Side-by-Side Comparison of Health plans Offered

Blue Cross

Member Copayments
	Blue Shield PPO 90/70		Blue Shield HMO	Blue Shield PPO/HRA
Life and AD&D Insurance	$10,000 for all Active Employees
Medical Lifetime Benefit Maximum	$6,000,000		Unlimited	$6,000,000
	Blue Shield PPO 90/70		Blue Shield HMO	Blue Shield PPO/HRA
	Network	Outside	Network Only	Network	Outside
Calendar Year Deductible	$100/Person $200/Family	$250/Person $500/Family	None	$1,500/Person $3,000/Family
Calendar Year Copayment Maximum	$1,000/Person $2,000/Family	$3,000/Person $6,000/Family	$1,000/Person $2,000/Family	$4,500/Person $9,000/Family
	Blue Shield PPO 90/70		Blue Shield HMO	Blue Shield PPO/HRA
	Network	Outside	Network Only	Network	Outside
Physician Services	10%	30%	$15 per visit	20%	40%
Lab, X-rays, Diagnostics	10%	30%	no charge	20%	40%
Hospitalization Services	10%	30%	no charge	20%	40%
Emergency Health Coverage (Deductible waived if admitted as inpatient)	10%		$50	20%
Durable Medical Equipment	10%	30%	20% of Allowed Charges	20%	40%
Mental Health Services (Psychiatric)
	Blue Shield PPO 90/70		Blue Shield HMO	Blue Shield PPO/HRA
	Network	Outside	Network Only	Network	Outside
Inpatient	10%	30%	no charge	20%	40%
Outpatient	50%		$25 per visit	50%	not covered
Chemical Dependency Services (Substance Abuse)
	Blue Shield PPO 90/70		Blue Shield HMO	Blue Shield PPO/HRA
	Network	Outside	Network Only	Network	Outside
Inpatient (up to 30 days per Calendar Year)	10%	30%		20%	40%
Outpatient visits (up to 20 visits per Calendar Year)	50%		$15 per visit	50%	not covered
Prescription Drug Coverage
	Blue Shield PPO 90/70		Blue Shield HMO	Blue Shield PPO/HRA
	Network	Outside	Network Only	Network	Outside
Generic	$5 network $10 mail service	$5	$10 network $20 mail service	$10 network $20 mail service	25% of allowable amount plus co-pay of $10
Brand Name	$10 network $20 mail service	$10	$20 network $40 mail service	$25 network $50 mail service	25% of allowable amount plus co-pay of $25
Non-Formulary Brand Name	$25 network $50 mail service	$25	$35 network $70 mail service	$40 network $80 mail service	25% of allowable amount plus co-pay of $40
Injectable Medications	30% up to $150 copay per prescription	not covered	20% up to $100 copay per prescription	30% up to $150 copay per prescription	not covered
*prescriptions filled at the pharmacy (in-Network) are for 30-day supply, Mail service is 90-day supply

Kaiser

	Northern California	Southern California
Life and AD&D	$10,000 for all active employees
Lifetime Maximum Medical Benefit	unlimited	unlimited
Physician Office Visits	$15 per visit	$10 per visit
Maternity Office Visits	$15 per visit	$10 per visit
Hospital Services	no charge	no charge
Skilled Nursing Facility	100 days at no charge	100 days at no charge
Diagnostic Lab & X-ray	no charge	no charge
Mental Health - Outpatient	$15 per visit, up to 20 visits per year *AB88 Diagnosis = unlimited visits	$10 per visit, up to 20 visits per year *AB88 Diagnosis = unlimited visits
Mental Health - Inpatient	no charge - up to 45 days per year	no charge - up to 30 days per year
Substance Abuse - Inpatient/Outpatient	$15 per visit - no charge detox only	$10 per visit - no charge detox only
Emergency Room Services	$50 copay per qualified ER visit	$35 copay per qualified ER visit
Prescription Drugs	$10 generic $20 name brand for 100-day supply or Manufacturers smallest package (whichever is greater)	$10 copay per 100-day supply
Durable Medical Equipment	covered only if prescribed and in accordance with DME formulary