2020 Open Enrollment Health Benefit Summary

1 2020 | Health Benefit Summary Helping you make an informed decision about your Health plan About CalPERS About This Publication CalPERS is the largest purchaser of public The 2020 Health Benefit Summary provides valuable employee Health benefits in California, and the information to help you make an informed choice about second largest public purchaser in the nation your Health plan and Health care providers. This publication after the federal government. Our program compares covered services, co-payments, and benefits for provides benefits for million public each CalPERS Health plan . It also provides information employees, retirees, and their families. about plan availability by county and a chart summarizing Depending on where you reside or work, important differences among Health plan types.

2 CalPERS offers active employees and retirees You can use this information to determine which Health one or more types of Health plans, which plan offers the services you need at the cost that works for you. may include: The 2020 Health plan premiums are available at the CalPERS. Health Maintenance Organization (HMO) website at Check with your employer Preferred Provider Organization (PPO) to find out how much they contribute toward your premium. Exclusive Provider Organization (EPO) The 2020 Health Benefit Summary provides only a (for members in certain California counties) general overview of certain benefits . It does not include details of all covered expenses or exclusions and limita- The CalPERS Board of Administration annu- tions. Please refer to each Health plan 's Evidence of Coverage ally determines Health plan availability, covered (EOC) booklet for the exact terms and conditions of cover- benefits , Health premiums, and co-payments.

3 Age. Health plans mail EOCs to new members at the Whether you are working or retired, your beginning of the year, and to existing members upon employer or former employer makes monthly request. In case of a conflict between this Summary and contributions toward your Health premiums. your Health plan 's EOC, the EOC establishes the benefits The amount of this contribution varies. Your that will be provided. cost may depend on your employer or former We recommend that you only use this publication in employer's contribution to your premium, the conjunction with the current year's Health premium rate length of your employment, and the Health plan schedule and EOCs. To obtain a copy of the Health premium you choose. For monthly contribution amounts, rate schedule for any Health plan , please go to the CalPERS.

4 Active employees should contact their employer, website at or contact CalPERS at State retirees should contact CalPERS, and 888 CalPERS (or 888 225 7377). contracting agency retirees should contact their former employer. Other Health Publications This publication is one of many resources CalPERS offers to Health Care Affordability help you choose and use your Health plan . Others include: Transform Health care purchasing and delivery Health Program Guide: Describes Basic and Medicare to achieve affordability Health plan eligibility, Enrollment , and choices We aspire to transform Health care CalPERS Medicare Enrollment Guide: Provides purchasing and delivery, to make it affordable information about how Medicare works with your while providing the best value in Health care to CalPERS Health benefits our members.

5 We seek to understand rising Health care costs and the impact of wellness You can obtain the above publications and other on those costs. information about your CalPERS Health benefits through my|CalPERS at or by calling CalPERS. at 888 CalPERS (or 888 225 7377). Contents Considering Your Health plan Choices .. 2 Additional Resources.. 14. Understanding How CalPERS Health Plans Work .. 3 Health plan Directory .. 14. CalPERS Health plan Choices .. 4 Obtaining Health Care Quality Information .. 15. Choosing Your Doctor and Hospital .. 5. Enrolling in a Health plan Using Your Residential CalPERS Health plan Benefit Comparison or Work ZIP Code .. 5 Basic Plans.. 16. Health plan Availability Medicare Plans..24. Basic Plans .. 6. Medicare Plans.

6 8. Tools to Help You Choose Your Health plan .. 10. Accessing Health plan Information with my|CalPERS .. 10. my|CalPERS Health plan Comparison Feature .. 10. Comparing Your Options: Search Health Plans .. 11. Comparing Your Options: Health plan Choice Worksheet .. 11. Health plan Choice Worksheet.. 12. CalPERS Health plan Member Survey Results ..13. 2020 Health Benefit Summary | 1. Considering Your Health plan Choices Selecting a Health plan for you and your family is one We realize that comparing Health plan benefits , of the most important decisions you will make. This deci- features, and costs can be complicated. This section sion involves balancing the cost of each plan , along with provides information that can simplify your decision- other features, such as access to doctors and hospitals, making process.

7 As you begin that process, the following pharmacy services, and special programs for managing are some questions you should ask: specific medical conditions. Choosing the right plan Do you prefer to receive your Health care from an ensures that you receive the Health benefits and services HMO or PPO? Your preference will impact the plans that matter to you. available to you, your access to Health care providers, If you are a new CalPERS member or you are consider- and how much you pay for certain services. See the ing changing your Health plan during Open Enrollment , chart on the next page for a Summary of the differences you will need to make two related decisions: among plan Which Health plan is best for you and your family? What are the costs (premiums, co-payments, deduct- Which doctors and hospitals do you want to provide ibles, and coinsurance)?

8 Beginning on page 16. your care? of this booklet, you will find information about benefits , The combination of Health plan and providers that is co-payments, and covered services. Visit the CalPERS. right for you depends on a variety of factors, such as website at to find out what the whether you prefer a Health Maintenance Organization premiums are for the various plans. (HMO) or Preferred Provider Organization (PPO); your Does the plan provide access to the doctors and hospi- premium and out-of-pocket costs; and whether you want tals you want? Contact Health plans directly for this to have access to specific doctors and hospitals. information. See the Health plan Directory on page 14. of this booklet for Health plan contact information. 1.

9 Note that in a few counties where access to HMOs is limited, a third option, Exclusive Provider Organization (EPO), is available. An EPO. provides benefits similar to an HMO with some PPO features. 2 | 2020 Health Benefit Summary Understanding How CalPERS Health Plans Work The following chart will help you understand some important differences among Health plan types. Features HMO PPO EPO. Accessing Contracts with providers Gives you access to a network of Gives you access to the EPO. Health care (doctors, medical groups, Health care providers (doctors, network of Health care providers hospitals, labs, pharmacies, hospitals, labs, pharmacies, etc.) providers (doctors, hospitals, etc.) to provide you services known as preferred providers labs, pharmacies, etc.)

10 At a fixed price Selecting a Most HMOs require you to Does not require you to select Does not require you to primary care select a PCP who will work a PCP select a PCP. physician with you to manage your (PCP) Health care needs 1. Seeing a Requires advance approval Allows you access to many types Allows you access to many specialist from the medical group or of services without receiving a types of services without Health plan for some services, referral or advance approval receiving a referral or such as treatment by a specialist advance approval or certain types of tests Obtaining care Generally requires you to obtain Encourages you to seek services Requires you to obtain care care from providers who are a from preferred providers to ensure from providers who are a part part of the plan network your coinsurance and co-payments of the plan network are counted toward your calendar Requires you to pay the total year out-of-pocket maximums 2 Requires you to pay the total cost of services if you obtain cost of services if you obtain care outside the HMO's Allows you the option of seeing care outside the EPO's provider network without a non-preferred providers.