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Medicare Plans
CCPOA Medical Plan Medicare (PPO)
Western Health Advantage MyCare Select (HMO)
UnitedHealthcare Group Medicare Advantage Edge (PPO)
PERS Gold
PERS Platinum
CAHP Medicare Supplement (Association Plan)
PORAC (Association Plan)
PPO Non PPO
PPO Non PPO
BENEFITS
Calendar Year Deductible
Individual
N/A N/A
N/A N/A
N/A N/A
N/A N/A
N/A N/A
N/A N/A
N/A N/A
Family
Maximum Calendar Year Copay or Coinsurance (excluding pharmacy)
$1,500 (copay/ coinsurance)
$3,000 1,2 (co insurance)
$0 (copay)
$1,500 (copay)
Individual
N/A
N/A
N/A
N/A
Family
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Hospital (including Mental Health and Substance Abuse)
$100/ admission
No Charge
No Charge
No Charge No Charge
Inpatient
No Charge
No Charge
Outpatient Facility/ Surgery Services
No Charge
No Charge
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
No Charge
No Charge
Home Health Services
No Charge
No Charge
$15/visit
No Charge
No Charge
No Charge
No Charge
Hospice
No Charge
No Charge
No Charge
No Charge
No Charge
No Charge
No Charge
Emergency Services (waived if admitted or hospitalized as an outpatient)
No Charge
$50
No Charge
No Charge
No Charge
No Charge
No Charge
Ambulance Services
No Charge
No Charge
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
2023 Health Benefit Summary | 25
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