Medical Benefits

Actives, Retirees Under 65, Retirees - Not Medicare Eligible

• Blue Shield PPO 250 Standard
  (Preferred Provider Organization)
  • Blue Shield PPO 250 Standard allows you to choose your own doctors and hospitals, but provide higher coverage levels if you choose a PPO network provider.
  • For example, you pay only $25 for most in-network physician’s office visits, and other in-network services are typically reimbursed at 80% of covered costs after you pay the annual deductible.
  • Prescription drugs are $5.00 for generic and
  • $10.00 for brand name.
  • Customer Services Number 1 800 444-1409
• Blue Shield PPO Savings Plan
  (Preferred Provider Organization)
  • Blue Shield PPO Savings Plan allows you to choose your own doctors and hospitals from Choice and Affiliate providers. Different co-payments may apply for Choice or Affiliate providers.
  • Calendar-year deductible for an individual is $2,250 with a maximum co-pay of $3,000.
  • Members co-pay are typically reimbursed at 80% of covered costs after you pay the calendar-year deductible.
  • Plan typically pays 80% of the cost for prescription drugs.
  • Customer Services Number 1 800 444-1409
• Blue Shield Active Choice 500
  • Blue Shield Active Choice 500 offers coverage for preventive care services with no up-front deductible, as well as a $500 individual/ $1,000 family ‘First Dollar Services’ coverage for specified services.
  • Each calendar year, the member can spend this First Dollar Services coverage on certain outpatient professional and diagnostic services, from an office visit for preventive care to physical therapy benefits.
  • This plan allows you to choose your own doctors and hospitals from Choice and Affiliate providers.
  • Prescription drugs are $10 for generic and $20 for brand name.
  • Customer Services Number 1 800 444-1409
• Blue Shield HMO
  (Health Maintenance Organization)
  • Blue Shield HMO offers care through a network of doctors and hospitals. All of your care generally must be provided through the HMO network and coordinated with your primary care physician (PCP) you select when you enroll.
  • Most in-network services are covered at 100% with a co-payment of $10 required for physician’s office visits, hospital admissions, and certain other services.
  • Prescription drugs are $10 for generic and $20 for brand name.
  • Customer Service Number 1 800 424-6521
  • MERP Reimbursement Plan
• Kaiser Permanente
  • Kaiser offers care through the Kaiser’s network of doctors and hospitals. All of your care generally is provided through Kaiser’s network.
  • Office visits are $10.
  • Prescription drugs are $10 for generic and $20 for brand name.
  • Customer Service Number – Roseville 916 784-4000
  • MERP Reimbursement Plan
  • Medical Eye Services (800) 877-6372; www.mesvision.com

Retirees 65 years and over - Medicare A/ B eligible

• Kaiser Senior Advantage
  • Kaiser Senior Advantage offers care through Kaiser’s network of doctors and Hospitals. All of your care generally is provided through Kaiser’s network.
  • Office visits are $10.
  • Prescription drugs are $10. $5 for generic and $15 for brand name.
  • Customer Service Number – Roseville 916 784-4000
• Hartford
  • Hartford is a Medicare Risk plan which covers doctors and hospital visits at 100%.
  • Prescription drugs are $20 for a 100 day supply.
  • Prescription plan of the program is provided through U.S. Script.
  • Customer Service Number for Hartford 1 800 717-7410 Ext. 5946
  • Customer Service Number for Claims for Hartford 1 800 368-3653
  • Customer Service Number for U.S. Script 1 800 460-8988 Ext. 3715