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CalPERS Health Plans Benefit Comparison — Medicare Plans, Continued CalPERS Health Plan Benefit Comparison— Medicare Plans, Continued

For more details about the benefits provided by a specific plan, refer to that plan’s Evidence of Coverage (EOC) booklet.

Medicare Plans

UnitedHealthcare Group Medicare Advantage Edge (PPO)

Kaiser Permanente Senior Advantage

Anthem Medicare Preferred (PPO)

Blue Shield Medicare (PPO)

Sharp Direct Advantage (HMO)

UnitedHealthcare Group Medicare Advantage (PPO)

BENEFITS

Diabetes Services Glucose monitors

10% (coinsurance)

No Charge

No Charge

No Charge

No Charge

No Charge

Hearing Services Routine Hearing Exam

$10 $10

No Charge

No Charge

No Charge

No Charge

No Charge No Charge

Physician Services

$10

$10

$10

$10

$1,000 max/ 36 months

$1,000 max/ 36 months

$1,000 max/ 36 months

$1,000 max/ 36 months

$1,000 max/ 36 months

$2,000 allowance every 24 months

Hearing Aids

Vision Care

Vision Exam

$10

$10

$10

$10

$10

No Charge

Eyeglasses (following cataract surgery)

No Charge

No Charge

No Charge

No Charge

No Charge

No Charge

Contact Lenses (following cataract surgery)

No Charge

No Charge

No Charge

No Charge

No Charge

No Charge

Benefits Beyond Medicare (Services covered beyond Medicare coverage) Acupuncture $15/visit (acupuncture/ chiropractic; $15/visit (acupuncture/ chiropractic;

$15/visit (acupuncture/ chiropractic; combined 20 visits per calendar year)

$15/visit (acupuncture/ chiropractic;

$15/visit (acupuncture/ chiropractic;

$15/visit (acupuncture/ chiropractic;

combined 20 visits per calendar year)

combined 20 visits per calendar year)

combined 20 visits per calendar year)

combined 20 visits per calendar year)

combined 20 visits per calendar year)

Chiropractic

$15/visit (acupuncture/ chiropractic;

$15/visit (acupuncture/ chiropractic;

$15/visit (acupuncture/ chiropractic; combined 20 visits per calendar year)

$15/visit (acupuncture/ chiropractic;

$15/visit (acupuncture/ chiropractic;

$15/visit (acupuncture/ chiropractic;

combined 20 visits per calendar year)

combined 20 visits per calendar year)

combined 20 visits per calendar year)

combined 20 visits per calendar year)

combined 20 visits per calendar year)

30 | 2022 Health Benefit Summary

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