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BENEFITS City Health Plan <br />Administered by ODS Health Plans <br />Outpatient Services <br />X-Ray, Lab Tests and Radiation 80% after deductible for illness; 80% no deductible for treatment of <br />Therapy accidental injury. <br />Rehabilitation (Physical Therapy) 80% after deductible if prescribed by physician. <br />Occupational and Speech 80% after deductible for certain medical conditions if prescribed by <br />Therapy physician. <br />Special Provisions <br />Mental Health Services & Benefits provided in accordance with state and federal requirements. <br />Chemical Dependency including <br />Alcoholism <br />Emergency Care <br />Within Service Area 80% after deductible for treatment of illness; <br /> 80% with no deductible for treatment of accidental injury. <br />Outside of Service Area 80% after deductible for treatment of illness; <br /> 80% with no deductible for treatment of accidental injury. <br />Emergency Transportation 80% after deductible for local ambulance service. <br />Other Medical Treatment <br />Alternate Care / Acupuncture and Chiropractor: 80% after deductible. <br /> / Office visits to Licensed Naturopaths ($300 benefit max), Licensed <br /> Massage Therapists ($300 benefit max), and Registered Dietitians <br /> ($200 benefit max): 80% after deductible. Benefit maximums per <br /> calendar year as noted. No limitation on number of visits. <br />Hearing Aids 50% of eligible expenses covered after deductible, up to a $1000 <br /> maximum benefit during a 36-month period. <br />Home Health Care Covered in full after deductible when provided by RN or registered <br /> physical therapist and prescribed by a physician. <br />Hospice Care Covered in full after deductible. <br />Podiatrist 80% after deductible. <br />Prescription Drugs* Retail (after the deductible): <br /> Generic: $10 co-payment <br /> Others: 20% co-payment <br /> Mail Order (Walareens): <br /> Generic: $10 co-payment <br /> Preferred: $20 co-payment <br /> Premium: $25 co-payment or 25%, whichever is greater (with a <br /> $50 cap) <br />*See attached information for definitions and /ist of preferred & premium brands under City P/an. <br />CITY OF EUGENE: Summary of Benefits for AFSCME-Represented Limited Duration & <br />Benefited Temporary Recreation Employees (FY2005) -- Page 3 of 4 <br />