Small Group and CalChoice Benefit Comparison

Transcription

1 Small Group and CalChoice Benefit Comparison A guide to choosing the right plan for your business Effective January, 09

2 San Diegans choose Sharp Health Plan Sharp Health Plan delivers direct access to high-quality, affordable health care for our community. With a range of solutions and provider networks, we have the right plan to meet your unique small business needs. Highest member-rated health plan Additional benefits included with every plan Sharp Health Plan is the highest member-rated health plan in California for The convenience of Sharp Health Plan extends beyond San Diego and standard business hours. the fourth year in a row, with the highest member ratings for health care, All Sharp Health Plan members receive these value-added benefits. health plan and personal doctor among reporting California health plans. As a Sharp Health Plan member, you ll receive award-winning care from our nationally recognized doctors, medical groups and hospitals. Local and not-for-profit After-Hours Nurse Advice We ve been connecting San Diegans to health insurance Connection. They can talk with you about an illness or injury, help you decide where to seek After-hours and on weekends, registered nurses are available through Sharp Nurse since 99. We re a local not-for-profit commercial health care and provide advice on any of your health concerns. plan, designed for people just like you. Call , 5 p.m. 8 a.m., Monday to Friday and 4 hours on weekends Customizable MinuteClinic With a multitude of plan designs, four provider networks and a broad range of pricing options, you have the ability MinuteClinic is the walk-in medical clinic located inside select CVS Pharmacy stores. to tailor your plan to your business needs. MinuteClinic provides convenient access to basic care without an appointment. cvs.com/minuteclinic Emergency Travel Services When faced with a medical emergency while traveling 00 miles or more away from home or in another country, we can connect you to doctors, hospitals, pharmacies and other services. sharphealthplan.com/travel Best Health wellness program Best Health is one of just a few health plan wellness programs to receive national accreditation. With interactive online tools and resources like meal plans and health trackers, this program helps you reach your health goals while on-the-go. yourbesthealth.com T he source for this data is Quality Compass 08 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 08 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Sharp Health Plan achieved the following summary ratings (9+0): 6.4 for Rating of the Health Care compared to the California all LOBs average (excluding PPOs & EPOs) of 5.6; 56.7 for Rating of Health Plan compared to the California all LOBs average (excluding PPOs & EPOs) of 47.08; and 7.5 for Rating of Personal Doctor compared to the California all LOBs average (excluding PPOs & EPOs) of Y our PCP copay will apply to most services. We re here to help! sharphealthplan.com 3

3 Small Group 90 Plans effective Jan., 09 HMO NG HMO NG 9 HMO NG HMO NG 8 HMO NG 5 HMO NG 3 HMO NG 7 HMO NG 4 HMO NG 6 Calendar Year Deductible (per individual / per family) (applies only to those covered benefits indicated) None None None None None None None None None Calendar Year Deductible (per individual / per family) For Covered Prescription Drugs (preferred and non-preferred) None None None None None None None None None There are no lifetime maximums for this plan. Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Annual Out-of-Pocket Maximum, Including Deductible (per individual / per family) $3,000 / $6,000 $4,000 / $8,000 $,900 / $5,800 $,500 / $5,000 $,600 / $5,00 $,000 / $4,000 $,400 / $4,800 $,000 / $4,000 $3,000 / $6,000 Primary Care Physician Office Visit (for consultation, treatment, diagnostic testing, etc.) $0 $0 $5 $0 $0 $0 $0 $0 $0 Specialist Physician Office Visit (for consultation, treatment, diagnostic testing, etc.) $0 $0 $5 $0 $30 $30 $30 $40 $30 Preventive Services² $0 $0 $0 $0 $0 $0 $0 $0 $0 Prenatal and Postpartum Office Visits $0 $0 $0 $0 $0 $0 $0 $0 $0 Allergy Injections $0 $0 $5 $0 $0 $0 $0 $0 $0 Allergy Testing $0 $0 $5 $0 $30 $30 $30 $40 $30 Outpatient Surgery $00 / procedure 0% coinsurance 3 $50 / procedure $5 / procedure $300 / procedure $500 / procedure $50 / procedure $500 / procedure $500 / procedure Radiology Services (X-rays and diagnostic imaging) (per visit) $0 $40 $0 $40 $0 $0 $0 $0 $0 Advanced Radiology (per procedure) $00 $50 $00 $50 $00 $00 $00 $00 $00 Physical, Occupational and Speech Therapy (per visit) $0 $0 $5 $0 $0 $0 $0 $0 $0 Inpatient $300 / day (3-day max) $350 / day (5-day max) $50 / day (3-day max) $50 / admission $300 / day (3-day max) $500 / day (3-day max) $500 / admission $,000 / admission $,000 / admission Emergency Room (waived if admitted) (per visit) $00 $00 $00 $00 $00 $00 $00 $50 $00 Urgent Care (per visit) $0 $0 $5 $0 $30 $30 $30 $40 $30 (in connection with hospital admission or emergency services) $00 $00 $00 $00 $00 $00 $00 $50 $00 Drugs Administered in a Practitioner s Office, Hospital or Outpatient Facility $0 $0 $0 $0 $0 $0 $0 $0 $0 Preferred Generic / Preferred Brand / Non-preferred Medications up to 30-Day Supply $5 / $35 / $50 $0 / $5 / $50 $5 / $35 / $50 $0 / $5 / $50 $9 / $30 / $70 $9 / $35 / $70 $0 / $5 / $50 $5 / $35 / $50 $5 / $35 / $50 Preferred Generic / Preferred Brand / Non-preferred Medications up to 90-Day Supply by Mail Order $30 / $70 / $00 $0 / $50 / $00 $30 / $70 / $00 $0 / $50 / $00 $38 / $60 / $40 $38 / $70 / $40 $0 / $50 / $00 $30 / $70 / $00 $30 / $70 / $00 Preferred Generic and Prescribed Over-the-Counter Contraceptives for Women $0 $0 $0 $0 $0 $0 $0 $0 $0 Durable Medical Equipment 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 Diabetic Supplies 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 Prosthetics and Orthotics (per visit) $0 $0 $5 $0 $30 $30 $30 $40 $30 Inpatient $300 / day (3-day max) $350 / day (5-day max) $50 / day (3-day max) $50 / admission $300 / day (3-day max) $500 / day (3-day max) $500 / admission $,000 / admission $,000 / admission Outpatient Office Visit $0 / visit $0 / visit $5 / visit $0 / visit $0 / visit $0 / visit $0 / visit $0 / visit $0 / visit Inpatient $300 / day (3-day max) $350 / day (5-day max) $50 / day (3-day max) $50 / admission $300 / day (3-day max) $500 / day (3-day max) $500 / admission $,000 / admission $,000 / admission Outpatient Office Visit $0 / visit $0 / visit $5 / visit $0 / visit $0 / visit $0 / visit $0 / visit $0 / visit $0 / visit Emergency Services for Acute Drug or Alcohol Detoxification $00 / visit $00 / visit $00 / visit $00 / visit $00 / visit $00 / visit $00 / visit $50 / visit $00 / visit Skilled Nursing Facility Services (maximum of 00 days per benefit period) $00 / day (3-day max) $00 / admission $00 / day (3-day max) $50 / day (5-day max) $00 / day (3-day max) $00 / day (3-day max) $50 / day (5-day max) $00 / admission $00 / admission Home Health Services (maximum of 00 visits per calendar year) $0 / visit $0 / visit $5 / visit $0 / visit $0 / visit $0 / visit $0 / visit $0 / visit $0 / visit Hospice Care Inpatient $00 / day (3-day max) $0 / admission $50 / day (3-day max) $00 / admission $500 / day (3-day max) $500 / day (3-day max) $0 / admission $00 / admission $00 / admission Hospice Care Outpatient (per visit) $0 $0 $0 $0 $0 $0 $0 $0 $0 Copayments and deductibles for supplemental benefits (assisted reproductive technologies, chiropractic services, adult vision) do not apply to the annual out-of-pocket maximum. Includes preventive services with a rating of A or B from the US Preventive Services Task Force; immunizations for children, adolescents and adults recommended by the Centers of Disease Control; and preventive care and screenings supported by the Health Resources and Services Administration for infants, children, adolescents and women. If preventive care is received at the time of other services, the applicable copayment for such services other than preventive care may apply. 3 Of contracted rates. 4 Deductible applies. 5 Individuals enrolled in family plan will reach the annual deductible maximum if the member meets the individual deductible maximum amount or if any combination of enrolled family members meets the family deductible maximum amount, whichever comes first. 4 5

4 Gold 80 / Silver 70 / Bronze 60 effective Jan., 09 Gold HMO NG 5 Gold HMO NG 4 Gold HMO NG Gold HMO NG Gold HMO NG 3 Gold HMO NG 7 Gold HMO NG 6 Silver HMO NG Silver HMO NG Bronze HDHP NG Calendar Year Deductible (per individual / per family) (applies only to those covered benefits indicated) None None None None None $500 5 / $,000 5 $,000 5 / $,000 5 $,50 5 / $4,300 5 $,300 5 / $4,600 5 $5,650 5 / $,300 5 Calendar Year Deductible (per individual / per family) For Covered Prescription Drugs (preferred and non-preferred) None None None None $50 / $300 None $50 / $300 $50 / $300 $0 Integrated There are no lifetime maximums for this plan. Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Annual Out-of-Pocket Maximum, Including Deductible (per individual / per family) $5,700 / $,400 $7,900 / $5,800 $5,000 / $0,000 $6,600 / $3,00 $7,000 / $4,000 $6,850 / $3,700 $3,800 /$7,600 $7,900 / $5,800 $7,300 / $4,600 $6,650 / $3,300 Primary Care Physician Office Visit (for consultation, treatment, diagnostic testing, etc.) $40 $40 $35 $30 $30 $0 $35 $60 $50 $60 4 Specialist Physician Office Visit (for consultation, treatment, diagnostic testing, etc.) $75 $40 $75 $60 $60 $0 $75 $70 $75 $75 4 Preventive Services² $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Prenatal and Postpartum Office Visits $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Allergy Injections $40 $40 $35 $30 $30 $0 $35 $60 $50 $60 4 Allergy Testing $75 $40 $75 $60 $60 $0 $75 $70 $75 $75 4 Outpatient Surgery 30% coinsurance 3 40% coinsurance 3 $600 / procedure $750 / procedure $600 / procedure 50% coinsurance 3,4 30% coinsurance 3,4 50% coinsurance 3,4 50% coinsurance 3,4 50% coinsurance 3,4 Radiology Services (X-rays and diagnostic imaging) (per visit) $00 $50 $00 $0 $80 $0 $00 $40 $60 50% coinsurance 3,4 Advanced Radiology (per procedure) 30% coinsurance 3 $50 $00 $50 $50 $50 $00 $400 $500 50% coinsurance 3,4 Physical, Occupational and Speech Therapy (per visit) $40 $40 $35 $30 $30 $0 $35 $60 $50 $60 4 Inpatient 30% coinsurance 3 40% coinsurance 3 $,500 / admission $,000 / day $,000 / day 50% coinsurance 3,4 30% coinsurance 3,4 50% coinsurance 3,4 50% coinsurance 3,4 50% coinsurance 3,4 Emergency Room (waived if admitted) (per visit) $50 $00 $00 $00 $75 50% coinsurance 3,4 $00 4 $ % coinsurance 3,4 50% coinsurance 3,4 Urgent Care (per visit) $75 $40 $75 $60 $60 $0 $75 $70 $75 $0 4 (in connection with hospital admission or emergency services) $50 $00 $00 $00 $75 50% coinsurance 3,4 $00 4 $ % coinsurance 3,4 50% coinsurance 3,4 Drugs Administered in a Practitioner s Office, Hospital or Outpatient Facility $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Preferred Generic / Preferred Brand / Non-preferred Medications up to 30-Day Supply $0 / $50 / $70 $9 / $35 / $70 $9 / $35 / $70 $9 / $35 / $70 $9 / $35 4 / $50 4 $0 / $40 / $70 $0 / $35 4 / $70 4 $0 / $60 4 / $70 4 $0 / $60 / $00 $30 4 / $70 4 / $00 4 Preferred Generic / Preferred Brand / Non-preferred Medications up to 90-Day Supply by Mail Order $40 / $00 / $40 $38 / $70 / $40 $38 / $70 / $40 $38 / $70 / $40 $38 / $70 4 / $00 4 $0 / $80 / $40 $40 / $70 4 / $40 4 $40 / $0 4 / $40 4 $40 / $0 / $00 $60 4 / $40 4 / $00 4 Preferred Generic and Prescribed Over-the-Counter Contraceptives for Women $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Durable Medical Equipment 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3,4 50% coinsurance 3,4 50% coinsurance 3,4 50% coinsurance 3,4 50% coinsurance 3,4 Diabetic Supplies 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 50% coinsurance 3,4 Prosthetics and Orthotics (per visit) $75 $40 $75 $60 $60 $0 $75 $70 $75 $75 4 Inpatient 30% coinsurance 3 40% coinsurance 3 $,500 / admission $,000 / day $,000 / day 50% coinsurance 3,4 30% coinsurance 3,4 50% coinsurance 3,4 50% coinsurance 3,4 50% coinsurance 3,4 Outpatient Office Visit $40 / visit $40 / visit $35 / visit $30 / visit $30 / visit $0 / visit $35 / visit $60 / visit $50 / visit $0 4 Inpatient 30% coinsurance 3 40% coinsurance 3 $,500 / admission $,000 / day $,000 / day 50% coinsurance 3,4 30% coinsurance 3,4 50% coinsurance 3,4 50% coinsurance 3,4 50% coinsurance 3,4 Outpatient Office Visit $40 / visit $40 / visit $35 / visit $30 / visit $30 / visit $0 / visit $35 / visit $60 / visit $50 / visit $0 Emergency Services for Acute Drug or Alcohol Detoxification $50 / visit $00 / visit $00 / visit $00 / visit $75 / visit 50% coinsurance 3,4 $00 / visit 4 $00 / visit 4 50% coinsurance 3,4 50% coinsurance 3,4 Skilled Nursing Facility Services (maximum of 00 days per benefit period) 30% coinsurance 3 $50 / day $75 / admission $50 / admission $50 / day 50% coinsurance 3,4 30% coinsurance 3,4 50% coinsurance 3,4 50% coinsurance 3,4 50% coinsurance 3,4 Home Health Services (maximum of 00 visits per calendar year) $40 / visit $40 / visit $35 / visit $30 / visit $30 / visit $0 / visit $35 / visit $40 / visit $50 / visit $60 / visit 4 Hospice Care Inpatient $50 / day $50 / day $0 / admission $50 / admission $50 / day $0 / admission 4 30% coinsurance 3,4 50% coinsurance 3,4 $0 / admission 4 $0 / admission 4 Hospice Care Outpatient (per visit) $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 4 Copayments and deductibles for supplemental benefits (assisted reproductive technologies, chiropractic services, adult vision) do not apply to the annual out-of-pocket maximum. Includes preventive services with a rating of A or B from the U.S. Preventive Services Task Force; immunizations for children, adolescents and adults recommended by the Centers of Disease Control; and preventive care and screenings supported by the Health Resources and Services Administration for infants, children, adolescents and women. If preventive care is received at the time of other services, the applicable copayment for such services other than preventive care may apply. 3 Of contracted rates. 4 Deductible applies. 5 Individuals enrolled in family plan will reach the annual deductible maximum if the member meets the individual deductible maximum amount or if any combination of enrolled family members meets the family deductible maximum amount, whichever comes first. 6 7

5 Additional 90 / Gold 80 Plans * effective Jan., 09 Sharp 90 HMO 0 / 5 / 0% Sharp 90 HMO 0 / 5 / 50 Sharp Gold 80 HMO 0 / 30 / 0% Sharp Gold 80 HMO 0 / 30 / 600 Calendar Year Deductible (per individual / per family) (applies only to those covered benefits indicated) None None None None Calendar Year Deductible (per individual / per family) For Covered Prescription Drugs (preferred and non-preferred) None None None None There are no lifetime maximums for this plan. Unlimited Unlimited Unlimited Unlimited Annual Out-of-Pocket Maximum, Including Deductible (per individual / per family) $3,350 / $6,700 $3,350 / $6,700 $7,00 / $4,400 $7,00 / $4,400 Primary Care Physician Office Visit (for consultation, treatment, diagnostic testing, etc.) $5 $5 $30 $30 Specialist Physician Office Visit (for consultation, treatment, diagnostic testing, etc.) $30 $30 $55 $55 Preventive Services² $0 $0 $0 $0 Prenatal and Postpartum Office Visits $0 $0 $0 $0 Allergy Injections $30 $30 $55 $55 Allergy Testing $30 $30 $55 $55 Outpatient Surgery 0% coinsurance 3 / 0% coinsurance 3 $00 per procedure / $5 per visit 0% coinsurance 3 / 0% coinsurance 3 $300 per procedure / $40 per visit Radiology Services (X-rays and diagnostic imaging) (per visit) $30 / visit $30 / visit $55 / visit $55 / visit Advanced Radiology (per procedure) 0% coinsurance 3 $75 / procedure 0% coinsurance 3 $75 / procedure Physical, Occupational and Speech Therapy (per visit) $5 / visit $5 / visit $30 / visit $30 / visit Inpatient 0% coinsurance 3 / 0% coinsurance 3 $50 per day (5-day max) / $0 per visit 0% coinsurance 3 / 0% coinsurance 3 $600 per day (5-day max) / $0 per visit Emergency Room (waived if admitted) (per visit) $50 per visit / $0 $50 per visit / $0 $35 per visit / $0 $50 per visit / $0 Urgent Care (per visit) $5 $5 $30 $30 (in connection with hospital admission or emergency services) $50 $50 $50 $50 Drugs Administered in a Practitioner s Office, Hospital or Outpatient Facility $0 $0 $0 $0 Preferred Generic / Preferred Brand / Non-preferred Medications up to 30-Day Supply $5 / $5 / $5 / 0% 4 $5 / $5 / $5 / 0% 4 $5 / $55 / $75 / 0% 4 $5 / $55 / $75 / 0% 4 Preferred Generic / Preferred Brand / Non-preferred Medications up to 90-Day Supply by Mail Order $0 / $30 / $50 $0 / $30 / $50 $30 / $0 / $50 $30 / $0 / $50 Preferred Generic and Prescribed Over-the-Counter Contraceptives for Women $0 $0 $0 $0 Durable Medical Equipment 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 Diabetic Supplies 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 Prosthetics and Orthotics (per visit) 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 Inpatient 0% coinsurance 3 / 0% coinsurance 3 $50 per day (5-day max) / $0 per visit 0% coinsurance 3 / 0% coinsurance 3 $600 per day (5-day max) / $0 per visit Outpatient Office Visit $0 / visit $0 / visit $0 / visit $0 / visit Inpatient 0% coinsurance 3 / 0% coinsurance 3 $50 per day (5-day max) / $0 per visit 0% coinsurance 3 / 0% coinsurance 3 $600 per day (5-day max) / $0 per visit Outpatient Office Visit $0 $0 $0 / visit $0 / visit Emergency Services for Acute Drug or Alcohol Detoxification $50 per visit / $0 $50 per visit / $0 $35 per visit / $0 $35 per visit / $0 Skilled Nursing Facility Services (maximum of 00 days per benefit period) 0% coinsurance 3 $50 / day (5-day max) 0% coinsurance 3 $300 / day (5-day max) Home Health Services (maximum of 00 visits per calendar year) 0% coinsurance 3 $0 / visit 0% coinsurance 3 $30 / visit Hospice Care Inpatient $0 / admission $0 / admission $0 / admission $0 / admission Hospice Care Outpatient (per visit) $0 $0 $0 $0 *These plans are also available through Covered California on either the Performance or Premier network only, and plan copays on Plans available through Covered CA might vary slightly. Copayments and deductibles for supplemental benefits (assisted reproductive technologies, chiropractic services, adult vision) do not apply to the annual out-of-pocket maximum. Includes preventive services with a rating of A or B from the U.S. Preventive Services Task Force; immunizations for children, adolescents and adults recommended by the Centers of Disease Control; and preventive care and screenings supported by the Health Resources and Services Administration for infants, children, adolescents and women. If preventive care is received at the time of other services, the applicable copayment for such services other than preventive care may apply. 3 Of contracted rates. 4 Up to $50 per 30-day supply. 8 9

6 Additional Silver 70 / Bronze 60 Plans * effective Jan., 09 Sharp Silver 70 HMO 000 / 45 / 0% - 0% Sharp Silver 70 HMO 000 / 45 / 0% Sharp Silver 70 HDHP HMO 500 / 0% / 0% Sharp Bronze 60 HMO 6300 / 75 / 00% Sharp Bronze 60 HDHP HMO 6000 / 40% / 40% Calendar Year Deductible (per individual / per family) (applies only to those covered benefits indicated) $,000 6 / $4,000 6 $,000 6 / $4,000 6 $,500 4 / $5,000 4 $6,300 6 / $,600 6 $6,000 4 / $,000 4 Calendar Year Deductible (per individual / per family) For Covered Prescription Drugs (preferred and non-preferred) $00 / $400 $00 / $400 Integrated $500 / $,000 Integrated There are no lifetime maximums for this plan. Unlimited Unlimited Unlimited Unlimited Unlimited Annual Out-of-Pocket Maximum, Including Deductible (per individual / per family) $7,550 / $5,00 $7,550 / $5,00 $6,650 / $3,300 $7,550 / $5,00 $6,650 / $3,300 Primary Care Physician Office Visit (for consultation, treatment, diagnostic testing, etc.) $45 $45 0% coinsurance 3,5 $75 5,7 40% coinsurance 3,5 Specialist Physician Office Visit (for consultation, treatment, diagnostic testing, etc.) $80 $80 0% coinsurance 3,5 $05 5,7 40% coinsurance 3,5 Preventive Services² $0 $0 $0 $0 $0 Prenatal and Postpartum Office Visits $0 $0 $0 $0 $0 Allergy Injections $80 $80 0% coinsurance 3,5 $ % coinsurance 3,5 Allergy Testing $80 $80 0% coinsurance 3,5 $ % coinsurance 3,5 Outpatient Surgery 0% coinsurance 3 / 0% coinsurance 3 0% coinsurance 3 / 0% coinsurance 3 0% coinsurance 3,5 / 0% coinsurance 3,5 00% coinsurance 3,5 / 00% coinsurance 3,5 40% coinsurance 3,5 / 40% coinsurance 3,5 Radiology Services (X-rays and diagnostic imaging) (per visit) $75 / visit $75 / visit 0% coinsurance 3,5 00% coinsurance 3,5 40% coinsurance 3,5 Advanced Radiology (per procedure) 0% coinsurance 3 $300 / procedure 0% coinsurance 3,5 00% coinsurance 3,5 40% coinsurance 3,5 Physical, Occupational and Speech Therapy (per visit) $45 / visit $45 / visit 0% coinsurance 3,5 $75 / visit 40% coinsurance 3,5 Inpatient 0% coinsurance 3,5 / 0% coinsurance 3,5 0% coinsurance 3,5 / 0% coinsurance 3 0% coinsurance 3,5 / 0% coinsurance 3,5 00% coinsurance 3,5 / 00% coinsurance 3,5 40% coinsurance 3,5 / 40% coinsurance 3,5 Emergency Room (waived if admitted) (per visit) $350 per visit / $0 $350 per visit / $0 0% coinsurance 3,5 / $0 5 00% coinsurance 3,5 / 0% coinsurance 40% coinsurance 3,5 / 0% coinsurance 5 Urgent Care (per visit) $45 $45 0% coinsurance 3,5 $75 5,7 40% coinsurance 3,5 (in connection with hospital admission or emergency services) $50 5 $50 5 0% coinsurance 3,5 00% coinsurance 3,5 40% coinsurance 3,5 Drugs Administered in a Practitioner s Office, Hospital or Outpatient Facility $0 $0 $0 $0 $0 Preferred Generic / Preferred Brand / Non-preferred Medications up to 30-Day Supply $5 5 / $55 5 / $85 5 / 0% 5,8 $5 5 / $55 5 / $85 5 / 0% 5,8 0% coinsurance 3,5,8 00% coinsurance 5,9 40% coinsurance 3,5,9 Preferred Generic / Preferred Brand / Non-preferred Medications up to 90-Day Supply by Mail Order $30 5 / $0 5 / $70 5 $30 5 / $0 5 / $70 5 0% coinsurance 3,5,8 00% coinsurance 5,9 40% coinsurance 3,5,9 Preferred Generic and Prescribed Over-the-Counter Contraceptives for Women $0 $0 $0 $0 $0 Durable Medical Equipment 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3,5 00% coinsurance 3,5 40% coinsurance 3,5 Diabetic Supplies 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3,5 00% coinsurance 3,5 40% coinsurance 3,5 Prosthetics and Orthotics (per visit) 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3,5 00% coinsurance 3,5 40% coinsurance 3,5 Inpatient 0% coinsurance 3,5 / 0% coinsurance 3,5 0% coinsurance 3,5 / 0% coinsurance 3 0% coinsurance 3,5 / 0% coinsurance 3,5 00% coinsurance 3,5 / 00% coinsurance 3,5 40% coinsurance 3,5 / 40% coinsurance 3,5 Outpatient Office Visit $45 / visit $0 / visit $0 / visit 5 $0 / visit $0 / visit 5 Inpatient 0% coinsurance 3,5 / 0% coinsurance 3,5 0% coinsurance 3,5 / 0% coinsurance 3 0% coinsurance 3,5 / 0% coinsurance 3,5 00% coinsurance 3,5 / 00% coinsurance 3,5 40% coinsurance 3,5 / 40% coinsurance 3,5 Outpatient Office Visit $45 / visit $0 / visit $0 / visit 5 $0 / visit $0 / visit,5 Emergency Services for Acute Drug or Alcohol Detoxification $350 per visit / $0 $350 per visit / $0 0% coinsurance 3,5 / $0 5 00% coinsurance 3,5 / 0% coinsurance 40% coinsurance 3,5 / 0% coinsurance 5 Skilled Nursing Facility Services (maximum of 00 days per benefit period) 0% coinsurance 3,5 0% coinsurance 3,5 0% coinsurance 3,5 00% coinsurance 3,5 40% coinsurance 3,5 Home Health Services (maximum of 00 visits per calendar year) 0% coinsurance 3 $45 / visit 0% coinsurance 3,5 00% coinsurance 3,5 40% coinsurance 3,5 Hospice Care Inpatient $0 / admission $0 / admission $0 / admission 5 $0 / admission $0 / admission 5 Hospice Care Outpatient (per visit) $0 $0 $0 5 $0 $0 5 *These plans are also available through Covered California on either the Performance or Premier network only, and plan copays on Plans available through Covered CA might vary slightly. Copayments and deductibles for supplemental benefits (assisted reproductive technologies, chiropractic services, adult vision) do not apply to the annual out-of-pocket maximum. Includes preventive services with a rating of A or B from the U.S. Preventive Services Task Force; immunizations for children, adolescents and adults recommended by the Centers of Disease Control; and preventive care and screenings supported by the Health Resources and Services Administration for infants, children, adolescents and women. If preventive care is received at the time of other services, the applicable copayment for such services other than preventive care may apply. 3 Of contracted rates. 4 In high-deductible health plans (HDHPs) linked to health savings accounts (HSAs), each individual in a family plan must meet an amount of either $,700 or the individual deductible, whichever is higher, until the family deductible is met. 5 Deductible applies. 6 Individuals enrolled in family plan will reach the annual deductible maximum if the member meets the individual deductible maximum amount or if any combination of enrolled family members meets the family deductible maximum amount, whichever comes first. 5 Deductible applies after the first three non-preventive visits. 8 Up to $50 per 30-day supply after pharmacy or integrated deductible. 9 Member cost-share after deductible will not exceed $500 per 30-day supply. 0

7 CalChoice 90 / Gold 80 plans effective Jan., 09 CalChoice HMO NG CalChoice HMO NG CalChoice HMO NG 3 CalChoice Gold HMO NG CalChoice Gold HMO NG 3 CalChoice Gold HMO NG 55 Calendar Year Deductible (per individual / per family) (applies only to those covered benefits indicated) None None None None None None Calendar Year Deductible (per individual / per family) For Covered Prescription Drugs (preferred and non-preferred) $0 $0 $0 $50 / $300 $50 / $300 $0 There are no lifetime maximums for this plan. Unlimited Unlimited Unlimited Unlimited Unlimited Unlimited Annual Out-of-Pocket Maximum, Including Deductible (per individual / per family) $3,500 / $7,000 $3,000 / $6,000 $4,000 / $8,000 $6,850 / $3,700 $7,900 / $5,800 $5,000 / $0,000 Primary Care Physician Office Visit (for consultation, treatment, diagnostic testing, etc.) $5 $5 $0 $5 $0 $35 Specialist Physician Office Visit (for consultation, treatment, diagnostic testing, etc.) $0 $30 $0 $60 $50 $75 Preventive Services² $0 $0 $0 $0 $0 $0 Prenatal and Postpartum Office Visits $0 $0 $0 $0 $0 $0 Allergy Injections $5 $5 $0 $5 $0 $35 Allergy Testing $0 $30 $0 $60 $50 $75 Outpatient Surgery 0% coinsurance 3 5% coinsurance 3 0% coinsurance 3 5% coinsurance 3 30% coinsurance 3 $600 Radiology Services (X-rays and diagnostic imaging) (per visit) $0 $0 $40 $60 $0 $00 Advanced Radiology (per procedure) $50 $00 $50 $75 $75 $00 Physical, Occupational and Speech Therapy (per visit) $5 $5 $0 $5 $0 $35 Inpatient $400 / admission 5% coinsurance 3 $350 / day (5-day max) $600 / day (5-day max) 30% coinsurance 3 $,500 / admission Emergency Room (waived if admitted) (per visit) $50 5% coinsurance 3 $00 $00 30% coinsurance 3 $00 Urgent Care (per visit) $0 $30 $0 $60 $50 $75 (in connection with hospital admission or emergency services) $50 5% coinsurance 3 $00 $00 30% coinsurance 3 $00 Drugs Administered in a Practitioner s Office, Hospital or Outpatient Facility $0 $0 $0 $0 $0 $0 Preferred Generic / Preferred Brand / Non-preferred Medications up to 30-Day Supply $0 / $5 / $50 $0 / $5 / $50 $0 / $5 / $50 $9 / $35 4 / $70 4 $9 / $35 4 / $70 4 $9 / $35 / $70 Preferred Generic / Preferred Brand / Non-preferred Medications up to 90-Day Supply by Mail Order $0 / $50 / $00 $0 / $50 / $00 $0 / $50 / $00 $38 / $70 4 / $40 4 $38 / $70 4 / $40 4 $38 / $70 / $40 Preferred Generic and Prescribed Over-the-Counter Contraceptives for Women $0 $0 $0 $0 $0 $0 Durable Medical Equipment 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 50% coinsurance 3 Diabetic Supplies 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 0% coinsurance 3 Prosthetics and Orthotics (per visit) $0 $30 $0 $60 $50 $75 Inpatient $400 / admission 5% coinsurance 3 $350 / day (5-day max) $600 / day (5-day max) 30% coinsurance 3 $,500 / admission Outpatient Office Visit $5 $5 $0 $5 $0 $35 Inpatient $400 / admission 5% coinsurance 3 $350 / day (5-day max) $600 / day (5-day max) 30% coinsurance 3 $,500 / admission Outpatient Office Visit $5 $5 $0 $5 $0 $35 Emergency Services for Acute Drug or Alcohol Detoxification $50 5% coinsurance 3 $00 $00 30% coinsurance 3 $00 Skilled Nursing Facility Services (maximum of 00 days per benefit period) $00 / admission 5% coinsurance 3 $00 / admission $00 / day 30% coinsurance 3 $75 / admission Home Health Services (maximum of 00 visits per calendar year) $5 $5 $0 $5 $0 $35 Hospice Care Inpatient $0 $0 $0 $0 $0 $0 Hospice Care Outpatient (per visit) $0 $0 $0 $0 $0 $0 Copayments and deductibles for supplemental benefits (assisted reproductive technologies, chiropractic services, adult vision) do not apply to the annual out-of-pocket maximum. Includes preventive services with a rating of A or B from the U.S. Preventive Services Task Force; immunizations for children, adolescents and adults recommended by the Centers of Disease Control; and preventive care and screenings supported by the Health Resources and Services Administration for infants, children, adolescents and women. If preventive care is received at the time of other services, the applicable copayment for such services other than preventive care may apply. 3 Of contracted rates. 4 Deductible applies. 5 Individuals enrolled in a family plan will reach the annual deductible if the Member meets the individual deductible or if any combination of enrolled family members meets the family deductible amount, whichever comes first. 3

8 CalChoice Silver 70 / Bronze 60 plans effective Jan., 09 CalChoice Silver HMO NG CalChoice Silver HMO NG CalChoice Silver HMO NG 3 CalChoice Bronze HMO NG CalChoice Bronze HDHP NG 3 Calendar Year Deductible (per individual / per family) (applies only to those covered benefits indicated) $,00 / $4,00 $,00 / $4,00 $,000 / $4,000 $6,900 / $3,800 $5,650 / $,300 Calendar Year Deductible (per individual / per family) For Covered Prescription Drugs (preferred and non-preferred) $00 / $400 $00 / $400 $0 Integrated Integrated There are no lifetime maximums for this plan. Unlimited Unlimited Unlimited Unlimited Unlimited Annual Out-of-Pocket Maximum, Including Deductible (per individual / per family) $7,900 / $5,800 $7,900 / $5,800 $7,900 / $5,800 $7,900 / $5,800 $6,650 / $3,300 Primary Care Physician Office Visit (for consultation, treatment, diagnostic testing, etc.) $40 $40 $40 $ % coinsurance 3,5 Specialist Physician Office Visit (for consultation, treatment, diagnostic testing, etc.) $70 $70 $70 $ % coinsurance 3,5 Preventive Services² $0 $0 $0 $0 $0 Prenatal and Postpartum Office Visits $0 $0 $0 $0 $0 Allergy Injections $40 $40 $40 $ % coinsurance 3,5 Allergy Testing $70 $70 $70 $ % coinsurance 3,5 Outpatient Surgery 50% coinsurance 3,5 40% coinsurance 3,5 50% coinsurance 3,5 40% coinsurance 3,5 40% coinsurance 3,5 Radiology Services (X-rays and diagnostic imaging) (per visit) $60 5 $30 4 $50 5 $ % coinsurance 3,5 Advanced Radiology (per procedure) $50 5 $300 4 $500 5 $ % coinsurance 3,5 Physical, Occupational and Speech Therapy (per visit) $40 $40 $40 $ % coinsurance 3,5 Inpatient $750 / day 5 40% coinsurance 3,5 50% coinsurance 3,5 $,500 / day (3-day max) 5 40% coinsurance 3,5 Emergency Room (waived if admitted) (per visit) $ % coinsurance 3,5 50% coinsurance 3,5 $ % coinsurance 3,5 Urgent Care (per visit) $70 $70 $70 $ % coinsurance 3,5 (in connection with hospital admission or emergency services) $400 40% coinsurance 3 50% coinsurance 3 $ % coinsurance 3,5 Drugs Administered in a Practitioner s Office, Hospital or Outpatient Facility $0 $0 $0 $0 $0 Preferred Generic / Preferred Brand / Non-preferred Medications up to 30-Day Supply Preferred Generic / Preferred Brand / Non-preferred Medications up to 90-Day Supply by Mail Order $0 / $50 5 / $80 5 $0 / $50 5 / $00 5 $0 / $50 / $00 $9 / $60 5 / $ % coinsurance 5 (up to $500 per 30 day supply after deductible) $40 / $00 5 / $60 5 $40 / $00 5 / $00 5 $40 / $00 / $00 $38 / $0 5 / $ % coinsurance 5 (up to $500 per 30 day supply after deductible) Preferred Generic and Prescribed Over-the-Counter Contraceptives for Women $0 $0 $0 $0 $0 Durable Medical Equipment 50% coinsurance 3,5 50% coinsurance 3,5 50% coinsurance 3,5 50% coinsurance 3,5 50% coinsurance 3,5 Diabetic Supplies 0% coinsurance 3,5 0% coinsurance 3,5 0% coinsurance 3,5 0% coinsurance 3,5 0% coinsurance 3,5 Prosthetics and Orthotics (per visit) $70 $70 $70 $ % coinsurance 3,5 Inpatient $750 / day 5 40% coinsurance 3,5 50% coinsurance 3,5 $,500 / day (3-day max) 5 40% coinsurance 3,5 Outpatient Office Visit $40 $40 $40 $ % coinsurance 3,5 Inpatient $750 / day 5 40% coinsurance 3,5 50% coinsurance 3,5 $,500 / day (3-day max) 5 40% coinsurance 3,5 Outpatient Office Visit $40 $40 $40 $ % coinsurance 3,5 Emergency Services for Acute Drug or Alcohol Detoxification $ % coinsurance 3,5 50% coinsurance 3,5 $ % coinsurance 3,5 Skilled Nursing Facility Services (maximum of 00 days per benefit period) $00 / day 5 40% coinsurance 3,5 50% coinsurance 3,5 $00 / day 5 40% coinsurance 3,5 Home Health Services (maximum of 00 visits per calendar year) $40 $40 $40 $ % coinsurance 3,5 Hospice Care Inpatient $0 $0 $0 $0 $0 5 Hospice Care Outpatient (per visit) $0 $0 $0 $0 $0 5 4 Copayments and deductibles for supplemental benefits (assisted reproductive technologies, chiropractic services, adult vision) do not apply to the annual out-of-pocket maximum. Includes preventive services with a rating of A or B from the U.S. Preventive Services Task Force; immunizations for children, adolescents and adults recommended by the Centers of Disease Control; and preventive care and screenings supported by the Health Resources and Services Administration for infants, children, adolescents and women. If preventive care is received at the 5 time of other services, the applicable copayment for such services other than preventive care may apply. 3 Of contracted rates. 4 In high-deductible health plans (HDHPs) linked to health savings accounts (HSAs), each individual in a family plan must meet an amount of either $,700 or the individual deductible, whichever is higher, until the family deductible is met. 5 Deductible applies.

9 Elite-rated health care Sharp Health Plan has a family of providers and pharmacies close to where you live and work. In addition to regional partners, our network includes Sharp Rees-Stealy Medical Group and Sharp Community Medical Group, both awarded Elite status, the highest possible rating for Standards of Excellence. * Supplemental benefits available with every plan All plans include pediatric vision and dental benefits for members up to age 9. A portfolio of dental HMO and PPO plans, provided through Premier Access Dental, is also available.,400+ Doctors * Chiropractic Services: American Specialty Health (ASH) Plans CH5_40 $5 per visit / 40 visits per year CHB CHD $0 per visit / 30 visits per year $0 per visit / 0 visits per year 3 Hospitals * Acupuncture Services: ASH Plans 0 Medical Groups * AC0_0 AC0_5 AC0_ AC5_0 AC5_5 $0 per visit / 0 visits per year $0 per visit / 5 visits per year $0 per visit / visits per year $5 per visit / 0 visits per year $5 per visit / 5 visits per year 40+ Urgent Care Centers * AC5_ $5 per visit / visits per year Chiropractic + Acupuncture Services: ASH Plans 450+ Pharmacies * 5 MinuteClinics ACCH5_40 ACCH0_40 ACCH0_0 ACCH0_5 ACCH0_ ACCH5_0 ACCH5_5 ACCH5_ $5 per visit / 40 visits per year $0 per visit / 40 visits per year $0 per visit / 0 visits per year $0 per visit / 5 visits per year $0 per visit / visits per year $5 per visit / 0 visits per year $5 per visit / 5 visits per year $5 per visit / visits per year Vision Services: Vision Service Plan (VSP) VSOE $0 per visit / Eye exam: every months / Frames: every 4 months / Lenses: every months Assisted Reproductive Technologies (ART): For Employers With 0+ Employees ARTC Copayments equal to 50% coinsurance of covered fertility services Recipients of Elite status in 08 by America s Physician Groups. * Based on Choice Network as of 9/30/8. Network varies based on your or your employer sponsored plan. Provider counts vary based on network. 6 We re here to help! sharphealthplan.com 7

10 Provider Network Comparison At Sharp Health Plan, we offer four provider networks to deliver cost-effective solutions to meet the unique needs of every employer. With thousands of local doctors across our networks, we have an option that's right for you. Participating physicians are subject to change; for the most current information, please visit sharphealthplan.com/findadoctor. Premier Network Performance Network Value Network Choice Network A smaller, more select network offering the most value, and covering a subset of San Diego County.,00+ Doctors Plan Medical Groups Sharp Rees-Stealy Medical Group Carmel Valley Chula Vista Del Mar Downtown San Diego El Cajon Frost Street / Frost Street North Genesee La Mesa / La Mesa West Mira Mesa Mount Helix Murphy Canyon Otay Ranch Point Loma Rancho Bernardo San Carlos San Diego Scripps Ranch Sorrento Mesa Sharp Community Medical Group Alpine Campo Chula Vista Clairemont College Area Coronado Del Cerro Downtown San Diego East San Diego El Cajon Encinitas Hillcrest Imperial Beach Kearny Mesa La Jolla La Mesa An affordable network in San Diego County offering more choice for people living in the North County area.,700+ Doctors A large network offering care throughout San Diego County and Southern Riverside County.,900+ Doctors Sharp Community Medical Group, continued Lakeside Linda Vista Mira Mesa Mission Valley National City Point Loma San Diego Santee University City Sharp Community Medical Group Arch Health Medical Group Carlsbad Oceanside Poway Ramona San Marcos Vista Sharp Community Medical Group Graybill Medical Group Carlsbad Fallbrook Oceanside Ramona San Marcos Vista Sharp Community Medical Group Graybill Temecula Medical Group Fallbrook Menifee Murrieta Temecula A broad network offering greater choice, and covering all of San Diego County and Southern Riverside County.,400+ Doctors Plan Medical Groups, continued Sharp Community Medical Group Inland North Fallbrook Poway San Marcos Vista Rady Children s Health Network / Children s Physicians Medical Group Allied Gardens Carlsbad Chula Vista Clairemont Del Mar Heights Downtown San Diego Eastlake East San Diego El Cajon Encinitas Fallbrook Hillcrest Kearny Mesa La Jolla La Mesa Linda Vista Menifee Murrieta National City Oceanside Poway Point Loma Rancho Bernardo San Diego San Marcos Scripps Ranch Temecula Greater Tri Cities IPA Medical Group Carlsbad Encinitas Oceanside San Marcos Vista Primary Care Associates Medical Group Carlsbad Encinitas Fallbrook Oceanside Poway Solana Beach Vista Independent Physicians,000+ * independently contracted primary care physicians and specialists Acute Care Hospitals Palomar Medical Center Palomar Medical Center Poway Rady Children s Hospital ( locations) Sharp Chula Vista Medical Center Sharp Coronado Hospital and Healthcare Center Sharp Grossmont Hospital Sharp Mary Birch Hospital for Women & Newborns Sharp Memorial Hospital Sharp Mesa Vista Hospital Temecula Valley Hospital Inland Valley Medical Center Rancho Springs Medical Center Tri-City Medical Center Pharmacies Albertsons / Sav-on Pharmacy Costco Pharmacy CVS Pharmacy locations, including those at Target Ralphs Pharmacy Rite Aid Pharmacy Sharp Rees-Stealy Pharmacy Vons / Pavillion Pharmacy Walgreens Pharmacy Walmart Pharmacy Independently contracted neighborhood pharmacies The data shown here reflects Sharp Health Plan networks as of Sept. 30, 08. Coverage area includes but is not limited to the locations in this document. Premier is a preferred premium rate provider network and is available in select ZIP codes throughout San Diego County. To see if your business qualifies for this provider network, please contact your Sharp Health Plan account management executive. Sharp Mesa Vista Hospital is an acute care psychiatric hospital. 8 9

11 Consider us your personal health care assistant sharphealthplan.com