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REDWOOD EMPIRE ELECTRICAL WORKERS HEALTH & WELFARE TRUST FUND
MEDICAL PLAN COMPARISONS
Summary Only – Actual Plan Documents Will Govern
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SELF-FUNDED INDEMNITY PLAN
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HEALTH NET
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KAISER
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PPO
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Non-PPO
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HMO
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HMO
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Deductible
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Emergency Room
All Other
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$100 Individual
$500 Individual
$1,500 Family
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$100 Individual
$500 Individual
$1,500 Family
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$50 co-pay waived if admitted
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$10 co-pay waived if admitted
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Choice of Physicians
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Contract Providers
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Non-contract Providers
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Health Net Panel of Physicians and Hospitals
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Kaiser Panel of Physicians and Hospitals
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Out of Pocket Maximum
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$2,000 Individual
$4,000 Family
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$4,000 Individual
$8,000 Family
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$1,500 Individual
$3,000 2-Party
$4,500 Family
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$1,500 Individual
$3,000 Family
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Lifetime Maximum
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$2,000,000
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$2,000,000
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Unlimited
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Unlimited
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Hospital Services
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Room and Board
Miscellaneous
Intensive Care Unit
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80%*
80%*
80%*
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50%*
50%*
50%*
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$100 co-pay per admission
$100 co-pay per admission
$100 co-pay per admission
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No charge
No charge
No charge
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Surgeon and Assist. Surgeon
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Office or Home visits
In Surgeon Charges
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$10 co-pay
80%*
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$20 co-pay, then 50% of UCR
50%*
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Office - $10 co-pay
Home - $20 co-pay
No charge
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$10 co-pay
No charge
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Anesthesia
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Office or Home Visits
In and Outpatient Hospital Visits
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$10 co-pay
80%*
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$20 co-pay, then 50%
70%*
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Office - $10 co-pay
Home - $20 co-pay
No charge
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No charge
No charge
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Physician’s Visits
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Office or Home visits
In and Outpatient Hospital Visits
Chiropractic Visits
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$10 co-pay
80%*
$10 co-pay Maximum Benefit $1,500 per year
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$20 co-pay, then 50%
50%*
$20 co-pay, then 50%*
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Office - $10 co-pay
Home - $20 co-pay
No charge
$10 co-pay/20 visits
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$10 co-pay
$10 co-pay
Not available
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Physical Therapy
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Per Visit
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$10 co-pay Maximum Benefit $1,500 per year
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$20 co-pay, then 50%
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No charge
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$10 co-pay
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Speech Therapy
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Per Visit
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$10 co-pay
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$20 co-pay, then 50%
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No charge
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$10 co-pay
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SELF-FUNDED INDEMNITY PLAN
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HEALTH NET
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KAISER
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PPO
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Non-PPO
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HMO
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HMO
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Laboratory and X-Ray
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Office or
Freestanding Lab/X-Ray
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$10 co-pay
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$20 co-pay, then 50%
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No charge
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No charge
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In and Outpatient Hospital
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80%*
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50%*
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No charge
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No charge
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Prescription Drugs
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Retail
Mail Order
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$0 co-pay for Generic & 30% for Brand
30 day supply
$0 Generic/$20 Brand
90 day supply
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$0 co-pay for Generic & 30% for Brand
30 day supply
$0 Generic/$20 Brand
90 day supply
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$10 Generic/$20 Brand/$50 non formulary
30 day supply
$20/Generic/$40/Brand/$100 non-formulary
90 day supply
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$7 co-pay
100 day supply
non-formulary-pay retail
$7 co-pay
(refills only)
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Maternity
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Pre and Post visit
Delivery
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$10 co-pay
80%*
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$20 co-pay, then 50%
50%*
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$10 co-pay per office visit
$100 co-pay per admission
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$5 co-pay
No charge
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Home Health Care
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80%*
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80%*
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$10 co-pay
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No charge (limits)
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Ambulance
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80%*
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80%*
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No charge
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No charge
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Convalescent Care
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50%* of Semi-private room, max. 120 days.
(certain conditions apply)
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50%* of Semi-private room, max.120 days.
(certain conditions apply)
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100%
for 100 days
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No charge
100 days
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Hospice Care
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80%*
(certain conditions apply)
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80%*
(certain conditions apply)
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100%
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No charge
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Mental Health
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Inpatient
Outpatient
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Maximum 15 days/Cal Yr. 80% of PPO allow charges after deductible.
Maximum 20 visits/Cal Yr. 60% of PPO allow charges after deductible.
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Maximum 15 days/Cal Yr. 50% of UCR charges after deductible.
Maximum 20 visits/Cal Yr. 50% of UCR charges after deductible.
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Severe Mental Illness:
Unlimited visits, no charge
Other Mental Illness: Max 30 visits, no charge
Severe Mental Illness: Unlimited visits, $5 co-pay Other Mental Illness: Max 30 visits, $30 co-pay
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No day limit for mental health parity diagnosis
90 days per lifetime.
Up to 45 days per Cal Yr,
$10 co-pay up to 20 visits per Cal Yr. No limit for
mental health parity
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Alcohol/Drug
Rehabilitation Benefit
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See below
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See below
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No coverage under Health Net (only detox covered)
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Inpatient detox no charge Outpatient: Indiv. $10/visit Group $5/visit Transitional residential recovery $100 admission
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Special Stand alone providers available to eligible Participants and their spouses regardless of the medical plan enrolled in.
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* Benefits subject to Calendar Year deductible
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