10/1/2011 Renewal Meeting
May 26, 2011
Table of Contents
Section 1: Renewal Summary
Section 2: Financial Summary – Medical Only
Section 3: SISC Blue Shield HMO Medical Renewal
 HMO High Plan Options
 HMO Low Plan Options
Section 4: SISC Blue Shield PPO Medical Renewal
 PPO High Plan Options
 PPO Medium Plan Options
Section 5: CompanionCare/Kaiser Permanente (Individual Retiree Plan)
Section 6: Contributions with Options
Section 7: Next Steps
2
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 1: Renewal Summary
 Blue Shield HMO
 HMO High Plan - 5.6% increase
 HMO Low Plan – 5.4% increase
 Current Blue Shield Rx will be replaced with Medco
 3 tier (generic/brand/’non-formulary) to 2 tier (generic/brand) co-pays
 Blue Shield PPO




PPO High Plan - 4.9% increase
PPO Medium Plan – 4.8% increase
PPO Low HDHP Plan – 7.0% increase
$0 generic copay at Costco
 CompanionCare (Medicare Supplement Plan)
 Rate decrease effective October 1, 2011
 Rx plan change effective January 1, 2012
 Costco Generic Prescriptions
 Take your prescription for a generic medication to a Costco Pharmacy
 Present the pharmacist with your insurance card
 Get your generic medication with a $0 co-payment (excluding some narcotic
pain medications and some cough medications)
3
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 2: Financial Summary
FINANCIAL SUMMARY
Effective October 1, 2011
10/1/2010
10/1/2011
$∆
%∆
153
214
96
30
25
518
$215,530
$230,785
$114,563
$37,871
$18,200
$616,949
$227,588
$243,339
$120,128
$39,690
$19,467
$650,212
$12,058
$12,554
$5,565
$1,819
$1,267
$33,263
5.6%
5.4%
4.9%
4.8%
7.0%
5.4%
10
6
39
2
1
58
$12,368
$6,190
$42,451
$1,476
$962
$63,447
$13,064
$6,528
$44,504
$1,548
$1,030
$66,674
$696
$338
$2,053
$72
$68
$3,227
5.6%
5.5%
4.8%
4.9%
7.1%
5.1%
CompanionCare
CompanionCare
9
$4,807
$4,697
($110)
-2.3%
KAISER PERMANENTE (IND. RETIREE
PLAN)
KP (Ind. Retiree Plan)
1
$324
$324
$0
0%
6
4
49
2
0
61
647
$3,000
$2,712
$27,060
$976
$0
$33,748
$719,275
$8,631,300
$3,132
$2,900
$28,600
$1,032
$0
$35,664
$757,571
$9,090,852
$132
$188
$1,540
$56
$0
$1,916
$38,296
$459,552
4.4%
6.9%
5.7%
5.7%
0.0%
5.7%
5.3%
5.3%
Line of Coverage
ACTIVE EMPLOYEES
HMO High ($10 copay)
HMO Low ($25 copay)
PPO High ($300 ded)
PPO Med ($500 ded)
PPO Low ($2,500 ded)
RETIREE UNDER AGE 65
HMO High ($10 copay)
HMO Low ($25 copay)
PPO High ($300 ded)
PPO Med ($500 ded)
PPO Low ($2,500 ded)
RETIREE OVER AGE 65
HMO High ($10 copay)
HMO Low ($25 copay)
PPO High ($300 ded)
PPO Med ($500 ded)
PPO Low ($2,500 ded)
MONTHLY TOTAL
ANNUAL TOTAL
Medical Headcounts as of 5-11-11
4
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 3: High HMO Plan Renewal
High HMO (Access HMO $10-0)
Plans
Current
None
Renewal
None
$1,000 / $2,000
$1,000 / $2,000
$10
$10/$30**
$0
No charge
$10
$10/$30**
$0
No charge
No charge
No charge
No charge
No charge
$100
$100 (waived if admitted)
20%**
$10 in your service area;
$50 outside your service area
$100
$100 (waived if admitted)
20%**
$10 in your service area;
$50 outside your service area
Chiropractic Services (see separate rider)
$10
(up to 30 visits per cal year)**
$10
(up to 30 visits per cal year)**
Skilled Nursing (up to 100/days/cal year
Home Health Care
No charge
$10 (up to 100 visits p/cal yr)**
No charge
$10 (up to 100 visits p/cal yr)**
No charge
No charge
Calendar Year Deductible
Calendar Year Copayment Maximum
Individual / Family
MAJOR MEDICAL
Physician Office Visit
Specialist Visit
Preventive Care
Lab & X-Ray
Outpatient Surgery
Hospitalization
Inpatient
Ambulance
Emergency Room
Durable Medical Equipment
Urgent Care
Mental Health Care
Inpatient hospital facility
Outpatient Physician Visit
Substance Abuse - (see separate rider)
Inpatient Detox
Inpatient hospital facility
Outpatient Physician Visit
Outpatient Prescription Drugs
(At participating Pharmacies only)
Retail - 30 day supply
Mail order - 90 day supply
No annual deductible
$10**
$10**
No charge
No charge
$10**
Blue Shield
Generic/Brand/Non-Formulary**
$5 / $10 / $25
$10 / $20 / $50
20% for home self injectables;
max of $100 per prescription
$10**
Medco
Generic/Brand**
$5/$10
$10/$20
Self Injectables;
Covered at generic or brand copay
* Access + Specialist (self-referred office visits within your medical group are available for higher copay)
** These member payments do not apply to the member calendar year Copayment Maximum
ACTIVES
Employee Only
Employee + 1
Family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
RETIREE UNDER AGE 65
Retiree
Retiree plus 1 dependent
Retiree plus family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
RETIREE OVER AGE 65
Employee Only
Employee + 1
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
61
30
62
153
Current
$738.00
$1,476.00
$2,036.00
$215,530
$2,586,360
Renewal
$780.00
$1,559.00
$2,149.00
$227,588
$2,731,056
$144,696
5.6%
4
5
1
10
Current
$738.00
$1,476.00
$2,036.00
$12,368
$148,416
Renewal
$780.00
$1,559.00
$2,149.00
$13,064
$156,768
$8,352
5.6%
6
0
6
Current
$500.00
$1,000.00
$3,000
$36,000
Renewal
$522.00
$1,044.00
$3,132
$37,584
$1,584
4.4%
5
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 3: Low HMO Plan Renewal
Low HMO (Access HMO $25-500 Admit)
Current
Renewal
None
None
Plans
Calendar Year Deductible
Calendar Year Copayment Maximum
Individual / Family
MAJOR MEDICAL
Physician Office Visit
Specialist Visit
Preventive Care
Lab & X-Ray
$2,000 / $4,000
$2,000 / $4,000
$25
$25/$30**
$0
No charge
$150 at an Ambulatory Surgery Center;
$300 at a Hospital
$25
$25/$30**
$0
No charge
$150 at an Ambulatory Surgery Center;
$300 at a Hospital
$500 / Admit
$500 / Admit
$100
$100 (waived if admitted)
20%**
$25 in your service area;
$50 outside your service area
$100
$100 (waived if admitted)
20%**
$25 in your service area;
$50 outside your service area
Chiropractic Services (see separate rider)
$10
(up to 30 visits per cal year)**
$10
(up to 30 visits per cal year)**
Skilled Nursing (up to 100/days/cal year
Home Health Care
$100 per day
$25 (up to 100 visits p/cal yr)
$100 per day
$25 (up to 100 visits p/cal yr)
Outpatient Surgery
Hospitalization
Inpatient
Ambulance
Emergency Room
Durable Medical Equipment
Urgent Care
Mental Health Care
Inpatient hospital facility
Outpatient Physician Visit
Substance Abuse - (see separate rider)
Inpatient Detox
Inpatient hospital facility
Outpatient Physician Visit
Outpatient Prescription Drugs
(At participating Pharmacies only)
Retail - 30 day supply
Mail order - 90 day supply
No annual deductible
$500 / Admit
$500 / Admit
$25 per visit**
$25 per visit**
$500 / Admit
$500 / Admit
$25**
Blue Shield
Generic/Brand/Non-Formulary**
$10 / $20 / $35
$20 / $40 / $70
20% for home self injectables;
max of $100 per prescription
$25**
Medco
Generic/Brand**
$5/$20
$10/$50
Self Injectables;
Covered at generic or brand copay
* Access + Specialist (self-referred office visits within your medical group are available for higher copay)
** These member payments do not apply to the member calendar year Copayment Maximum
ACTIVES
Employee Only
Employee + 1
Family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
RETIREE UNDER AGE 65
Retiree
Retiree plus 1 dependent
Retiree plus family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
RETIREE OVER AGE 65
Employee Only
Employee + 1
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
103
48
63
214
2
4
0
6
Current
$619.00
$1,238.00
$1,708.00
$230,785
$2,769,420
Renewal
$654.00
$1,305.00
$1,799.00
$243,339
$2,920,068
$150,648
5.4%
$619.00
$1,238.00
$1,708.00
$6,190
$74,280
$654.00
$1,305.00
$1,799.00
$6,528
$78,336
$4,056
5.5%
2
2
4
Current
$452.00
$904.00
$2,712
$32,544
Renewal
$483.00
$967.00
$2,900
$34,800
$2,256
6.9%
6
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 3: High HMO Plan - Options
Alternative 1
Alternative 2
Current
None
Renewal
None
10-0 w/Chiro
$5/$20 Rx
None
20-250 w/Chiro
$5/$10
None
$1,000 / $2,000
$1,000 / $2,000
$1,000 / $2,000
$1,500/$3,000
$10
$10/$30**
No charge
No charge
No charge
$10
$10/$30**
No charge
No charge
No charge
$10
$10/$30**
No charge
No charge
No charge
$20
$20/$30**
No charge
No charge
$100 performed in an ASC; $150 in a hospital
No charge
No charge
No charge
$250 / admission
$100
$100 (waived if admitted)
$100
$100 (waived if admitted)
$100
$100 (waived if admitted)
$100
$100 (waived if admitted)
High HMO (Access HMO $10-0)
Plans
Calendar Year Deductible
Calendar Year Copayment Maximum
Individual / Family
MAJOR MEDICAL
Physician Office Visit
Specialist Visit
Preventive Care
Lab & X-Ray
Outpatient Surgery
Hospitalization
Inpatient
Ambulance
Emergency Room
Durable Medical Equipment
20%**
20%**
20%**
20%**
Urgent Care
$10 in your service area;
$50 outside your service area
$10 in your service area;
$50 outside your service area
$10 in your service area;
$50 outside your service area
Chiropractic Services (see separate rider)
$10
(up to 30 visits per cal year)**
$10
(up to 30 visits per cal year)**
$10
(up to 30 visits per cal year)**
$20 in your service area;
$50 outside your service area
$10
(up to 30 visits per cal year)**
Skilled Nursing (up to 100/days/cal year
Home Health Care
No charge
$10 (up to 100 visits p/cal yr)
No charge
$10 (up to 100 visits p/cal yr)
No charge
$10 (up to 100 visits p/cal yr)
$100/day
$25 (up to 100 visits p/cal yr)
No charge
No charge
No charge
$250 / admission
$10**
$10
$10
$20
No charge
No charge
No charge
$250 / admission
$10
Medco
Generic/Brand**
$5/$10
$10/$20
Self Injectables;
Covered at generic or brand copay
$10
Medco
Generic/Brand**
$5/$20
$10/$50
Self Injectables;
Covered at generic or brand copay
$20
Medco
Generic/Brand**
$5/$10
$10/$20
Self Injectables;
Covered at generic or brand copay
Renewal
$780.00
$1,559.00
$2,149.00
$227,588
$2,731,056
$144,696
5.6%
$769.00
$1,539.00
$2,125.00
$224,829
$2,697,948
$111,588
4.3%
$719.00
$1,435.00
$1,977.00
$209,483
$2,513,796
-$72,564
-2.8%
Mental Health Care
Inpatient hospital facility
Outpatient Physician Visit
Substance Abuse - (see separate rider)
Inpatient Detox
Inpatient hospital facility
Outpatient Physician Visit
Outpatient Prescription Drugs
(At participating Pharmacies only)
Retail - 30 day supply
Mail order - 90 day supply
$10
Blue Shield
Generic/Brand/Non-Formulary**
$5 / $10 / $25
$10 / $20 / $50
20% for home self injectables;
No annual deductible
max of $100 per prescription
* Access + Specialist (self-referred office visits within your medical group are available for higher copay)
** These member payments do not apply to the member calendar year Copayment Maximum
Active
Current
Employee Only
61
$738.00
Employee + 1
30
$1,476.00
Family
62
$2,036.00
TOTAL MONTHLY PREMIUM
153
$215,530
TOTAL ANNUAL PREMIUM
$2,586,360
$ ∆ from Current
% ∆ from Current
RETIREE UNDER AGE 65
Retiree
Retiree plus 1 dependent
Retiree plus family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
RETIREE OVER AGE 65
Retiree
Retiree plus 1
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
4
5
1
10
Current
$738.00
$1,476.00
$2,036.00
$12,368
$148,416
Renewal
$780.00
$1,559.00
$2,149.00
$13,064
$156,768
$8,352
5.6%
$769.00
$1,539.00
$2,125.00
$12,896
$154,752
$6,336
4.3%
$719.00
$1,435.00
$1,977.00
$12,028
$144,336
-$4,080
-2.7%
6
0
6
Current
$500.00
$1,000.00
$3,000
$36,000
Renewal
$522.00
$1,044.00
$3,132
$37,584
$1,584
4.4%
TBD
TBD
$0
$0
TBD
TBD
TBD
TBD
$0
$0
TBD
TBD
7
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 3: Low HMO Plan - Options
Plans
Low HMO (Access HMO $25-500 Admit w/Chiro)
Current
Renewal
None
None
Calendar Year Deductible
Calendar Year Copayment Maximum
Individual / Family
MAJOR MEDICAL
Physician Office Visit
Specialist Visit
Preventive Care
Lab & X-Ray
Outpatient Surgery
Hospitalization
Inpatient
Ambulance
Emergency Room
Durable Medical Equipment
Alternative 1
Alternative 2
$25-500 w/Chiro
$9/$35 Rx
None
30-20% Zero Facility
$5/$10 Rx
None
$2,000 / $4,000
$2,000 / $4,000
$2,000 / $4,000
$1,500 p/member
$25
$25/$30**
$0
No charge
$150 at an Ambulatory Surgery Center;
$300 at a Hospital
$25
$25/$30**
$0
No charge
$150 at an Ambulatory Surgery Center;
$300 at a Hospital
$25
$25/$30**
$0
No charge
$150 at an Ambulatory Surgery Center;
$300 at a Hospital
$30
$30/$45**
$0
No charge
$500 / Admit
$500 / Admit
$500 / Admit
20%
$100
$100 (waived if admitted)
$100
$100 (waived if admitted)
$100
$100 (waived if admitted)
$100
$150 (waived if admitted)
No charge
20%**
20%**
20%**
50%**
Urgent Care
$25 in your service area;
$50 outside your service area
$25 in your service area;
$50 outside your service area
$25 in your service area;
$50 outside your service area
Chiropractic Services (see separate rider)
$10
(up to 30 visits per cal year)**
$10
(up to 30 visits per cal year)**
$10
(up to 30 visits per cal year)**
$30 in your service area;
$50 outside your service area
$10
(up to 30 visits per cal year)**
Skilled Nursing (up to 100/days/cal year
Home Health Care
$100 per day
$25 (up to 100 visits p/cal yr)
$100 per day
$25 (up to 100 visits p/cal yr)
$100 per day
$25 (up to 100 visits p/cal yr)
20%
$20 (up to 100 visits p/cal yr)
$500 / Admit
$500 / Admit
$500 / Admit
20%
$30 per visit
Mental Health Care
Inpatient hospital facility
Outpatient Physician Visit
Substance Abuse - (see separate rider)
Inpatient Detox
Inpatient hospital facility
Outpatient Physician Visit
Outpatient Prescription Drugs
(At participating Pharmacies only)
Retail - 30 day supply
Mail order - 90 day supply
$25 per visit
$25 per visit
$25 per visit
$500 / Admit
$500 / Admit
$500 / Admit
20%
$25
Medco
Generic/Brand**
$5/$20
$10/$50
Self Injectables;
Covered at generic or brand copay
$25
Medco
Generic/Brand**
$9/$35
$18/$90
Self Injectables;
Covered at generic or brand copay
$30
Medco
Generic/Brand**
$5/$10
$10/$20
Self Injectables;
Covered at generic or brand copay
Renewal
$654
$1,305
$1,799
$243,339
$2,920,068
$150,648
5.4%
$644
$1,288
$1,777
$240,107
$2,881,284
$111,864
4.0%
$615
$1,222
$1,681
$227,904
$2,734,848
-$34,572
-1.2%
$25
Blue Shield
Generic/Brand/Non-Formulary**
$10 / $20 / $35
$20 / $40 / $70
20% for home self injectables;
No annual deductible
max of $100 per prescription
* Access + Specialist (self-referred office visits within your medical group are available for higher copay)
** These member payments do not apply to the member calendar year Copayment Maximum
Current
Active
Employee Only
103
$619
Employee + 1
48
$1,238
Family
63
$1,708
TOTAL MONTHLY PREMIUM
214
$230,785
TOTAL ANNUAL PREMIUM
$2,769,420
$ ∆ from Current
% ∆ from Current
RETIREE UNDER AGE 65
Retiree
Retiree plus 1 dependent
Retiree plus family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
RETIREE OVER AGE 65
Retiree
Retiree plus 1 dependent
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
2
4
0
6
Current
$619
$1,238
$1,708
$6,190
$74,280
Renewal
$654
$1,305
$1,799
$6,528
$78,336
$4,056
5.5%
$644
$1,288
$1,777
$6,440
$77,280
$3,000
4.0%
$615
$1,222
$1,681
$6,118
$73,416
-$864
-1.2%
2
2
4
Current
$452.00
$904.00
$2,712
$32,544
Renewal
$483.00
$967.00
$2,900
$34,800
$2,256
6.9%
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
8
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 4: PPO Renewal
High PPO
(90-E $10, Rx 5-20 w $100 brand deductible)
Current
Renewal
$300 p/ind; $600 p/fam
$300 p/ind; $600 p/fam
$600 p/ind; $1,800 per fam
$600 p/ind; $1,800 per fam
Plans
Calendar Year Deductible(s)
Maximum *Co-Insurance
Co-insurance is the member's responsibility
to pay when the plan is paying less
than 100% ( i.e. plan pays 80%, member
pays the other 20%)
Services
Office Visits
Inpatient Hospital
Room, Board & Support Services
(prior authorization required)
Ambulatory Surgery Center
Emergency Room (non-emergency)
Facility Expenses:
Professional Expenses:
Surgeon & Anesthetist
Accident Care (Professional)
(initial care)
Preventive Care
Routine Exam
Diagnostic X-Ray & Lab
Once the memb er's 10% co-insurance totals $600 per
individual, the plan will pay 100% of the allowab le amount for
the remainder of the calendar year.
Once the memb er's 20% co-insurance totals $1,000 per
individual, the plan will pay 100% of the allowab le amount for
the remainder of the calendar year.
Once the memb er's 20% co-insurance totals $1,000 per
individual, the plan will pay 100% of the allowab le amount for
the remainder of the calendar year.
In Network
$10; (does not apply to
deductible or coinsurance
max.)
Out of Network
In Network
$10; (does not apply to
deductible or coinsurance
max.)
Out of Network
In Network
$10;
does not apply to ded or
max
Out of Network
In Network
$10;
does not apply to ded or
max
Out of Network
In Network
Out of Network
In Network
Out of Network
50%
90%
50%
90%
50%
90%
$600 p/day
90%
$600 p/day
80%
$600 p/day
80%
$600 p/day
90%
90%
90%
50%
$350 p/day
$100 copay
90% of eligible expenses
50%
50%
90%
Chiropractic
Low PPO
(HDHP -B w/HSA Compatibility)
Current
Renewal
$2,500 p/ind; $5,000 p/fam
$2,500 p/ind; $5,000 p/fam
$5,000 p/ind or $10,000 per fam
$5,000 p/ind or $10,000 per fam
Once the memb er's 10% co-insurance totals $600 per
individual, the plan will pay 100% of the allowab le amount for
the remainder of the calendar year.
90%
Physical Medicine PT, OT
Speech Therapy
Acupuncture
12 visits per year
Durable Medical Equipment
Hearing Aid ($700 maximum every 24 months)
Hospice
Ambulance
Home Health Care
100 visits/yr (prior authorization required)
Psychiatric
Inpatient
Outpatient Visits For Severe Conditions
Outpatient Visits For Non-Severe Conditions
Substance Abuse
Inpatient For Acute Detox
Outpatient Visits
Outpatient Prescription Drugs
Medium PPO
(80-G $10, Rx 5-20 w $100 brand deductible)
Current
Renewal
$500 p/ind; $1,000 p/fam
$500 p/ind; $1,000 p/fam
$1,000 p/ind; $3,000 per fam
$1,000 p/ind; $3,000 per fam
90%
90%
90%
90%
90%
50%
$350 p/day
$100 copay
90% of eligible expenses
50%
50%
80%
80%
80%
80%
90%
90%
50%
$350 p/day
$100 copay
90% of eligible expenses
50%
50%
80%
80%
80%
80%
80%
80%
NOTE: This plan has an Annual Out-of-Pocket Maximum that
includes the deductib le, copays and co-insurance.
90%
$350 p/day
$100 copay
90% of eligible expenses
50%
50%
80%
90%
90%
90%
90%
80%
$600 p/day
$350 p/day
$100 copay
90% of eligible expenses
50%
50%
90%
90%
NOTE: This plan has an Annual Out-of-Pocket Maximum that
includes the deductib le, copays and co-insurance.
90%
90%
90%
90%
90%
$600 p/day
$350 p/day
$100 copay
90% of eligible expenses
50%
50%
90%
90%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
90%
50%
20 Visits per year
90%
50%
90%
50%
90%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
90%
50%
20 Visits per year
90%
50%
90%
50%
90%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
80%
50%
20 Visits per year
80%
50%
80%
50%
80%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
80%
50%
20 Visits per year
80%
50%
80%
50%
80%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
90%
50%
12 Visits per year
90% up to $25 p/visit
50% up to $25 p/visit
90%
50%
90%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
90%
50%
12 Visits per year
90% up to $25 p/visit
50% up to $25 p/visit
90%
50%
90%
50%
90% up to $50 p/visit
50% up to $25 p/visit
90% up to $50 p/visit
50% up to $25 p/visit
80% up to $50 p/visit
50% up to $25 p/visit
80% up to $50 p/visit
50% up to $25 p/visit
90% up to $30 p/visit
50% up to $30 p/visit
90% up to $30 p/visit
50% up to $30 p/visit
90%
90%
90%
90%
50%
90%
Not cov. unless pre auth
90%
Not covered unless pre
auth
90%
90%
90%
90%
50%
90%
Not cov. unless pre auth
90%
Not covered unless pre
auth
80%
80%
80%
80%
50%
80%
Not cov. unless pre auth
80%
Not covered unless pre
auth
80%
80%
80%
80%
50%
80%
Not cov. unless pre auth
80%
Not covered unless pre
auth
90%
90%
90%
90%
50%
90%
Not cov. unless pre auth
90%
Not covered unless pre
auth
90%
90%
90%
90%
50%
90%
Not cov. unless pre auth
90%
Not covered unless pre
auth
90%
$600 p/day
90%
$600 p/day
80%
$600 p/day
80%
$600 p/day
90%
$600 p/day
90%
$10 copay
50%
$10 copay
50%
$10 copay
50%
$10 copay
50%
90%
50%
90%
50%
90%
$600 p/day
90%
$600 p/day
80%
$600 p/day
80%
$600 p/day
90%
$600 p/day
90%
$600 p/day
90%
90%
80%
80%
90%
90%
$600 p/day
Supply
Generic Drugs
Single Source Brand Name Drugs
Multi Source Brand Name Drugs
$10 copay
50%
Medco Rx plan $5-20 w/$100 brand ded
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
$10 copay
50%
Medco Rx plan $5-20 w/$100 brand ded
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
$10 copay
50%
Medco Rx plan $5-20 w/$100 brand ded
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
$10 copay
50%
Medco Rx plan $5-20 w/$100 brand ded
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
90%
50%
Rx w/ Blue Shield Contracted Provider
Retail
Mail
30 days
90 days
$7
$14
$25
$14
$25
$60
90%
50%
Rx w/ Blue Shield Contracted Provider
Retail
Mail
30 days
90 days
$7
$14
$25
$14
$25
$60
Brand Name Calendar Year Deductible
$100 per individual up to $300 per family
$100 per individual up to $300 per family
$100 per individual up to $300 per family
$100 per individual up to $300 per family
$2,500 medical deductible must be met before
co-pays apply
$2,500 medical deductible must be met before
co-pays apply
11
12
7
30
$738
$1,311
$2,003
$37,871
$454,452
$774
$1,373
$2,100
$39,690
$476,280
$21,828
4.8%
19
2
4
25
$540
$962
$1,504
$18,200
$218,400
$577
$1,030
$1,611
$19,467
$233,604
$15,204
7.0%
2
0
0
$738
$1,311
$2,003
$1,476
$774
$1,373
$2,100
$1,548
0
1
0
$540
$962
$1,504
$962
$577
$1,030
$1,611
$1,030
$17,712
$18,576
$11,544
$12,360
* This is only a brief summary of benefits. For details, limitations and exclusions, please refer to the summary plan descriptions.
Active
Employee Only
Employee + 1
Family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ from Current
% ∆ from Current
RETIREE UNDER AGE 65
Retiree
Retiree plus 1 dependent
Retiree plus family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
RETIREE OVER AGE 65
Retiree
Retiree plus 1 dependent
Retiree plus family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
54
29
13
96
22
17
0
39
43
6
0
49
Current
$813
$1,445
$2,212
$114,563
$1,374,756
Renewal
$853
$1,514
$2,320
$120,128
$1,441,536
$66,780
4.9%
Current
Renewal
$813
$1,445
$2,212
$42,451
$853
$1,514
$2,320
$44,504
$509,412
$534,048
2
1
$24,636
$864
$816
4.8%
4.9%
7.1%
Current
Renewal
$492
$984
$1,266
$27,060
$520
$1,040
$1,350
$28,600
$324,720
$343,200
$18,480
5.7%
2
0
0
2
$488
$976
$1,254
$976
$516
$1,032
$1,388
$1,032
$11,712
$12,384
$672
5.7%
0
0
0
0
$506
$1,012
$1,518
$0
$497
$994
$1,342
$0
$0
$0
$0
0%
9
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 4: High PPO Plan Options
Current
$300 p/ind; $600 p/fam
$600 p/ind; $1,800 per fam
Calendar Year Deductible(s)
Maximum *Co-Insurance
Co-insurance is the member's responsibility
to pay when the plan is paying less
than 100% ( i.e. plan pays 80%, member
pays the other 20%)
Services
Office Visits
Inpatient Hospital
Room, Board & Support Services
(prior authorization required)
Ambulatory Surgery Center
Emergency Room (non-emergency)
Facility Expenses:
Professional Expenses:
Surgeon & Anesthetist
Accident Care (Professional)
(initial care)
Preventive Care
Routine Exam
Diagnostic X-Ray & Lab
Renewal
$300 p/ind; $600 p/fam
$600 p/ind; $1,800 per fam
80%-D $20
Rx $5/$20
$200 p/ind; $500 p/fam
$300 p/ind; $900 per fam
$200 p/ind; $500 p/fam
$1,000 p/ind; $3,000 per fam
Once the member's 10% co-insurance totals $600 per Once the member's 10% co-insurance totals $300 per Once the member's 20% co-insurance totals $1,000
per individual, the plan will pay 100% of the allowable
individual, the plan will pay 100% of the allowable amount
individual, the plan will pay 100% of the allowable
amount for the remainder of the calendar year.
for the remainder of the calendar year.
amount for the remainder of the calendar year.
In Network
$10; (does not apply to
deductible or coinsurance
max.)
In Network
$10; (does not apply to
deductible or coinsurance
max.)
Out of Network
50%
Out of Network
50%
22
17
0
39
Out of Network
50%
In Network
$20; (does not apply to
deductible or coinsurance
max)
Out of Network
50%
90%
$600 p/day
90%
$600 p/day
90%
$600 p/day
80%
$600 p/day
$350 p/day
90%
$350 p/day
90%
$350 p/day
80%
$350 p/day
$100 copay
90% of eligible expenses
50%
50%
90%
90%
90%
90%
$100 copay
90% of eligible expenses
50%
50%
90%
90%
90%
90%
90%
$100 copay
90% of eligible expenses
50%
50%
90%
90%
80%
80%
80%
$100 copay
90% of eligible expenses
50%
50%
80%
80%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
90%
50%
20 Visits per year
90%
50%
90%
50%
90%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
90%
50%
20 Visits per year
90%
50%
90%
50%
90%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
90%
50%
20 Visits per year
90%
50%
90%
50%
90%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
80%
50%
20 Visits per year
80%
50%
80%
50%
80%
50%
90% up to $50 p/visit
50% up to $25 p/visit
90% up to $50 p/visit
50% up to $25 p/visit
90% up to $50 p/visit
50% up to $25 p/visit
80% up to $50 p/visit
50% up to $25 p/visit
90%
90%
90%
90%
50%
90%
Not cov. unless pre auth
90%
90%
90%
90%
90%
50%
90%
Not cov. unless pre auth
90%
90%
90%
90%
90%
50%
90%
Not cov. unless pre auth
90%
80%
80%
80%
80%
50%
80%
Not cov. unless pre auth
80%
90%
Not covered unless pre auth
90%
Not covered unless pre auth
90%
Not covered unless pre auth
80%
Not covered unless pre auth
90%
$600 p/day
90%
$600 p/day
90%
$600 p/day
80%
$600 p/day
$10 copay
50%
$10 copay
50%
$30 copay
50%
$20 copay
50%
90%
$600 p/day
90%
$600 p/day
90%
$600 p/day
80%
$600 p/day
$10 copay
50%
$10 copay
50%
Medco Rx plan $5-20 w/$100 brand ded
Medco Rx plan $5-20 w/$100 brand ded
Retail
Mail
Retail
Mail
Supply
30 days
90 days
30 days
90 days
Generic Drugs
$5
$10
$5
$10
Single Source Brand Name Drugs
$20
$50
$20
$50
Multi Source Brand Name Drugs
$5 + cost diff
$10 + cost diff
$5 + cost diff
$10 + cost diff
$100 per individual up to $300 per family
$100 per individual up to $300 per family
Brand Name Calendar Year Deductible
* This is only a brief summary of benefits. For details, limitations and exclusions, please refer to the summary plan descriptions.
54
29
13
96
In Network
$30; (does not apply to
deductible or coinsurance
max.)
90%
90%
Chiropractic
RETIREE UNDER AGE 65
Retiree
Retiree plus 1 dependent
Retiree plus family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
Alternative 2
90-C $30
Rx $7/$25
Once the member's 10% co-insurance totals $600 per
individual, the plan will pay 100% of the allowable amount
for the remainder of the calendar year.
90%
90%
90%
Physical Medicine PT, OT
Speech Therapy
Acupuncture
12 visits per year
Durable Medical Equipment
Hearing Aid ($700 maximum every 24 months)
Hospice
Ambulance
Home Health Care
100 visits/yr (prior authorization required)
Psychiatric
Inpatient
Outpatient Visits For Severe Conditions
Outpatient Visits For Non-Severe Conditions
Substance Abuse
Inpatient For Acute Detox
Outpatient Visits
Outpatient Prescription Drugs
Active
Employee Only
Employee + 1
Family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ from Current
% ∆ from Current
Alternative 1
High PPO
(90-E $10, Rx 5-20 w $100 brand deductible)
Plans
Current
$813
$1,445
$2,212
$114,563
$1,374,756
$30 copay
50%
Medco Rx plan $7/$25
Retail
Mail
30 days
90 days
$7
$14
$25
$60
$7 + cost diff
$14 + cost diff
None
$10 copay
50%
Medco Rx plan $5/$20
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
None
$841
$1,494
$2,288
$118,484
$1,421,808
$47,052
3.4%
$829
$1,471
$2,246
$116,623
$1,399,476
$24,720
1.80%
$853
$1,514
$2,320
$120,128
$1,441,536
$66,780
4.9%
Current
Renewal
$813
$1,445
$2,212
$42,451
$853
$1,514
$2,320
$44,504
$841
$1,494
$2,288
$43,900
$829
$1,471
$2,246
$43,245
$509,412
$534,048
$526,800
$518,940
$24,636
$17,388
$9,528
4.8%
3.4%
1.87%
\
RETIREE OVER AGE 65
Retiree
Retiree plus 1 dependent
Retiree plus family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
43
6
0
49
Current
Renewal
$492
$984
$1,266
$27,060
$520
$1,040
$1,350
$28,600
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
$324,720
$343,200
TBD
TBD
$18,480
TBD
TBD
5.7%
TBD
TBD
10
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 4: Medium PPO Plan Options
Alternative 1
Alternative 2
80%-E $30
Rx $9/$35
80%-G $30
Rx $5/$20
80%-G $20
Rx $5/$20
Medium PPO (80-G $10, Rx 5-20 w $100 brand deductible)
Plans
Calendar Year Deductible(s)
Maximum *Co-Insurance
Co-insurance is the member's responsibility
to pay when the plan is paying less
than 100% ( i.e. plan pays 80%, member
pays the other 20%)
Services
Office Visits
Inpatient Hospital
Room, Board & Support Services
(prior authorization required)
Ambulatory Surgery Center
Emergency Room (non-emergency)
Facility Expenses:
Professional Expenses:
Surgeon & Anesthetist
Accident Care (Professional)
(initial care)
Preventative Care
Routine Exam
Diagnostic X-Ray & Lab
Current
$500 p/ind; $1,000 p/fam
$1,000 p/ind; $3,000 per fam
Renewal
$500 p/ind; $1,000 p/fam
$1,000 p/ind; $3,000 per fam
$300 p/ind; $600 p/fam
$1,000 p/ind; $3,000 per fam
$500 p/ind; $1,000 p/fam
$1,000 p/ind; $3,000 per fam
$500 p/ind; $1,000 p/fam
$1,000 p/ind; $3,000 per fam
Once the member's 20% co-insurance totals $1,000
per individual, the plan will pay 100% of the allowable
amount for the remainder of the calendar year.
Once the member's 20% co-insurance totals $1,000
per individual, the plan will pay 100% of the allowable
amount for the remainder of the calendar year.
Once the member's 10% co-insurance totals $1,000
per individual, the plan will pay 100% of the allowable
amount for the remainder of the calendar year.
Once the member's 20% co-insurance totals $1,000
per individual, the plan will pay 100% of the allowable
amount for the remainder of the calendar year.
Once the member's 20% co-insurance totals $1,000
per individual, the plan will pay 100% of the allowable
amount for the remainder of the calendar year.
In Network
$10;
does not apply to ded or
max
Out of Network
In Network
$10;
does not apply to ded or
max
Out of Network
In Network
$30; (does not apply to
deductible or
coinsurance max)
Out of Network
In Network
$30; (does not apply to
deductible or
coinsurance max)
Out of Network
In Network
$20; (does not apply to
deductible or
coinsurance max)
Out of Network
80%
$600 p/day
80%
$600 p/day
80%
$600 p/day
80%
$600 p/day
80%
$600 p/day
80%
$350 p/day
80%
$350 p/day
80%
$350 p/day
80%
$350 p/day
80%
80%
80%
80%
50%
$100 copay
90% of eligible expenses
50%
50%
80%
Chiropractic
Physical Medicine PT, OT
Speech Therapy
Acupuncture
12 visits per year
Durable Medical Equipment
Hearing Aid ($700 maximum every 24 months)
Hospice
Ambulance
Home Health Care
100 visits/yr (prior authorization required)
Psychiatric
Inpatient
Outpatient Visits For Severe Conditions
Outpatient Visits For Non-Severe Conditions
Substance Abuse
Inpatient For Acute Detox
Outpatient Visits
Outpatient Prescription Drugs
Alternative 3
80%
80%
80%
80%
50%
$100 copay
90% of eligible expenses
50%
50%
80%
80%
80%
80%
80%
50%
$100 copay
90% of eligible expenses
50%
50%
80%
80%
80%
80%
80%
50%
$100 copay
90% of eligible expenses
50%
50%
80%
80%
80%
80%
80%
50%
$350 p/day
$100 copay
90% of eligible expenses
50%
50%
80%
80%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
80%
50%
20 Visits per year
80%
50%
80%
50%
80%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
80%
50%
20 Visits per year
80%
50%
80%
50%
80%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
80%
50%
20 Visits per year
80%
50%
80%
50%
80%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
80%
50%
20 Visits per year
80%
50%
80%
50%
80%
50%
Ded waived; 100%
50%
Ded waived; 100%
Not Covered
80%
50%
20 Visits per year
80%
50%
80%
50%
80%
50%
80% up to $50 p/visit
50% up to $25 p/visit
80% up to $50 p/visit
50% up to $25 p/visit
80% up to $50 p/visit
50% up to $25 p/visit
80% up to $50 p/visit
50% up to $25 p/visit
80% up to $50 p/visit
50% up to $25 p/visit
80%
80%
80%
80%
50%
80%
Not cov. unless pre auth
80%
80%
80%
80%
80%
50%
80%
Not cov. unless pre auth
80%
80%
80%
80%
80%
80%
80%
80%
80%
Not covered unless pre auth
80%
Not covered unless pre auth
80%
50%
80%
Not cov. unless pre auth
80%
Not covered unless pre
auth
80%
80%
80%
80%
80%
50%
80%
Not cov. unless pre auth
80%
Not covered unless pre
auth
50%
80%
Not cov. unless pre auth
80%
Not covered unless pre
auth
80%
$600 p/day
80%
$600 p/day
80%
$600 p/day
80%
$600 p/day
80%
$10 copay
50%
$10 copay
50%
$30 copay
50%
$30 copay
50%
$20 copay
50%
80%
$600 p/day
80%
$600 p/day
80%
$600 p/day
80%
$600 p/day
80%
$600 p/day
80%
80%
$600 p/day
Supply
Generic Drugs
Single Source Brand Name Drugs
Multi Source Brand Name Drugs
$10 copay
50%
Medco Rx plan $5-20 w/$100 brand ded
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
$10 copay
50%
Medco Rx plan $5-20 w/$100 brand ded
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
$30 copay
50%
Medco Rx plan $9/$35
Retail
Mail
30 days
90 days
$9
$18
$35
$90
$9 + cost diff
$18 + cost diff
$30 copay
50%
Medco Rx plan $5/$20
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
$20 copay
50%
Medco Rx plan $5/$20
Retail
Mail
30 days
90 days
$5
$10
$20
$50
$5 + cost diff
$10 + cost diff
Brand Name Calendar Year Deductible
$100 per individual up to $300 per family
$100 per individual up to $300 per family
None
None
None
$769
$1,365
$2,094
$39,497
$473,964
$19,512
4.3%
$755
$1,340
$2,040
$38,665
$463,980
$9,528
2.1%
$770
$1,366
$2,081
$39,429
$473,148
$18,696
4.1%
* This is only a brief summary of benefits. For details, limitations and exclusions, please refer to the summary plan descriptions.
Current
Active
Employee Only
Employee + 1
Family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ from Current
% ∆ from Current
RETIREE UNDER AGE 65
Retiree
Retiree plus 1 dependent
Retiree plus family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
RETIREE OVER AGE 65
Retiree
Retiree plus 1 dependent
Retiree plus family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
11
12
7
30
2
0
0
2
2
0
0
2
Renewal
$738
$1,311
$2,003
$37,871
$454,452
$774
$1,373
$2,100
$39,690
$476,280
$21,828
4.8%
Current
Renewal
$738
$1,311
$2,003
$1,476
$774
$1,373
$2,100
$1,548
$769
$1,365
$2,094
$1,538
$755
$1,340
$2,040
$1,510
$770
$1,366
$2,081
$1,540
$17,712
$18,576
$18,456
$18,120
$18,480
$864
$744
$408
$768
4.9%
4.2%
2.3%
4.3%
Current
Renewal
$488
$976
$1,254
$976
$516
$1,032
$1,388
$1,032
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
TBD
$11,712
$12,384
TBD
TBD
TBD
$672
TBD
TBD
TBD
5.7%
TBD
TBD
TBD
11
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 5: CompanionCare/Kaiser Permanente
CompanionCare
Current
MEDICARE
SERVICES
2010 Benefits
Pays all but first $1100 for 1st
60 days
Pays all but first $275 a day for
the 61st to 90th day
Inpatient Hospital (Part A)
Skilled Nursing Facilites
(Must be approved by Medicare)
Deductible (Part B)
Blood (Part B)
EE
7
2
0
9
Pays $283 a day
Pays 100% for 151st day to
515th day
Pays nothing
Pays $137.50 a day for 21st to
100th day
Pays nothing after 100th day
Pays nothing after Lifetime
Reserve is used
Pays 100% for 1st 20 days
Pays all but $141.50 a day for
21st to 100th day
Pays nothing after 100th day
Pays 100% for 151st day to 515th
day
Pays nothing
Pays $141.50 a day for 21st to 100th
day
Pays nothing after 100th day
Pays $155
$162 Part B deductible per year
Pays $162
80% Medicare Approved (MA)
charges after Part B deductible
20% MA charges including 100% of
Medicare Part B deductible
80% MA charges
20% MA charges
100% of MA charges
Pays nothing
80% MA charges
20% MA charges including
100% of Medicare Part B
deductible
20% MA charges
100% of MA charges
Pays nothing
20% MA charges up to the
Medicare annual benefit
amount. (Physical & Speech
Therapy Combined)
Pays 1st 3 pints unreplaced
blood and 20% MA charges
Pays 80% inpatient hospital,
surgery, anestetist and in
hospital visits for medically
Rx drug plan enhanced through Medco Health effective
10/01/2011 thru 12/31/2011
CompanionCare EMPLOYEES
Retiree
Retiree plus 1 dependent
Retiree plus family
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
Pays $1132
Pays nothing after Lifetime
Reserve is used
Pays 100% for 1st 20 days
Pays all but $137.50 a day for
21st to 100th day
Pays nothing after 100th day
Not covered
Outpatient Presrciption Drugs
Pays all but first $1132 for 1st
60 days
Pays all but first $283 a day for
the 61st to 90th day
Pays $566 a day
80% MA charges after 3 pints
Travel Coverage
(when outside the US for less than
6 consecutive months)
Based on 2011 Medicare Benefits
Pays all but $566 a day Lifetime
Reserve for 91st to 150th day
80% MA Charges up to the
Medicare annual benefit amount
Physical/Speech Therapy (Part B)
Pays $275 a day
CompanionCare
2011 Benefits
Pays $550 a day
80% Medicare Approved (MA)
charges after Part B deductible
Medical Services (Part B)
Doctor, x-ray, appliances, &
ambulance Lab
Pays $1100
MEDICARE
Pays all but $550 a day Lifetime
Reserve for 91st to 150th day
$155 Part B deductible per year
Basis of Payment (Part B)
Renewal
CompanionCare
Based on 2010 Medicare
Benefits
20% MA charges up to the Medicare
80% MA Charges up to the
annual benefit amount. (Physical &
Medicare annual benefit amount
Speech Therapy Combined)
80% MA charges after 3 pints
Not covered
Pays 1st 3 pints unreplaced blood
and 20% MA charges
Pays 80% inpatient hospital, surgery,
anestetist and in hospital visits for
medically necessary services for 90
Rx drug plan enhanced through Medco Health effective 1/1/2012
* Generic: $7 co-pay for a 30* Generic: $9 co-pay for a 30-day
day supply at a retail pharmacy
or $14 co-pay for a 90-day
SISC will automatically enroll
SISC will automatically enroll supply at a retail pharmacy or $18
CompanionCare members into supply through home delivery CompanionCare members into co-pay for a 90-day supply through
home delivery service
service
Medicare Part D. No additional
Medicare Part D. No additional
* Brand: $35 co-pay for a 30-day
premium required. SISC plans * Brand: $25 co-pay for a 30- premium required. SISC plans
are not subject to the
are not subject to the
supply at a retail pharmacy or $90
day supply at a retail pharmacy
'doughnout hole'.
'doughnout hole'.
or $60 co-pay for a 90-day
co-pay for a 90-day supply through
supply through home delivery
home delivery service
service
Current
Renewal
$437
$427
$874
$854
$0
$0
$4,807
$4,697
$57,684
$56,364
-$1,320
-2.3%
* CompanionCare is a Medicare Supplement plan that pays for medically necessary services and procedures that are considered as a Medicare Approved Expense
12
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 5: : CompanionCare/Kaiser Permanente
Kaiser Permanente Individual Retiree Plan
SERVICES
Current
Renewal
Hospitalization
* Inpatient
* Emergency Room
$200/Admit
$50 co-pay/waived if admitted
$200/Admit
$50 co-pay/waived if admitted
Skilled Nursing Facility
Covered in full for 100 days per
benefit period
Covered in full for 100 days per
benefit period
$10 co-pay per visit
$10 co-pay per visit
No charge
No charge
Physician Services/Basic Health Services
* Office visits
* Consultation, diagnosis, and treatment by a
specialist
X-Ray Services
* Includes routine annual mammography
Laboratory Services
Annual Physical Examination
* Includes pap smears
Outpatient Mental Health/20visits
Vision Care
* Examination for eyeglasses
* Glaucoma testing
* Standard frame/lenses every 24 months
No charge
No charge
$10 co-pay per visit
$10 co-pay per visit
$10 co-pay per visit
$10 co-pay per visit; $5 co-pay per
group visit
$10 per visit
$10 per visit
$10 co-pay per visit
$10 co-pay per visit
$150 frame and lens allowance every $150 frame and lens allowance every
24 months
24 months
Not covered
Not covered
$10 co-pay per visit
$10 co-pay per visit
Dental Care (DeltaCare)
Hearing Examination
Immunizations
* Includes flu injections and all Medicare
approved immunizations
Ambulance
No charge
No charge
$50/Trip
$10 co-pay per visit
(subject to medical necessity)
$50/Trip
$10 co-pay per visit
(subject to medical necessity)
Prescription Drugs
$10 co-pay per generic/$20 co-pay
per brand name up to $100 day
supply at Kaiser pharmacies
$10 co-pay per generic/$20 co-pay
per brand name up to $100 day
supply at Kaiser pharmacies
* Prescription drugs related to sexual dysfunction
50% co-insurance;
limited to 27 doses in any 100-day
period
50% co-insurance;
limited to 27 doses in any 100-day
period
Current
$324
$324
$3,888
Renewal
$324
$324
$3,888
$0
Manual Manipulation of the Spine
EARLY RETIREES
Employee Only
TOTAL MONTHLY PREMIUM
TOTAL ANNUAL PREMIUM
$ ∆ to Current
% ∆ to Current
1
1
0%
13
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 6: Contributions with options
Employer Stipend Change
CURRENT 10/01/2010 Rates
Low HMO
High PPO
Medium PPO
(Access HMO $10-0)
(Access HMO $25-500 Admit)
(90-E $10)
(80-G $10)
Low PPO
(HDHP-B)
$10
No charge
$100 copay
$1,000/$2,000
$25
$500 admit
$100 copay
$2,000/$4,000
$10
90%
$100 copay
$300/$600
$10
80%
$100 copay
$500/$1,000
90%
90%
$100 copay
$2,500 ind/$5,000 fam
$5/$10/$25
$10/$20/$50
Total Premium Employee Cost
$738.00
$119.00
$1,476.00
$238.00
$2,036.00
$328.00
$10/$20/$35
$20/$40/$70
Total Premium Employee Cost
$619.00
$0.00
$1,238.00
$0.00
$1,708.00
$0.00
$5/$20
$10/$50
Total Premium Employee Cost
$813.00
$194.00
$1,445.00
$207.00
$2,212.00
$504.00
$5/$20
$10/$50
Total Premium Employee Cost
$738.00
$119.00
$1,311.00
$73.00
$2,003.00
$295.00
$7/$25
$14/$60
Total Premium Employee Cost
$540.00
$0.00
$962.00
$0.00
$1,504.00
$0.00
High HMO
Office Visit
Inpatient Hospital
Emergency Room
Annual Maximum
Prescription
Retail
Mail Order
Stipend
$619.00
$1,238.00
$1,708.00
Single
2-party
Family
Option 1 - with Renewal Rates
Option 1 - Stipend = Low Cost HMO 2011/2012 (Current Formula + Renewal Increase on Low HMO)
Single
2-party
Family
2010/2011
Stipend
Stipend
Increase
2011/2012
Stipend
$619.00
$1,238.00
$1,708.00
$35.00
$67.00
$91.00
$654.00
$1,305.00
$1,799.00
2010/2011
Stipend
Stipend
Increase
(2.7%)
2011/2012
Stipend
$619.00
$1,238.00
$1,708.00
$16.71
$33.43
$46.12
$635.71
$1,271.43
$1,754.12
2010/2011
Stipend
Stipend
Increase
2011/2012
Stipend
$619.00
$1,238.00
$1,708.00
$10.00
$30.00
$50.00
$629.00
$1,268.00
$1,758.00
High HMO
Low HMO
High PPO
Medium PPO
(Access HMO $10-0)
(Access HMO $25-500 Admit)
(90-E $10)
(80-G $10)
Total Premium
$780.00
$1,559.00
$2,149.00
Employee Cost
$126.00
$254.00
$350.00
Total Premium
$654.00
$1,305.00
$1,799.00
Employee Cost
$0.00
$0.00
$0.00
Total Premium
$853.00
$1,514.00
$2,320.00
Employee Cost
$199.00
$209.00
$521.00
Total Premium
$774.00
$1,373.00
$2,100.00
Employee Cost
$120.00
$68.00
$301.00
Low PPO
(HDHP-B)
Total Premium
$577.00
$1,030.00
$1,611.00
Employee Cost
$0.00
$0.00
$0.00
Option 2 - with Renewal Rates
Option 2 - 2010/2011 Stipend Capped at CPI (March 2011 CPI at 2.7%)
Single
2-party
Family
High HMO
Low HMO
High PPO
Medium PPO
(Access HMO $10-0)
(Access HMO $25-500 Admit)
(90-E $10)
(80-G $10)
Total Premium
$780.00
$1,559.00
$2,149.00
Employee Cost
$144.29
$287.57
$394.88
Total Premium
$654.00
$1,305.00
$1,799.00
Employee Cost
$18.29
$33.57
$44.88
Total Premium
$853.00
$1,514.00
$2,320.00
Employee Cost
$217.29
$242.57
$565.88
Total Premium
$774.00
$1,373.00
$2,100.00
Employee Cost
$138.29
$101.57
$345.88
Low PPO
(HDHP-B)
Total Premium
$577.00
$1,030.00
$1,611.00
Employee Cost
$0.00
$0.00
$0.00
Option 3 - with Renewal Rates
Option 3 - 2010/2011 Stipend Capped at $10 Single /$30 - 2 Party /$50 - Family
Single
2-party
Family
High HMO
Low HMO
High PPO
Medium PPO
(Access HMO $10-0)
(Access HMO $25-500 Admit)
(90-E $10)
(80-G $10)
Total Premium
$780.00
$1,559.00
$2,149.00
Employee Cost
$151.00
$291.00
$391.00
Total Premium
$654.00
$1,305.00
$1,799.00
Employee Cost
$25.00
$37.00
$41.00
Total Premium
$853.00
$1,514.00
$2,320.00
Employee Cost
$224.00
$246.00
$562.00
Total Premium
$774.00
$1,373.00
$2,100.00
Employee Cost
$145.00
$105.00
$342.00
Low PPO
(HDHP-B)
Total Premium
$577.00
$1,030.00
$1,611.00
Employee Cost
$0.00
$0.00
$0.00
14
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 6: Contributions with options
Employee Contribution Change
CURRENT 10/01/2010 Rates
Low HMO
High PPO
(Access HMO $10-0)
(Access HMO $25-500 Admit)
(90-E $10)
(80-G $10)
Low PPO
(HDHP-B)
$10
No charge
$100 copay
$1,000/$2,000
$25
$500 admit
$100 copay
$2,000/$4,000
$10
90%
$100 copay
$300/$600
$10
80%
$100 copay
$500/$1,000
90%
90%
$100 copay
$2,500 ind/$5,000 fam
$5/$10/$25
$10/$20/$50
Total Premium Employee Cost
$738.00
$119.00
$1,476.00
$238.00
$2,036.00
$328.00
$10/$20/$35
$20/$40/$70
Total Premium Employee Cost
$619.00
$0.00
$1,238.00
$0.00
$1,708.00
$0.00
$5/$20
$10/$50
Total Premium Employee Cost
$813.00
$194.00
$1,445.00
$207.00
$2,212.00
$504.00
$5/$20
$10/$50
Total Premium Employee Cost
$738.00
$119.00
$1,311.00
$73.00
$2,003.00
$295.00
$7/$25
$14/$60
Total Premium Employee Cost
$540.00
$0.00
$962.00
$0.00
$1,504.00
$0.00
High HMO
Office Visit
Inpatient Hospital
Emergency Room
Annual Maximum
Prescription
Retail
Mail Order
Single
2-party
Family
Stipend
$619.00
$1,238.00
$1,708.00
Medium PPO
Option 4 - with Renewal Rates
Option 4 - 2010/2011 Employee Contibution Capped at CPI (March 2011 CPI at 2.7%)
2011/2012
Stipend
Single
2-party
Family
$635.71
$1,271.43
$1,754.12
High HMO
Low HMO
High PPO
Medium PPO
(Access HMO $10-0)
(Access HMO $25-500 Admit)
(90-E $10)
(80-G $10)
Total Premium
$780.00
$1,559.00
$2,149.00
Employee Cost
$122.21
$244.43
$336.86
New Stipend
$657.79
$1,314.57
$1,812.14
Single
2-party
Family
Total Premium
$654.00
$1,305.00
$1,799.00
Employee Cost
$0.00
$0.00
$0.00
New Stipend
$654.00
$1,305.00
$1,799.00
Total Premium
$853.00
$1,514.00
$2,320.00
Employee Cost
$199.24
$212.59
$517.61
New Stipend
$653.76
$1,301.41
$1,802.39
Total Premium
$774.00
$1,373.00
$2,100.00
Employee Cost
$122.21
$74.97
$302.97
New Stipend
$651.79
$1,298.03
$1,797.04
Low PPO
(HDHP-B)
Total Premium
$577.00
$1,030.00
$1,611.00
Employee Cost
$0.00
$0.00
$0.00
New Stipend
$577.00
$1,030.00
$1,611.00
Option 5 - with Renewal Rates
Option 5 - 2010/2011 Employee Contribution Capped at $10 Single /$30 - 2 Party /$50 - Family
2011/2012
Stipend
Single
2-party
Family
Single
2-party
Family
$629.00
$1,268.00
$1,758.00
High HMO
Low HMO
High PPO
Medium PPO
(Access HMO $10-0)
(Access HMO $25-500 Admit)
(90-E $10)
(80-G $10)
Total Premium
$780.00
$1,559.00
$2,149.00
New Stipend
$651.00
$1,291.00
$1,771.00
Employee Cost
$129.00
$268.00
$378.00
Total Premium
$654.00
$1,305.00
$1,799.00
New Stipend
$644.00
$1,275.00
$1,749.00
Employee Cost
$10.00
$30.00
$50.00
Total Premium
$853.00
$1,514.00
$2,320.00
New Stipend
$649.00
$1,277.00
$1,766.00
Employee Cost
$204.00
$237.00
$554.00
Total Premium
$774.00
$1,373.00
$2,100.00
Employee Cost
$129.00
$103.00
$345.00
New Stipend
$645.00
$1,270.00
$1,755.00
Low PPO
(HDHP-B)
Total Premium
$577.00
$1,030.00
$1,611.00
Employee Cost
$10.00
$30.00
$50.00
New Stipend
$567.00
$1,000.00
$1,561.00
15
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Section 7: Next Steps

ACSIG Dental – Renewal Expected Mid-June

Open Enrollment
16
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution
Public Entity Benefits Group
100 Pine Street, 11th Floor
San Francisco, CA 94111
Cabrillo College - 5/26/2011
Copyright © 2011 Alliant Insurance Services, Inc. Confidential; not for distribution