Group Insurance

Horizon Blue Cross/Blue Shield PPO

  • $300 In-Network annual deductible per person
  • $600 maximum for covered family
  • 20% co-insurance for negotiated fee charges
  • $2000 individual/$4000 family annual In-Network maximum

Horizon Blue Cross Blue Shield is a Preferred Provider Organization (PPO) plan that offers two plans in one, an In-network PPO model and an Out-of-network model.  Comprehensive medical and hospital benefits are available for employees and their eligible covered dependents that elect the In-network PPO. Covered individuals pay a $300 In-Network annual deductible per person, to a $600 maximum for covered family, and 20% co-insurance for negotiated fee charges. The annual In-Network out-of-pocket maximum is $2,000 individual and $4,000 family. Pre-certification of planned hospitalization is required in order to avoid paying more out of your pocket.

Employees and their eligible covered dependents have the option of receiving medical services under either side of the plan. Employees who elect the Out-of-network plan can choose to use a nonparticipating doctor, hospital or other health care professional for care and/or medical services. However, you are subject to an annual deductible of $1,000 per person, to a $3,000 maximum for covered family, and 30% co-insurance for negotiated fee charges. The annual out-of-pocket maximum is $4,000 per individual and $8,000 family.  . 
In addition, it will be your responsibility to file your claims and medical bills. Out-of-network participants may also be asked to pay the entire medical bill at the time of your visit. It will then be your responsibility to file claims with Horizon Blue Cross Blue Shield for partial reimbursement.

The Horizon Blue Cross Blue Shield prescription drug program is administered by Caremark (formerly AdvancePCS). Prescription drugs are subject to the following co-payments:

  • $10 for generic drugs
  • $25 for brand name drugs when a generic is not available
  • $50 for brand name drugs when a brand name is chosen over the generic

 

Kaiser Permanente of CA HMO (CA employees only)

  • $20 Co-payment fees
  • $50 Emergency and Ambulance service
  • $1,500 individual/$3,000 family annual In-Network maximum

Kaiser Permanente of CA is a Health Maintenance Organization (HMO) Plan that provides services directly to its members and eligible covered dependents through an integrated medical care program. The health plan, plan hospitals, and the medical group work together to provide its members with quality care. Members have access to all of the covered services including a personal plan physician, hospital care, urgent care, and other benefits. There are co-payments but no deductibles. Co-payment fees are $20 for primary care visits and outpatient services. Emergency Room and ambulance service is $50. The annual out-of-pocket maximum is $1,500 per individual; $3,000 family.

Prescription drugs are subject to the following
co-payments:

Supply of generic drugs Supply of brand name drugs

$10 per 30 days
$20 per 60 days
$30 per 100 days

$20 per 30 days
$40 per 60 days
$60 per 100 days 


Vision Care Plan (VSP)

  • $20 Co-payment for exams every 12 months
  • $20 C0payment for lenses every 12 months

Vision Service Plan (VSP) is a nationally recognized vision services provider with over 22,000 providers nationwide.  In recognizing the need for a viable vision benefit, we negotiated an outstanding vision benefit program through VSP.  

Under the plan you get affordable benefits with great savings, a WellVision Exam focused on your health, eyewear choices, laser vision care and VSP doctors nearby with flexible schedules.  There is a co-payment of $20 every 12 months for an exam and lenses.  You get the best value from your benefit when you see a VSP doctor.  If you see a non-VSP provider, you’ll pay the provider in full and must submit a claim to VSP for partial reimbursement less co-pays.  Coverage will be available on a pre-tax basis.

Dental Plan

MetLife Dental assists you and your eligible covered dependents in meeting some of your dental-related expenses. The dental plan has two options for dental coverage: the standard “Core” plan option, and the premium “Buy Up” plan option.

The Core plan preventative and diagnostic services are covered at 80% in-network and out-of-network (provided the charge is classified by MetLife to be ‘Reasonable & Customary’). There is a $50 deductible per covered individual and $150 per family. There is an annual maximum benefit of $1,000 paid per covered individual and a 50% lifetime maximum orthodontic benefit paid per covered dependent.

For the Buy Up plan, preventative and diagnostic services are covered at 100% in-network and out-of-network (provided the charge is classified by MetLife to be ‘Reasonable & Customary’). There is a $50 deductible, and an annual maximum benefit of $2,000 paid per covered individual. There is a 50% lifetime maximum orthodontic benefit paid per covered dependent.

Refer to the chart below for an illustration of dental services and reimbursement structure:

Standard / Core Plan
Service Category
Participarting Dentist*
Non-Participating Dentist*
Examples of Service
Preventive and Diagnostic
80%
80%
Routine exams;
x-rays; cleanings
Full Basic
80%
80%
Root canal therapy; periodontics; extractions of impacted wisdom teeth
Prosthetics
60%
60%
Full or partial denture; crowns; fixed bridges; inlays
Orthodontic
50%
50%
Diagnosis, construction, and insertion of appliance
*Based on usual and customary rates

 

Premium / Buy-Up Plan
Service Category
Participarting Dentist*
Non-Participating Dentist*
Examples of Service
Preventive and Diagnostic
100%
100%
Routine exams;
x-rays; cleanings
Full Basic
90%
90%
Root canal therapy; periodontics; extractions of impacted wisdom teeth
Prosthetics
60%
60%
Full or partial denture; crowns; fixed bridges; inlays
Orthodontic
50%
50%
Diagnosis, construction, and insertion of appliance
*Based on usual and customary rates


Flexible Spending Accounts (FSAs)

Ceridian administers the Health Care and Dependent Care Flexible Spending Accounts (FSA).
Under the plan you can put away the following amounts on an annual basis:

  • Health Care Account - Up to $4,000
  • Dependent care Account - Up to $5,000


An equal dollar amount will be deducted from each payroll check on a pre-tax basis. Please remember that the elected amount must be utilized by December 31, 2009 or the balance not utilized will be forfeited pursuant to IRS Regulation. The chosen annual contribution will be equally divided by pay periods.

Ceridian provides debit cards for your convenience.  Claim forms can also be utilized to receive benefits and can be submitted either by mail, e-mail or fax. You also have on-line access to your account.

 

 

Employee

     
    Benefit Details
    Medical
    Horizon - EPO                                   Horizon - PPO                                    
    Kaiser (Northern California)           
    Kaiser (Southern California)                       
    Dental
    MetLife Core                                   
    MetLife Buy-Up
                           
    Vision
    VSP   
                                                
    Life
    Metife Hourly                                   
    MetLife Salaried
                           
    Pension
    Employee Pension Plan 

    Short/Long Term Disability
    MetLife Disability