Santa Cruz County Chapter Open Enrollment

October 10, 2011 – November 4, 2011

What is open enrollment?

Open enrollment refers to the period of time during which all members of an employers group health insurance plan have the opportunity to enroll in certain benefit programs for the coming year.

Before making a choice:

– Check to see if your current physicians and area hospitals are in the plan’s network. Using network providers generally will save money on your health care.
– Check to see if spouses or dependents are covered. Some plans will cover spouses and other dependents, while other plans will not.
– Read all of the plan materials thoroughly. Doing so will tell you what your rights and responsibilities are under each plan.
– Review any pre-existing condition exclusions and prior authorization requirements in the plan materials.
– If you take prescription medications, check them against the list of approved drugs in each plan booklet.
– If any part of a plan is unclear to you, ask for help from the County Employee Benefit Hotline at 454-2241 or the insurance carrier.

Once enrolled in a health plan, you will not be able to make changes until the next open enrollment period, unless there is a life changing event such as a divorce, job change, marriage, and birth of a baby or adoption of a child.

Most common plans are:

NetValue HMO plan:
– Comprised of a smaller network of HMO providers.
– Affordable co-payment each time you see a physician.
– Currently limited to PMG network of doctors.
– No deductible.
– Low monthly rates, zero copayments for hospitalization and preventive care.
– elf-referral to specialists, using the Access+ Specialist referral feature.
– Health and wellness resources.

Summary – brief description

Evidence of Coverage

Access+ HMO:
– Comprised of a larger network of HMO providers.
– Affordable co-payment each time you see a physician.
– Currently PAMF and PMG network of doctors.
– No deductible.
– Higher monthly rates, zero copayments for hospitalization or preventive care.
– Self-referral to specialists, using the Access+ SpecialistSM referral feature.
– Health and wellness resources.

Summary – brief description

Evidence of Coverage

Q. What is the difference between the Blue Shield NetValue and Blue Shield Access + HMO plans?
A. Check these plans’ list of doctors if there is a particular doctor that you want to see. The NetValue Plan has a smaller network of doctors and hospitals. These providers are recognized for doing a better job of seeing that patients get the right care — avoiding care you don’t need and getting care that is proven to work.

For Basic members, you spend less for the NetValue Plan monthly premium. There is no difference between the two plans in your co-pay amounts when getting care.

For Medicare members the two plans’ monthly premiums are the same and there is no difference between the two plans in your co-pay amounts when getting care.

Q. What is the difference between the PERS plans?
A. Check these plans’ list of doctors if there is a particular doctor that you want to see. PERS Select has a smaller network of doctors and hospitals. These providers are recognized for doing a better job of seeing that patients get the right care – avoiding care you don’t need and getting care that is proven to work. PERS Choice and PERSCare use the same network of doctors, hospitals and other providers.

In PERSCare you pay a higher monthly premium but you pay a smaller share of medical bills when getting care. In PERS Select and PERS Choice you pay a lower monthly premium but you pay a larger share of medical bills (20%) when getting care compared to the PERSCare 10% coinsurance.

In all three plans, you do not pay for preventive care as it is fully covered when using an in-network provider. And, the doctor visit $20 co-pay, in-network, is the same for these plans.

Find a Provider:
To find out if your current doctor is in the network or to choose a new doctor, go to blueshieldca.com/findaprovider. Choose Find a Doctor, under Choose a Plan, select CalPERS, and then choose CalPERS NetValue HMO or CalPERS Access+. Need help? Call your dedicated Blue Shield Member Services team at (800) 334-5847 for personal assistance. You can change your Personal Physician at anytime for any reason, and your new doctor will be effective on the first of the following month.

PERS Select, PERS Choice & PERSCare Health plans

Click here for information.

General Representation Unit Health Rates 2012

Click here for information.

Please note: the County’s contribution of 95%, 90%, and 90% was previously based on the Access premium, but for 2012 it will be based on the cheaper Net Value premium. There will be a slight to a significant rate increase for health plans. Please review the rates.

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