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Benefit Comparison Summary: MEDICAL | DENTAL | VISION
Health Insurance Premiums: HEALTHCARE
| COBRA
COBRA | HIPAA | Care
Counsel | Employee Assistance
Eligibility | Open
Enrollment | Additional Info | Change
Waiver
of Coverage
Flexible Spending Accounts: Health | Dependent
Care | Transit
& Parking
BLUE SHIELD CSAC-EAI PLAN INFORMATION
The Blue Shield plans include Low EPO, High EPO, PPO (In-Network and Out of Network), and High Deductible (PPO) Plans.
- 2012 Premium Rates
- 2012 Premium Rates for Part Time Employees:
- 2012 Medical Plan Comparison Chart
- Eligibility for Benefits
- Additional Information Regarding Your Benefits
- Rules for Benefits Changes During the Year
- HEALTH & WELLNESS
- 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, yo
Medical Plan Provider – for more information including providers:
Blue Shield – www.blueshield.com/csac
Pharmacy Carrier - Medco will continue to be your pharmacy provider for retail and mail order prescriptions for all EPO and PPO plans. Blue Shield is the Pharmacy Provider for the High Deductible Health Plan (HDHP).
- EPO PLAN 2012
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.
- PPO PLAN 2012
Blue Shield PPO (Preferred Provider Organization):
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.
- HIGH DEDUCTIBLE 2012
Blue Shield HDHP (High Deductible Health Plan):
The HDHP plan provides choice and two levels of service; in-network and out-of-network. The HDHP plan 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 H.S.A. (Health Savings Account) is available to you if you are enrolled in a HDHP plan. 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 plan, 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.
- Health Savings Account (HSA) Information
Each enrollee in the Aetna HDHP (High Deductible) PPO Plan, unless already holding a medical spending account, is eligible to set up a pre-tax Health Savings Account (HSA). Unlike the Medical Spending Account, these funds carry over from year to year and the Court will contribute $900 annually for full-time employees.
HSA contributions can come from the employee, employer or both, all in the same tax year. Each year the IRS changes the maximum annual contribution. For 2011 the maximum is $3,050 for individuals and $6,150 for families (unchanged from 2010). Catch-up contributions can be made by individuals 55 and over up to $1,000.
HSAs are portable and move with an employee if there is a change in employment.
Unused HSA funds roll over from year to year and interest continues to grow on a tax-deferred basis.
Sterling allows HSA accountholders to self-direct HSA investments (subject to IRS limitations).
See information below for more details.
MEDCO PHARMACY
Medco is your pharmacy carrier if you are on the Blue Shield Low Option EPO, High Option EPO or PPO plan. You have a separate Medco pharmacy ID card for your prescription coverage. You must use the Medco 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 plan, you must use your Blue Shield ID card to obtain prescriptions ( Medco will not be your pharmacy carrier).
*If you have any questions, please call Human Resources staff at (805) 882-4739 or use the Carrier Contact listing.
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