Teammate Open Enrollment 2021

CalPERS Health Plans Benefit Comparison — Medicare Plans, Continued CalPERS Health Plan Benefit Comparison— Medicare Plans, Continued

For more details about the benefits provided by a specific plan, refer to that plan’s Evidence of Coverage (EOC) booklet.

Medicare Plans

CCPOA Medicare Supplement (Association Plan)

Kaiser Permanente Senior Advantage

Anthem Medicare Preferred (PPO)

Sharp Direct Advantage (HMO)

UnitedHealthcare Group Medicare Advantage (PPO)

BENEFITS

Hearing Services Routine Hearing Exam

$10 $10

No Charge

No Charge

No Charge

No Charge

Physician Services

$10

$10

$10

$15

$1,000 max/ 36 months

$1,000 max/ 36 months

$1,000 max/ 36 months

$1,000 max/ 36 months

Hearing Aids

$500 max/member

Vision Care

Vision Exam

$10

$10

$10

$10

$10

Eyeglasses (following cataract surgery)

No Charge

No Charge

No Charge

No Charge

No Charge

Contact Lenses (following cataract surgery)

No Charge

No Charge

No Charge

No Charge

No Charge

Benefits Beyond Medicare (Services covered beyond Medicare coverage) Acupuncture $15/visit (acupuncture/chiropractic; combined 20 visits per calendar year) $15/visit (acupuncture/chiropractic; combined 20 visits per calendar year)

$10/visit (acupuncture/chiropractic; combined 30 visits per calendar year)

$15/visit (acupuncture/chiropractic; combined 20 visits per calendar year)

N/A

Chiropractic

$15/visit (acupuncture/chiropractic; combined 20 visits per calendar year)

$10/visit (acupuncture/chiropractic; combined 30 visits per calendar year)

$15/visit (acupuncture/chiropractic; combined 20 visits per calendar year)

$15/visit (acupuncture/chiropractic; combined 20 visits per calendar year)

$15/visit (up to 20 visits per calendar year)

30  | 2021 Health Benefit Summary

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