dental and vision), up to IRS maximums (see Table)
- Have your contributions deducted on a pre-tax basis
- Change your contribution amount at any time
- Roll the funds to the following year (this is not a “use it or lose it” plan)
- Keep the account; it is portable; it goes with you if you leave employment
- Use a debit card to pay for qualified medical expenses
- Use the funds to pay for IRS tax dependents even if they are not enrolled in the HDHP
TABLE 1- HSA Contribution Limits for 2016
Annual Single Contribution Maximum
Annual Family Contribution Maximum
Annual Catch-Up Contribution Maximum
*These amounts are the maximum the IRS allows you to contribute to your HSA. If the Court contributes $900 into this account you have to deduct that amount from this limit As an example; $3,350 - $900 =$2,450 would be the annual single contribution maximum you can make on a pre-tax basis.
- If you have a Healthcare Flex Spending Account (FSA) for 2015, you cannot open an HSA until the available funds in your 2015 FSA Healthcare account have been used, and the balance in your Healthcare FSA account is $0.
- You cannot have an HSA and be a dependent on another person's health insurance plan, unless that plan is also a High Deductible Health Plan.
- The Court will contribute $900 annually over 24 pay periods into your Sterling HAS account.
You must open your HSA with Sterling HSA. If you do not open your account you will not be able to receive any of the Court’s contributions.
Health Savings Accounts are administered by Sterling
- HSA FAQs
- Setting up a Sterling HSA Account
- Sterling HSA Service Package
- Sterling HSA Enrollment
- HSA IRS Publication 969
Express Scripts is your pharmacy carrier if you are on Blue Shield. You have a separate pharmacy ID card for your prescription coverage. You must use this ID card to obtain your prescriptions from your local pharmacy. Your Blue Shield ID card will not be valid.
If you are enrolled in the Blue Shield HDHP, you must use your Blue Shield ID card to obtain prescriptions (Express Scripts will not be your pharmacy carrier).
- 2016 EXPRESS SCRIPTS
Express Scripts will be implementing pharmacy utilization management programs. Remember that drug formularies change on a regular basis. If you receive mail from Express Scripts or Blue Shield, please make sure to read the contents since it may be a notice of a potential change to prescription drug(s) that you are taking.
Express Scripts will be adding a Retail Refill Allowance (RRA) program for the Low EPO plan. Under this program, all members that are currently taking maintenance medications will be required to go to mail order for these drugs. On or after January 1, 2016, you can refill maintenance medication at your local pharmacy twice and thereafter, your refill will be denied. You will need to contact your doctor, preferably before January of 2016, and have him send a 12
months prescription to Express Scripts. If you are taking a maintenance medication, you will receive a letter from Express Scripts advising you of the required change with instructions on what you need to do.
Maintenance medications are medications prescribed for a chronic long term condition and are
taken on a regular basis (ex: high blood pressure, high cholesterol, etc.)
- 2015 EXPRESS SCRIPTS
Your preferred drug list is a list of brand-name and generic medications that are preferred by your plan. These medications are selected because they can safely and effectively treat most medical conditions while helping to contain costs for you and your plan. See Guide: 2015 Guide to your Preferred Drug List
The following is a list of the most commonly prescribed drugs. The list is not all-inclusive and does not guarantee coverage. You are encouraged t ask your doctor to prescribe generic drugs whenever appropriate. See more info below:
2015 Express Scripts National Preferred Formulary List
The excluded medications are not covered by the Express Scripts drug list. In most cases, if you fill a prescription for one of these drugs, you will pay the full retail price. If you are currently using one of the excluded medications, please ask your doctor to consider writing a new prescription for one of the preferred alternatives. See list:
2015 Preferred Drug List Exclusions
CONTACT HUMAN RESOURCES:
Superior Court Figueroa Division
118 East Figueroa Street
Santa Barbara, CA 93101
Superior Court Cook Division
Santa Maria Office
312 E. Cook St. Bldg. E.
2nd Floor Rm. 242
Santa Maria, CA 93454
Phone: (805) 882-4739