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Medicare Plans

CCPOA Medical Plan Medicare (PPO)

Western Health Advantage MyCare Select (HMO)

UnitedHealthcare Group Medicare Advantage Edge (PPO)

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

N/A N/A

Family

Maximum Calendar Year Copay or Coinsurance (excluding pharmacy)

$1,500 (copay/ coinsurance)

$3,000 1,2 (co insurance)

$0 (copay)

$1,500 (copay)

Individual

N/A

N/A

N/A

N/A

Family

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Hospital (including Mental Health and Substance Abuse)

$100/ admission

No Charge

No Charge

No Charge No Charge

Inpatient

No Charge

No Charge

Outpatient Facility/ Surgery Services

No Charge

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

No Charge

Home Health Services

No Charge

No Charge

$15/visit

No Charge

No Charge

No Charge

No Charge

Hospice

No Charge

No Charge

No Charge

No Charge

No Charge

No Charge

No Charge

Emergency Services (waived if admitted or hospitalized as an outpatient)

No Charge

$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

No Charge

1 See EOC for additional details 2 For Benefits Beyond Medicare 3 Of the allowed amount

2023 Health Benefit Summary | 25

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