2017-2018 SOCCCD Benefit Summary

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Medical
South Orange County Community College District gives you a choice between three medical plans through either
Blue Shield of California/SISC or Kaiser/SISC. You can find in-network providers by visiting
or irectly and selecting “Find a provider.” You will search under the “Access+ HMO” network
for the HMO plan and “Blue Shield of California PPO Network” for the PPO plan.
Blue Shield HMO (SISC) Blue Shield PPO
(SISC)
Kaiser Permanente HMO
(SISC)
In-Network In-Network Out-Of-Network In-Network
Annual Deductible None $100/individual
$300/family
$100/individual*
$300/family*
None
Annual Out-of-
Pocket Max
$1,000/individual
$2,000/family
$500/individual
$1,500/family
$500/individual*
$1,500/family*
$1,500 Self-Only Coverage
$1,500 Individual within a Family
(each member within a family)
$3,000 Family Coverage
(entire family of 2+ members)
Office Visit
Primary/Specialist $5 copay $10 copay3 10%1 $10 copay per visit
Access+Specialist $30 copay for self-referred
Access+ Specialist
N/A N/A N/A
Preventive
Services
No Charge No Charge 3 Not Covered No Charge
Chiropractic Care $10 copay (up to 30 visits per
year combined w/ Acu)4
$25 copay (up to
20 visits per year)
10% (up to 20
visits per year)1
$10 copay per visit (up to 30
visits per year combined w/ Acu)
Acupuncture $10 copay (up to 30 visits per
year combined with Chiro)4
$25 copay (up to
20 visits per year)
$25 copay (up to
20 visits per year)1
$10 copay (up to 30 visits per
year combined with Chiro)
Lab & X-Ray No Charge $10 copay 10%1 No Charge
Inpatient
Hospitalization
No Charge 10% No Charge (up to
$600/day)2
No Charge
Outpatient Surgery No Charge 10% No Charge (up to
$350/day)2
$10 per procedure
Emergency Room $100 copay (waived if
admitted)
$100 copay plus
10% (waived if
admitted)
$100 copay plus
10% (waived if
admitted)
$100 copay per visit (waived if
admitted)
* combined with in-network
1. Copayments/Coinsurance marked with this footnote do not accrue to Calendar Year out-of-pocket maximum. Copayments/Coinsurance and charges for
services not accruing to the member's Calendar Year out-of-pocket maximum continue to be the member's responsibility after the Calendar Year out-
of-pocket maximum is reached. This amount could be substantial. Please refer to the Plan Contract for exact terms and conditions of coverage.
2. Members are responsible for all charges in excess of the per day maximum payment.
3. Not subject to the calendar-year deductible.
4. Chiropractic Care and Acupuncture providers must be part of the American Specialty Health Network. Providers can be found by accessing the
ebsite or visitin