Special Olympics southern california SOSC-Open Enrollment Special Olympics southern california Open Enrollment 2018

Healthcare market data National Average Annual Premiums Single - $6,690; Family - $18,764 SOSC - Single - $5,933; Family - $12,231 (Volkswagon Jetta, Honda Civic, Jeep Renegade less expensive!) National Average Annual Deductible - $1,505 SOSC HMO plans have no deductible National Average in-network co-pay for primary care - $25; specialty care - $38 SOSC co-pay - similar

Flexible spending account Must re-elect for 2018 Medical limit $2,650 Dependent limit $5,000

Affordable Care Act Qualified Plans Children to age 26 SOSC-Open Enrollment Affordable Care Act Qualified Plans Children to age 26 Embedded pediatric dental/vision No lifetime maximums Medical Carriers Premium Changes Blue Shield PPO 1.13% Blue Shield HSA 4.33% Blue Shield HMO 9.36% Kaiser HMO 8.75%

Prescriptions In general, there are four tiers of classification for Prescription Drugs Tier 1 – Generic Formulary (Menu) Tier 2 – Brand Name Formulary (Menu) Tier 3 – Non- Formulary Tier 4 – Specialty Medications (Very Expensive) During the year, the classification of a drug can change between tiers

Teladoc-Blue Shield 24/7 access to doctors and pediatricians Teladoc provides you with access to board-certified doctors and pediatricians who are always available to resolve many of your medical issues via phone or online video consultations. Non emergency problems They can even write a prescription, if necessary, for you to pick up at your local pharmacy. Register at teladoc/bsc.com $5 co-pay for HMO & PPO; $40 for high deductible plan.

Platinum Access+ & TRIO HMO 0/25 Gold Full PPO 750/20 Blue Shield Kaiser Platinum Access+ & TRIO HMO 0/25 Gold Full PPO 750/20 Bronze Full PPO Savings 4300 Platinum 90 HMO 0/15   In Network Only In Network Out of Network Employee Deductible None $750 $1,500 $4,300 $8,600 Office Copay $25/$50 $30/$50 40% 50% $15/$30 Co-Insurance NA 20% Hospital Copay $250 per day, 3 day max. 40% max. 50% to $250 per day, 5 day max. to $2,000 per day $2,000 max. per day Employee Out of Pocket Limit $1,700 $7,000 $10,000 $6,550 $3,350 Prescriptions Not Covered Deductible $200 Combined Tier 1 $5 $10 40% to $500 max. Tier 2 $15 $30 Tier 3 $25 $50 Specialty Drugs 20% to $250 max. 30% to $250 max. 10% to $250 max.

Blue Shield Platinum Access+ & Trio HMO 0/25 HMO Benefits Blue Shield Platinum Access+ & Trio HMO 0/25 Office visit: $25/$50 Hospitalization: $250 co-pay, days 1-3 Out of pocket limit: $1700 Rx: $5/$15/$25 Pediatric dental & vision

Blue Shield Gold Full PPO 750/20 ppo benefits Blue Shield Gold Full PPO 750/20 Office visit: $30 pcp, $50 splst/40% Deductible: $750/$1500 Co-insurance: 20%/40% Out of pocket limit: $7000/$10000 Rx: $10/*$30/*$50 after $200 brand deductible Pediatric dental & vision

High deductible/HSA plan Blue Shield Bronze Full PPO Savings 4300/40% Office visit: 40%/50% Deductible: $4300/$8600 Co-insurance: 40%/50% Out of pocket limit: $6550/$10000 Rx: 40% to $500 max. Pediatric dental & vision

Kaiser HMO Benefits Kaiser Platinum 90 HMO 0/15 Office visit: $15/$30 Hospitalization: $250 co-pay, days 1-5 Out of pocket limit: $3350 Rx: $5/$15/$55 Pediatric dental & vision

Lincoln Financial Dental Options Dental PPO Dental HMO Freedom to use any dental provider $50 deductible Percentage reimbursement for dental services up to $1500 in a calendar year No orthodontic coverage Treatment plan review recommended Select your dentist from the network listing No deductible Co-pays listed for most dental codes. No benefit maximum Orthodontic coverage Treatment plan review recommended

Vision service plan Great selection of providers Exam every 12 months-$10 co-pay Lenses every 12 months Frames every 24 months-$130 allowance Equipment co-pay $25

Life & Accidental Death & Dismemberment Paid Short Term Disability Long Term Disability As a full-time employee, the following benefits are provided at no cost to you Life/AD&D In the event there is a loss of life, your beneficiary will receive one times your annual compensation to a maximum of $100,000. There is an equal amount of AD&D should the death be due to a covered accident. Short Term Disability After 30 days of covered accident or illness, Cigna will pay you 60% of your predisability earnings to a maximum of $1,500 per week, for 9 weeks. Long Term Disability After your Short Term Disability is exhausted, if you remain disabled, Cigna will pay you 60% of your predisability earnings to a maximum of $6,000 a month. Benefits will continue until you are no longer disabled, or Social Security Normal Retirement Age (whichever occurs first). You are able to buy additional Life insurance for yourself, spouse/domestic partner, and/or children. There are no medical questions for amounts up to $100,000 for you, $30,000 for your spouse/domestic partner, & $10,000 for child(ren). See application for details. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna

Open Enrollment Forms Please turn in the following forms by November 28 SOSC election form Lincoln Financial dental change form if needed FSA election form Blue Shield/Kaiser change form if needed