Page 8 - City of Newport City BG- Full Time

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, 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

New Blue Shield Trio HMO Plan percentage of the charges (coinsurance), and the plan
pays the balance up to the agreed upon amount. You
Similar to a traditional HMO plan, Trio Accountable have a choice of the following CalPERS Anthem Blue
Care Organization (ACO) HMO plans require members Cross PPO plans: PERS Choice, PERS Select,
to select a Personal Physician to coordinate and PERSCare, and PORAC (PORAC is only available to
direct their healthcare needs. The Trio ACO HMO dues paying members in the Police, Fire and
provider network includes a subset of Independent Lifeguard Management bargaining units).
Practice Associations (IPAs), medical groups, and
affiliated physicians from our Access+ HMO network. In order to ensure a smooth implementation, you
The Blue Shield of California Trio HMO plan offers must make your changes through Employee Self
identical benefits as the Full Network HMO; however, Service (ESS) no later than midnight on October
you will have to select care from a narrower list of 4, 2019. The waivers and proof of coverage are
physicians and hospitals that are under Blue Shield’s due by 4:30 p.m. on October 4, 2019.
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.

6