Teammate Handbook Cover
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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
Emergency Services (waived if admitted or hospitalized as an outpatient)
$50
No Charge
No Charge
No Charge
No Charge
No Charge
Ambulance Services
No Charge
No Charge
No Charge
No Charge
No Charge
No Charge
Surgery/Anesthesia
No Charge
No Charge
No Charge
No Charge
No Charge
No Charge
Physician Services (including Mental Health and Substance Abuse)
Office Visits
No Charge No Charge No Charge No Charge No Charge
$10
No Charge No Charge No Charge No Charge No Charge
No Charge No Charge No Charge No Charge No Charge
$10
No Charge No Charge No Charge No Charge No Charge
Inpatient Visits Outpatient Visits Urgent Care Visits Preventive Services
No Charge
No Charge No Charge No Charge No Charge
$10
No Charge No Charge
Diagnostic X-Ray/Lab
No Charge
No Charge
No Charge
No Charge
No Charge
No Charge
Durable Medical Equipment
No Charge
No Charge
No Charge
No Charge
No Charge
No Charge
2022 Health Benefit Summary | 27
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