Welcome UF Local 1 and Management Council Members

Welcome UF, Local 1 and Management Council Members A Comparison of Medical Plans Presented by the District Human Resources Department

Purpose The purpose of this presentation is to provide a comparison of current District medical plans with proposed medical plans offered by Anthem Blue Cross. Anthem is proposing to replace our current Health Net medical plan with their plans.

Agenda v Compare Medical Plans Active Employees: Kaiser HMO Health Net Elect Proposed - Anthem Blue Cross HMO Proposed - Anthem Blue Cross EPO Retired Employees: Kaiser Senior Advantage Health Net Medicare HMO Coordination of Benefits (COB) Plan Health Net Medicare PPO Coordination of Benefits (COB) Plan Proposed - Anthem Medicare Advantage PPO

Active Employees Kaiser Permanente Health Maintenance Organization (HMO) v. Kaiser makes medical coverage simple. v. Everything is under One Roof v. Kaiser Hospital v. Kaiser Doctors v. Kaiser Specialists v. Kaiser Pharmacy v. Kaiser Insurance

Active Employees Kaiser Permanente HMO Most copays are $15 Common copays include: $15 copay for office visits $5 copay for generic drugs $15 copay for brand name drugs $50 copay - if you go to an emergency room $100 copay - if you are checked into the hospital For a more comprehensive list see handbook or plan details.

Active Employees Health Net HMO When you enroll in Health Net HMO Assigned a Medical Group such as John Muir Medical Group, Hills Physicians or the Alta Bates medical groups. Assigned a primary care physician

Active Employees Health Net HMO Most copays are $15 Common copays include: $15 copay for office visits $5 copay for generic drugs $15 copay for brand name drugs $50 copay - if you go to an emergency room $100 copay - if you are checked into the hospital For a more comprehensive list see handbook or plan details.

Active Employees Anthem Blue Cross HMO When you enroll in Anthem Blue Cross HMO Assigned a Medical Group such as John Muir Medical Group, Hills Physicians or the Alta Bates medical groups. Assigned a primary care physician Same co-pay structure as Health Net HMO and Kaiser HMO

Anthem Blue Cross HMO California Care HMO Network Primary Care Physicians: 14, 458 Specialists: 19, 261 Hospitals: 370

Active Employees Health Net Elect allows you the choice of using either Tier 1 Health Net HMO network or Tier 2 the Health Net PPO network You can always stay on tier 1 – HMO and pay your normal copays. However, you can also use Tier 2 –PPO. Tier 2 PPO – you go to any doctor in CA outside of your medical group that accepts Health Net PPO. However, the cost structure is different and similar to that of a PPO. Office visits cost $25. 00 For most services your are responsible to pay 20% of the Health Net contracted rate Please see the cost structure for the Health Net Elect plan details which is online.

Active Employees Anthem Blue Cross Exclusive Provider Organization (EPO) Anthem Blue Cross EPO Easy to access Medical Groups are eliminated Go to any doctor in the country that takes Anthem Blue Cross PPO that is accepting patients Anthem EPO uses the Anthem PPO provider network. You don’t need a referral from a primary care physician The copay structure is the same as the Health Net HMO and Anthem HMO.

Number of Anthem CA Providers in EPO/PPO Number of CA Providers in PPO: PCPs: 22, 515 Specialists: 32, 191 Hospitals: 380 97% of the 1, 076 teaching hospitals in America contract with Blue plans nationally (compared to Aetna's 93%; CIGNA's 92% and UHC's 95%)

Retiree Kaiser Senior Advantage v. Same exact plan as the Traditional Kaiser plan for active employees with a few additional benefits v. Fixed $5 Co Pay v$150 optical allowance every 2 years v. Includes Medicare Part D

Retiree Health Net Medicare HMO Coordination of Benefits Plan v. Same exact plan as the Traditional Health Net HMO plan for active employees v. Includes Medicare Part D

Retiree Health Net Medicare PPO Coordination of Benefits Plan v. Retirees pay a deductible and a percentage of the cost which is 10% in-network or 30% out of network up to an annual maximum. v. Office copay $15 v. Maximum out of pocket in network $1, 500 person; out of network $3, 000 maximum family 3 or more v Includes Medicare Part D

Retiree Anthem Blue Cross Anthem Medicare Advantage v. Retirees pay a $15 copay and go to any doctor or hospital nationally that accepts Medicare or Anthem. v. Medicare is an 80/20 plan that covers 80% but not the remaining 20%. However, this plan covers the 20% gap plus any deductibles charged by Medicare.