1. Welcome UF, Local 1 and Management Council Members
A Comparison of Medical Plans
Presented by the District Human Resources Department
Welcome everyone, to the presentation today, titled, “A Comparison of Medical Plans.”

2. 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.
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 Blue Cross is proposing to replace the District’s current Health Net medical plan with their plans.

3. Agenda Compare Medical Plans Active Employees: Retired Employees:
Kaiser HMO
Health Net 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
Our agenda for today is to compare medical plans. We will take a look at current District medical plans for active employees and retirees. Medical plans for active employees include: Kaiser HMO, Health Net HMO and Health Net Elect. Anthem is proposing to replace the Health Net HMO and Health Nt Elect with Anthem Blue Cross HMO and Anthem Blue Cross EPO. The District’s retiree plans include: Kaiser Senior Advantage, Health Net Medicare HMO and Health Net Medicare PPO. Anthem is proposing to replace the Health Net Medicare HMO and Health Net PPO with Anthem Medicare Advantage.

4. Active Employees Kaiser Permanente Health Maintenance Organization (HMO)
Kaiser makes medical coverage simple.
Everything is under One Roof
Kaiser Hospital
Kaiser Doctors
Kaiser Specialists
Kaiser Pharmacy
Kaiser Insurance
First, lets talk about the HMO plans starting with Kaiser. A big advantage to Kaiser, is that everything is under one roof. You see your primary care physician, receive a referral to a specialist, and pick-up your prescriptions all at a Kaiser hospital.

5. 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.
Most Co Pays at Kaiser, are 15 dollars with a few exceptions. Common copays include: a 15 dollar copay for office visits, a 5 dollar copay for generic drugs, a 15 copay for brand name drugs, a 50 dollar copay for emergency room visits, and a 100 dollar copay if you are checked into the hospital.

6. 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
Health Net HMO is a little different than Kaiser HMO. When you enroll in Health Net HMO, you are assigned to a Medical Group, such as the John Muir Medical Group or the Hills Physicians Medical Group. Just like Kaiser, your primary care physician must provide you with a referral to a specialist.

7. 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.
The Co Pay Structure for Health Net HMO is the same as it is for Kaiser HMO. Most Co Pays at Health Net are 15 dollars with a few exceptions. Common copays include a 15 dollar copay for office visits, a 5 dollar copay for generic drugs, a 15 dollar copay for brand name drugs, a 50 dollar copay for emergency room visits and a 100 dollar copay if you are checked into the hospital.

8. 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 is structured similar to Health Net HMO. With Anthem HMO, you are assigned to a medical group, and receive referrals to a specialist from your primary care physician. The Co Pay structure, is similar to both Health Net HMO and Kaiser HMO.

9. Anthem Blue Cross HMO California Care HMO Network
Primary Care Physicians: 14,458
Specialists: 19,261
Hospitals: 370
The Anthems Blue Cross HMO network, in California has over 14,000 primary care physicians, over 19,000 specialists and over 350 hospitals.

10. Active Employees Health Net Elect
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.
Health Net Elect is different than Health Net HMO, Kaiser HMO and Anthem Blue Cross HMO. Health Net Elect provides two tiers. Tier 1 is the Health Net HMO tier. Tier 2 is a PPO tier. In Tier 2, go to any Health Net PPO doctor, in California, outside of your medical group. However, the cost structure for Tier 2 is not like Health Net HMO, it is similar to a PPO with a 20% in network Co Pay.

11. 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.
Anthem Blue Cross EPO, is different than any other medical plan. It is easy to access, medical groups are eliminated, go to any doctor in the country that takes Anthem Blue Cross PPO, pay a 15 dollar co pay. And, you don’t need a referral to see a specialist.

12. Number of Anthem CA Providers in EPO/PPO
Number of CA Providers in PPO:
PCPs: 22,515 Specialists: 32,191 Hospitals:
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%)
The Anthem EPO plan uses the Anthem PPO network which has over 22,000 primary care physicians, 32,000 specialists and 350 hospitals in California.

13. Retiree Kaiser Senior Advantage
Same exact plan as the Traditional Kaiser plan for active employees with a few additional benefits
Fixed $5 Co Pay
$150 optical allowance every 2 years
Includes Medicare Part D
Next, lets talk about our retiree plans starting with Kaiser Senior Advantage. Kaiser Senior Advantage is the same exact plan as the traditional Kaiser plan. However, it has a fixed 5 dollar co pay, a 150 dollar optical allowance, every 2 years, and includes Medicare Part D.

14. Retiree Health Net Medicare HMO Coordination of Benefits Plan
Same exact plan as the Traditional Health Net HMO plan for active employees
Includes Medicare Part D
Next, lets talk about the two Health Net Medicare plans starting with the Health Net Medicare HMO plan. The Health Net Medicare HMO is the same plan as the traditional Health Net HMO plan. However, it includes Medicare Part D.

15. Retiree Health Net Medicare PPO Coordination of Benefits Plan
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.
Office copay $15
Maximum out of pocket in network $1,500 per person; out of network $3,000 maximum family 3 or more
Includes Medicare Part D
The Health Net Medicare PPO is a two tiered PPO plan that requires retirees to pay a deductible, and 10 percent of the costs in-network, and 30 percent of the cost for out of network services, up to an annual maximum. This plan includes Medicare Part D.

16. Retiree Anthem Blue Cross Anthem Medicare Advantage
Retirees pay a $15 copay and go to any doctor or hospital nationally that accepts Medicare or Anthem.
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.
Next, lets talk about the Anthem Medicare plan. The Anthem Medicare Advantage plan, allows retirees to go, to any doctor or hospital in the country, that accepts Anthem PPO or Medicare, for a 15 dollar copay. This plan covers the 20%, Medicare gap, plus any deductibles charged by Medicare. This concludes the presentation. Thank you for your time.