Page 2 - California Eye Management OE Action Guide 2019

CONTRIBUTIONS
2019 CONTRIBUTIONS

Bi-Weekly Payroll Deductions

MEDICAL PLANS
CEMS pays 65% of costs for employees on base HMO plan(s) and employees have the choice to buy-up to other plan op-
tions.
TIER COST PER PAYCHECK
HMO DEDUCTABLE HSA PPO DHMO DPPO

MEDICAL HMO MEDICAL MEDICAL MEDICAL DENTAL DENTAL
Employee Only $52.62 $72.63 $108.48 $192.68 $1.85 $12.29

Employee + Spouse $233.00 $277.03 $355.91 $541.15 $7.15 $28.66
Employee + Child(ren) $172.87 $208.89 $273.43 $424.99 $7.15 $32.42
Employee + Family $368.29 $430.33 $541.48 $802.50 $13.78 $51.06

COMPANY PAID BENEFITS
Group Life/AD&D and Resource Advisor(EAP) are provided at no cost to the employees.

NEW PLAN OPTIONS!

Current Benefits NEW BENEFITS
End Dec. 31, 2018 January 1, 2019
FINDING A DOCTOR MEDICAL 3 Medical Plans 4 Medical Plans

HMO—Priority Select HMO
Go to www.anthem.com/ca - Out of Pocket Max (Ind/Fam) $4,000/$8,000 $3,000/$6,000
or call (866) 207-9878 for $20/$40 $20/$40
- Office Visit (PCP/Spec)
HSA or (800) 888-8288 for $250/day (max 4 copays) $250/day (max 3 copays)
- Inpatient Hospital
HMO and PPO. $5 or $20/$40/$70 $5 or $20/$40/$60
- Prescription Drugs

HMO: Select your state of HMO —Select HMO $500/person
residence - Network Deductible $3,000/$6,000
• Refer to the “Priority - Out of Pocket Max (Ind/Fam) N/A $20/$40
- Office Visit (PCP/Spec)
Select HMO” plan/ 20%
network when - Inpatient Hospital $5 or $20/$40/$75
prompted - Prescription Drugs
• Or refer to the “Select PPO
$1,000/$3,000 $1,000/$3,000
HMO” plan/network - Network Deductible (Ind/Fam) $5,000/$10,000 $5,000/$10,000
when prompted - Network Out of Pocket Max (Ind/Fam) $30/$60 $35/$35
- Office Visit Copay (PCP/Spec) 25%/50% 20%/40%
PPO: Select your state of - Coinsurance (Network/Non-Network) $5 or $20/$40/$70 $5 or $20/$30/$50
residence - Prescription Drugs
• Refer to the “Blue HSA
Cross PPO (Prudent - Network Deductible (Ind/Fam) $3,500/$7,000 $3,500/$7,000
Buyer) - Large Group” - Network Out of Pocket Max (Ind/Fam) $5,500/$11,000 $5,500/$11,000
plan/network when - Office Visit Copay (PCP/Spec) 30%/30% 20%/20%
30%/50%
20%/50%
prompted - Coinsurance (Network/Non-Network) $5 or $20/$40/$70 $5 or $15/$40/$60
- Prescription Drugs
HSA: Select your state of FSA
residence
• Refer to the “Lumenos Healthcare & Dependent Care Account Available to you as pre-tax benefits through Anthem Blue Cross;
Increased limit to $2700 for 2019
Plans” plan/network
when prompted HSA
Healthcare Spending Account Available to you as a tax-advantaged account that you own;
2 Increased limit to $3,500/individual & $7,000/family for 2019