Teammate Handbook Cover
CalPERS Health Plan Benefit Comparison Medicare Supplement Plans
For more details about the benefits provided by a specific plan, refer to that plan’s Evidence of Coverage (EOC) booklet. All benefits subject to regulatory approval.
Medicare Supplement Plans
Medicare Association Plans
PERS Gold
PERS Platinum
CCPOA Medical Plan Medicare Advantage (PPO)
CAHP Medicare Supplement
PORAC Medicare Supplement
Benefits
PPO Non-PPO PPO Non-PPO
Calendar Year Deductible
N/A
N/A
N/A
N/A
N/A
Individual
N/A
N/A
N/A
N/A
N/A
Family
Maximum Calendar Year Copay or Coinsurance (excluding pharmacy)
$3,000 1,2 (coinsurance)
$1,500 (copay)
N/A
N/A
N/A
N/A
Individual
N/A
N/A
N/A
N/A
N/A
Family
Hospital (including Mental Health and Substance Abuse)
No Charge
No Charge
No Charge
$100/admission
No Charge
Inpatient
Outpatient Facility/ Surgery Services
No Charge
No Charge
No Charge
No Charge
No Charge
Skilled Nursing Facility (up to 100 days/benefit period)
No Charge
No Charge
No Charge
No Charge
No Charge
Home Health Services
No Charge
No Charge
No Charge
$15/visit
No Charge
Hospice
No Charge
No Charge
No Charge
No Charge
No Charge
1 See EOC for additional details. 2 For Benefits Beyond Medicare. 3 Of the allowed amount.
28 | 2025 Health Benefit Summary
Made with FlippingBook - Online catalogs