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

2. 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

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

4. 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 %
Blue Shield HSA %
Blue Shield HMO 9.36%
Kaiser HMO %

5. 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

6. 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.

7. 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.

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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