Teammate Handbook Cover
Continued on next page
Medicare Plans
CCPOA Medicare Supplement (Association Plan)
Western Health Advantage MyCare Select (HMO)
PERS Gold
PERS Platinum CAHP Medicare Supplement (Association Plan)
PORAC (Association Plan)
PPO Non-PPO PPO Non-PPO
BENEFITS
Calendar Year Deductible
Individual
N/A N/A
N/A N/A
N/A N/A
N/A N/A
N/A N/A
N/A N/A
Family
Maximum Calendar Year Copay or Coinsurance (excluding pharmacy)
$3,000 1 (co- insurance)
$1,500 (copay/coinsurance)
$1,500 (copay)
Individual
N/A
N/A
N/A
N/A
$4,500 (3 or more)
Family
N/A
N/A
N/A
N/A
N/A
Hospital (including Mental Health and Substance Abuse)
Inpatient
No Charge
$100/admission
No Charge
No Charge
No Charge
No Charge
Outpatient Facility/ Surgery Services
No Charge
No Charge
No Charge
No Charge
No Charge
No Charge
Skilled Nursing Facility (up to 100 days/benefit period)
No Charge
No Charge
No Charge
No Charge
No Charge
No Charge
Home Health Services
$15/visit (up to 100 visits per calendar year)
No Charge
No Charge
No Charge
No Charge
No Charge
Hospice
No Charge
No Charge
No Charge
No Charge
No Charge
No Charge
1 See EOC for additional details.
2022 Health Benefit Summary | 25
Made with FlippingBook - Online catalogs