New Search
SUMMARY OF BENEFITS* <br />FOR <br />CITY OF EUGENE AFSCME-REPRESENTED EMPLOYEES <br />Effective July 1, 2004 <br />BENEFITS <br />City Health Plan <br />Administered by ODS Health Plans <br />PacificSource Health Plans <br />General Information <br />Benefit Levels <br />The City Health Plan uses the ODS <br />/Providence Vantage Preferred Provider <br />Organization (PPO) network. Benefit <br />levels after the deductible: <br />/ In-Network provider: 80% of <br />discounted rates; <br />/ Non-Network provider: 50% of <br />reasonable and customary charges. <br />Under PacificSource, it is necessary for <br />you and your covered dependents to <br />choose a Primary Care Practitioner <br />(PCP). Benefits are paid at the highest <br />level when provided or referred by your <br />PacificSource PCP. Most Non-Network <br />provider benefits are 50% of reasonable <br />and customary charges after copay. <br />Service Area <br />Choice of Physician <br />Calendar Yea r <br />Deductibles <br />Out-of Pocket <br />Medical Maximums <br />Lifetime Max. Benefit <br />Worldwide. Service area for PPO <br />includes all Oregon counties. Also <br />Pacific, Wahkiakum, Cowlitz, Clark, <br />Skamania, Klickitat, Benton, Walla Walla <br />Counties in Washington state. <br />Any qualified physician. While in the <br />service area, you must use a network <br />provider or hospital to receive in- <br />network benefits. <br />Benton, Clackamas, Clatsop, Columbia, <br />Coos, Crook, Curry, Deschutes, Douglas, <br />Grant, Harney, Hood River, Jackson, <br />Jefferson, Josephine, Lane, Linn, <br />Malheur, Marion, Multnomah, Polk, <br />Sherman, Wasco, Washington, Wheeler, <br />and Yamhill Counties in Oregon. <br />Except for Alternate Care, you must use <br />or be referred by your PacificSource PCP <br />to be paid at the highest benefit level. <br />$100 per person medical deductible; No deductible for medical coverage. <br />$300 maximum per family. <br />$50 per person dental deductible; $150 <br />maximum per family. All benefits paid <br />after the deductible is met unless <br />otherwise noted. <br />Covered under City Health Plan dental <br />coverage. <br />$750 per person each calendar year in <br />addition to the deductible for covered <br />services. Once this limit has been met, <br />eligible charges are covered in full for <br />remainder of calendar vear. <br />$2,000,000 <br />$1,000 per person each calendar year. <br />$2,000,000 for medical coverage. <br />*This comparison of benefits summarizes the general benefits under each p/an. It does not provide a full <br />description of benefits P/ease contact the indi~idua/ carriers for further information. <br />CITY OF EUGENE: Summary of Benefits for AFSCME-Represented Employees (FY2005) -- Page 1 of 6 <br />