doc2015 CCPOA MEDICAL RATES AND COVERAGE MAPS
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2015 CCPOA MEDICAL RATES AND COVERAGE MAPS
2015 CCPOA MEDICAL RATES AND COVERAGE MAPS CCPOA Medical Plan Service Area Employee Only Employee + 1 Dependent Employee + Family $157.33 315.26 475.13 37.88 76.30 153.82 CCPOA Coverage Areas NorCal Partial Coverage SoCal = CCPOA Medical = Facility Avenal State Prison California Medical Facility California State Prison, Corcoran California State Prison, Sacramento California State Prison, Solano California Substance Abuse Treatment Facility Central California Women’s Facility Deuel Vocational Institution Folsom State Prison Pleasant Valley State Prison San Quentin State Prison Valley State Prison for Women California Health Care Facility California City Correctional Facility California Correctional Institution California Institution for Men California Institution for Women California Men’s Colony California Rehabilitation Center California State Prison, LA County Calipatria State Prison Centinela State Prison Chuckawalla Valley State Prison Ironwood State Prison Kern Valley State Prison North Kern State Prison R.J. Donovan Correctional Facility Wasco State Prison California Correctional Center Correctional Training Facility High Desert State Prison Mule Creek State Prison Pelican Bay State Prison Salinas Valley State Prison Sierra Conservation Center Youth Facility O.H. Close Youth Correctional Facility N.A. Chaderjian Youth Correctional Facility Ventura Youth Correctional Facility City Avenal Vacaville Corcoran Represa Vacaville Corcoran Chowchilla Tracy Represa Coalinga San Quentin Chowchilla Stockton California City Tehachapi Chino Corona San Luis Obispo Norco Lancaster Calipatria Imperial Blythe Blythe Delano Delano San Diego Wasco Susanville Soledad Susanville Ione Cresent City Soledad Jamestown City Stockton Stockton Ventura County Kings Solano Kings Sacramento Solano Kings Madera San Joaquin Sacramento Fresno Marin Madera San Joaquin Kern Kern San Bernardino Riverside San Luis Obispo Riverside Los Angeles Imperial Imperial Riverside Riverside Kern Kern San Diego Kern Lassen Monterey Lassen Amador Del Norte Monterey Tuolumne County San Joaquin San Joaquin Ventura Anthem HMO Select Plan Service Area Employee Only Employee + 1 Dependent Employee + Family $115.45 $228.90 $294.57 ice Area C 2014 Proposed Agenda Item Attachment 2, Page 1 Anthem HMO Traditional Plan Service Area Employee Only 203.34 Service Area C Employee + 1 Dependent Employee + Family 404.68 523.08 2014 Proposed Agenda Item Attachment 2, Page 2 BSC Access Plus Plan Service Area Area C Employee Only Employee + 1 Dependent Employee + Family 194.16 386.32 499.22 2014 Proposed Agenda Item Attachment 2, Page 3 ea C BSC Net Value Plan Service Area Employee Only Employee + 1 Dependent Employee + Family 146.36 290.72 3774.94 2014 Proposed Agenda Item Attachment 2, Page 4 Health Net Salud y Mas Service Area Employee Only 11.97 ervice Area C Employee + 1 Dependent Employee + Family 21.94 25.52 2014 Proposed Agenda Item Attachment 2, Page 5 Health Net Smart Care Service Area Employee Only 147.47 ervice Area C Employee + 1 Dependent Employee + Family 292.94 377.82 2014 Proposed Agenda Item Attachment 2, Page 6 C Kaiser Service Area Employee Only Employee + 1 Dependent Employee + Family 109.04 216.08 277.90 2014 Proposed Agenda Item Attachment 2, Page 7 C Sharp Service Area Employee Only Employee & 1 Dependent Employee & Family 62.38 122.76 156.59 2014 Proposed Agenda Item Attachment 2, Page 8 C United Service Area Employee Only Employee & 1 Dependent Employee & Family 118.40 234.80 302.24 2014 Proposed Agenda Item Attachment 2, Page 9 2015 CCPOA Medical Rates Effective Date: 1/1/2015 – 12/31/2015 Active Member Out-Of-Pocket Cost PLAN Employee Only Employee + 1 Dependant Family Anthem Select HMO $115.45 $228.90 $294.57 Anthem Traditional HMO 203.34 404.68 523.08 Blue Shield Access+ 194.16 386.32 499.22 Blue Shield NetValue 146.36 290.72 3774.94 CCPOA (North) $157.33 315.26 475.13 CCPOA (South) 37.88 76.30 153.82 Health Net Salud y Más 11.97 21.94 25.52 Health Net SmartCare 147.47 292.94 377.82 Kaiser (CA) 109.04 216.08 277.90 Sharp 62.38 122.76 156.59 UnitedHealthcare 118.40 234.80 302.24 PERS Select 94.22 186.44 239.37 PERS Choice 116.45 230.90 297.17 PERSCare 194.93 387.86 501.22 NO TOWERS? NO TRUST A C C E P T N O S U B S T I T U T E S
