Teammate Handbook Cover
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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
Emergency Services (waived if admitted or hospitalized as an outpatient)
No Charge
No Charge
No Charge
No Charge
No Charge
Ambulance Services
No Charge
No Charge
No Charge
No Charge
No Charge
Surgery/Anesthesia
No Charge
No Charge
No Charge
No Charge
No Charge
Physician Services (including Mental Health and Substance Abuse)
No Charge
No Charge
$10
$10
No Charge
Office Visits
No Charge
No Charge
No Charge
No Charge
No Charge
Inpatient Visits
No Charge
No Charge
No Charge
$10
No Charge
Outpatient Visits
No Charge
No Charge
No Charge
No Charge
No Charge
Urgent Care Visits
No Charge
No Charge
No Charge
No Charge
No Charge
Preventive Services
Diagnostic X-ray/Lab
No Charge
No Charge
No Charge
No Charge
No Charge
Durable Medical Equipment
No Charge
No Charge
No Charge
No Charge
No Charge
2025 Health Benefit Summary | 29
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