Page 8 - 2020 City of Newport Beach Part Time Benefit Guide

Medical Benefits

The goal of the City of Newport Beach is to provide you with quality affordable health care benefits. Our medical
benefits are designed to help maintain wellness and protect you and your family from major financial hardship in
the event of an illness or injury. The City offers a variety of medical plans through the California Public Employees
Retirement System (CalPERS) medical program. As you consider your health plan choices, you should determine
which health plans are available in the ZIP Code in which you are enrolling. Employees may enroll in a health plan
using either their residential or work ZIP Code. It is recommended to contact the plan before enrolling to make sure
they cover your area and that your preferred provider is in their network. You may also visit the CalPERS website
for helpful resources and tools, such as, the MyCalPERS Health Plan Comparison Feature and the MyCalPERS
Health Plan Choice Worksheet. Pages 13 and 14 of this booklet provide a list of available plans including premiums
for Regions 2 and 3 covering counties from Ventura to San Diego.

Health Maintenance Organization (HMO) Preferred Provider Organization (PPO)

An HMO gives you more predictable costs but less The PPO plan is designed to provide choice, flexibility
flexibility. Out-of-network care is not covered except and value. The PPO plan is a managed care
in an emergency. You must choose a primary care organization of medical doctors, hospitals, and other
physician (PCP) as your personal doctor for routine
care, specialist referrals, and hospital stay health care providers who have contracted with
coordination. You pay a fixed copay for most services. Anthem Blue Cross to provide health care at reduced
rates to you. Participants have a choice of using
You have a choice of eight HMO plans offered by the
following carriers: Anthem Blue Cross, Blue Shield, network providers or going directly to any other
Health Net, Kaiser Permanente, Sharp and physician (non-network provider) without a referral.
UnitedHealthcare. There is an annual deductible to meet before benefits
apply. You are also responsible for a certain
percentage of the charges (coinsurance), and the plan
New Blue Shield Trio HMO Plan pays the balance up to the agreed upon amount.

Similar to a traditional HMO plan, Trio Accountable You have a choice of the following CalPERS Anthem
Care Organization (ACO) HMO plans require members Blue Cross PPO plans: PERS Choice, PERS Select
to select a Personal Physician to coordinate and and PERSCare,.
direct their healthcare needs. The Trio ACO HMO In order to ensure a smooth implementation, you
provider network includes a subset of Independent must make your changes through Employee Self
Practice Associations (IPAs), medical groups, and Service (ESS) no later than midnight on October
affiliated physicians from our Access+ HMO network. 4, 2019. The waivers and proof of coverage are
The Blue Shield of California Trio HMO plan offers due by 4:30 p.m. on October 4, 2019.
identical benefits as the Full Network HMO; however,
you will have to select care from a narrower list of
physicians and hospitals that are under Blue Shield’s
ACO Network Trio HMO. This plan is available in
Region 3, which includes, Los Angeles, San
Bernardino, and Riverside counties.

Why would I choose a PPO Plan? Why would I Not Choose a PPO plan?
You have a doctor you like and you would like to keep You don’t want the extra responsibility of managing
this doctor. your own care.
You want to see specialists and other providers PPOs are not as closely regulated by the government
without having to first get a referral and/or pre- as HMOs.
approval.
You want the freedom to see providers who are not in You do not want to pay the higher costs of a PPO.
the network. You do not want a primary care doctor.
You are confident that you can manage your own You do not want to get bills from providers.
care.

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