YOUR 2010 HEALTH PLAN OPTIONS AT A GLANCE

CORE PLAN / BUY-DOWN PLAN
PPO BENEFIT HIGHLIGHTS
CALENDAR YEAR DEDUCTIBLE: / In Network / Out of Network / In Network / Out of Network
Individual / $400 / $550
Family / $1,200 / $1,650
COINSURANCE: / 90% / 60% / 80% / 50%
OUT-OF-POCKET MAXIMUM:
(After Calendar Year Deductible is Satisfied)
Individual / $2,000 / $5,000 / $3,500 / $7,000
Family / $4,000 / $10,000 / $7,000 / $14,000
(Members responsible for 10% or 30% of eligible charges up to $20,000 per Family) / (Members responsible for 20% or 40% of eligible charges up to $20,000 per Family)
MAXIMUM LIFETIME BENEFIT: / $2,000,000 / $2,000,000
PHYSICIAN:
Office Visits / $25 Copay / 60% / $25 Copay / 50%
Hospital Visits / 90% / 60% / 80% / 50%
Outpatient Surgery / 90% / 60% / 80% / 50%
HOSPITAL:
Inpatient / 90% / 60% / 80% / 50%
Outpatient / 90% / 60% / 80% / 50%
Emergency Room Visit / 90% / 60% / 90% / 50%
(Additional $50 deductible per visit; waived if admitted as bed patient) / (Additional $50 deductible per visit; waived if admitted as bed patient)
Outpatient Surgery / 90% / 60% / 80% / 50%
PRESCRIPTION DRUGS:
Drug Card / $10 Copay Generic/$35 Copay Brand-Name / $10 Copay Generic/$35 Copay Brand-Name
Mail Order Drug Program / 2 Copays for 90 Day Supply (Generic & Brand) / 2 Copays for 90 Day Supply (Generic & Brand)
PREVENTIVE: / Mammograms and Pap Smears / Mammograms and Pap Smears
90% / 60% / 80% / 50%
Preventive Care - Children & Adults / Preventive Care - Children & Adults
Office Visits / Office Visits
$25 Copay / 60% / $25 Copay / 50%
(Limit of one office visit per year for adults) / (Limit of one office visit per year for adults)
Immunizations / Immunizations
90% / 60% / 80% / 50%

YOUR 2010 DENTAL PLAN OPTIONS AT A GLANCE

DEDUCTIBLES / Core: $25 per person, $75 per family, per calendar year
Buy-Down: $50 per person, $150 per family, per calendar year
ANNUAL MAXIMUM / The maximum benefit paid per calendar year is $1,500 per person
BENEFITS AND COVERED SERVICES* / In Network / Out-Of-Network
DIAGNOSTIC & PREVENTIVE BENEFITS -- Oral examinations, routine cleanings, x-rays, fluoride treatment, space maintainers, specialist consultations / 80 % / 80 %
BASIC BENEFITS -- Fillings, root canals, periodontics (gum treatment), tissue removal (biopsy), oral surgery (extractions), sealants / 80 % / 80 %
CROWNS, OTHER CAST RESTORATIONS -- Crowns, inlays, onlays and cast restorations / 50 % / 50 %
PROSTHODONTICS -- Bridges, partial dentures, full dentures, implants / 50 % / 50 %
ORTHODONTIC BENEFITS adults and dependent children / 50 % / 50 %
ORTHODONTIC MAXIMUMS / $ 1,000 Lifetime / $ 1,000 Lifetime

YOUR 2010 VISION PLAN AT A GLANCE

SERVICE / FREQUENCY / YOUR COPAY / IN-NETWORK (after copay) / OUT-OF-NETWORK (after copay)
Eye Exam / 12 months / $10 / 100% / Up to $45.00
Lenses / 12 months / $10 / 100% / Up to $45.00/single vision
Up to $65.00/lined bifocal
Up to $85.00/lined trifocal
Frames / 24 months / $10 / Frame allowance up to $120 / Up to $47
Contact Lenses (in lieu of frame and lenses) / 12 months / None / Contact allowance up to $120 / Up to $105

OVERVIEW OF YOUR CITY BENEFITS

Review this section to learn about the different benefits available, including those that are provided automatically at no cost to you, as well as benefits requiring you to contribute.

City of El Centro Benefits / Who pays the cost?
Core and Buy-Down Health plans / Employee and the City; City pays the majority of cost
Delta Dental Plan / Employee and the City; City pays the majority of cost
Vision Service Plan (VSP) / Employee and the City; City pays the majority of cost
Flexible Spending Accounts (FSA’s) / Employee can elect to contribute
Short Term Disability / City
Long Term Disability / City
Basic Life and Accident Insurance / City
Supplemental Life and Accident coverage / Employee
Employee Assistance Program / City
Voluntary Benefits: Aflac, Deferred Compensation / Employee

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