Open Enrollment Packet_v3

Open Enrollment Packet_v3

Inside you will find resources on your benefits coverage that are available to you and your family.

Open Enrollment Period: September 20 – October 15 ***Forms Due to HR: Friday, October 8 th ***

OPEN ENROLLMENT IS HERE! September 20 through October 15 Changes effective January 1, 20 22

To: All benefitted employees This is the only time each year that you can make changes to your health insurance plans, add/delete dependents, and enroll in the 2022 flexible spending account for medical and/or dependent care expenses. That makes this the perfect opportunity for you to review your benefit enrollments, update dependent information and make sure you are taking advantage of all the benefits available to you from the City! We want to make sure you are aware of 2022 key changes to your current health plan. CalPERS’ three PPO plans, PERSCare, PERS Choice, and PERS Select, will transition to two plans, PERS Gold and PERS Platinum. The two PPO plans will offer more distinction in benefit design, networks, and premium pricing.  PERSCare : Transitions to PERS Platinum. Retains the same 10% coinsurance benefit design and network as PERSCare.  PERS Choice : Transitions to PERS Platinum. Offers a 10% coinsurance benefit design and retains the same broad network as PERS Choice.  PERS Select : Transitions to PERS Gold. Retains the same 20% coinsurance benefit design and network as PERS Select.

During Open Enrollment, you can:

Change your CalPERS health plan.



 Add eligible dependents on medical, dental and/or vision.  Remove dependents on medical, dental and/or vision  Cancel your existing CalPERS health coverage.

We hope you will find this Open Enrollment Guide to be a useful resource and tool in planning your benefit elections for 2017. Inside you will find information on all your health plans and links to individual Health Plan Websites where you can research available services and search for providers in your health network.

Thank You, Jane Wilson

City of Carmel‐by‐the‐Sea | Human Resources Department | (831) 620‐ 2017 | [email protected]

Things to Consider if your Health Plan is changing ( CalPERS’ three PPO plans, PERSCare, PERS Choice, and PERS Select, will transition to two plans, PERS Gold and PERS Platinum) or if you are changing Your Health Plan?

 If you change your health plan, will you be able to keep your current doctor? Search for your primary care doctor and specialist using the Search Health Plans tool in myCalPERS to see which plans they participate in. Your health plan search results include member satisfaction ratings to help inform your decision. Medicare members will need to contact the plans directly, as they do today, to verify doctor availability. Keep in mind that information shown in the tool is subject to change. Therefore, before making any plan changes, check with your health plan or your doctor’s office to ensure your doctor is available in your plan

Important Health Enrollment Reminders

• A medical group ending its contract with a health plan does not create a qualifying event to change plans outside of Open Enrollment. • You will r eceive new health plan ID cards if you change your health plan or enroll for the first time. • Review your January 2022 paycheck to ensure the correct health plan premium deduction was made. • If you change plans during Open Enrollment and you don’t see the correct deduction applied by your February paycheck, contact Jane Wilson or Robin Scattini.

• If you change health plans, do not use your previous health plan after December 31, 2021.

* * * * * * T H I S P A G E I S B L A N K * * * * *

Open Enrollment Announcement

Table of Contents

2022 Health Benefits Rate Sheet

Note: Click on the tab to the right to view the corresponding document(s).

REQUIRED (All Employees) Status Change Form

CalPERS Medical

Delta Dental VSP Vision

Flexible Spending Account (FSA) Dependent Care FSA

My Benefits Coverage

Enrollment Forms

Questions?

CalPERS 2022 Monthly Premiums for Contracting Agencies

Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, Region 1 San Joaquin, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tuolumne, Yolo, Yuba

Effective Date: 1/1/2022 - 12/31/2022

Groups: At-Will, Unrepresented Employees, City Council 85% of Premium (Employer Paid) / 15% Employee Deduction

Employee Only

EE Deduction (Monthly)

PLAN

Employer Rate

Anthem HMO Select Kaiser Permanente

$ $ $ $ $

1,015.81

$ $ $ $ $

863.44 728.50 596.05 898.46 679.15

$ $ $ $ $

152.37 128.56 105.18 158.55 119.85

857.06 701.23

PERS Gold

PERS Platinum

1,057.01

PORAC

799.00

Employee & 1 Dependent

EE Deduction (Monthly)

PLAN

Employer Rate

Anthem HMO Select Kaiser Permanente

$ $ $ $ $

2,031.62 1,714.12 1,402.46 2,114.02 1,725.00

$ $ $ $ $

1,726.88 1,457.00 1,192.09 1,796.92 1,466.25

$ $ $ $ $

304.74 257.12 210.37 317.10 258.75

PERS Gold

PERS Platinum

PORAC

Employee & 2+ Dependents

EE Deduction (Monthly)

PLAN

Employer Rate

Anthem HMO Select Kaiser Permanente

$ $ $ $ $

2,641.11 2,228.36 1,823.20 2,748.23 2,219.00

$ $ $ $ $

2,244.94 1,894.11 1,549.72 2,336.00 1,886.15

$ $ $ $ $

396.17 334.25 273.48 412.23 332.85

PERS Gold

PERS Platinum

PORAC

CalPERS 2022 Monthly Premiums for Contracting Agencies Region 1

Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano,

Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tuolumne, Yolo, Yuba

Effective Date: 1/1/2022 - 12/31/2022

Bargaining Groups: LiUNA (General/Management), POA, Ambulance 80% of Premium (Employer Paid) / 20% Employee Deduction

Employee Only

EE Deduction (Monthly)

PLAN

Employer Rate

Anthem HMO Select Kaiser Permanente

$ $ $ $ $

1,015.81

$ $ $ $ $

812.65 685.65 560.98 845.61 639.20

$ $ $ $ $

203.16 171.41 140.25 211.40 159.80

857.06 701.23

PERS Gold

PERS Platinum

1,057.01

PORAC

799.00

Employee & 1 Dependent

EE Deduction (Monthly)

PLAN

Employer Rate

Anthem HMO Select Kaiser Permanente

$ $ $ $ $

2,031.62 1,714.12 1,402.46 2,114.02 1,725.00

$ $ $ $ $

1,625.30 1,371.30 1,121.97 1,691.22 1,380.00

$ $ $ $ $

406.32 342.82 280.49 422.80 345.00

PERS Gold

PERS Platinum

PORAC

Employee & 2+ Dependents

EE Deduction (Monthly)

PLAN

Employer Rate

Anthem HMO Select Kaiser Permanente

$ $ $ $ $

2,641.11 2,228.36 1,823.20 2,748.23 2,219.00

$ $ $ $ $

2,112.89 1,782.69 1,458.56 2,198.58 1,775.20

$ $ $ $ $

528.22 445.67 364.64 549.65 443.80

PERS Gold

PERS Platinum

PORAC

* * * * * * T H I S P A G E I S B L A N K * * * * *

All employees are required to complete and return this online Status Form to Human Resources no later than Friday, October 8. Upload any forms to change insurance.

2022 Select HMO Benefit guide

Access to a select network of HMO doctors; lower monthly premium

40184CAMENABC BV Rev. 05/21

How the Select HMO plan can help you

Your benefits should fit your needs. This booklet is designed to help you make the right choices by highlighting the benefits that come with the Select HMO plan. If you want more details on the Select HMO plan, you can visit anthem.com/ca/calpers and download an Evidence of Coverage (EOC) booklet. One of the best things about a health maintenance organization (HMO) plan is how simple it is to use. You choose a primary care physician (PCP) to coordinate your care, and costs are straightforward — so you know what you will pay for treatment. The Select HMO plan offers you: More-affordable health benefits. You have low copays and no deductible . In some cases, you pay nothing out of pocket for care:

Type of care

Copay

Office visit to see a doctor or referred specialist

$15

Urgent care

$15

Emergency care (waived if admitted)

$50

$15

Acupuncture or chiropractic care 1

Hospital or outpatient care

$0

Lab tests and X-rays

$0

Preventive care (such as checkups, well-baby visits, women’s wellness exams, and flu shots)

$0

2

100% coverage for preventive care. You do not have a copay when you see a doctor in your Select HMO plan’s network. Access to the doctors and hospitals you want to see. You have the freedom to choose a local doctor and medical group you may already know. If you travel out of the service area, out of state, or overseas, you have access to special programs when you need care. See Your coverage travels with you on page 4 for more information. Enhanced chiropractic and acupuncture benefits. You may have up to 20 chiropractic or acupuncture visits in a calendar year for covered services that are determined to be medically or clinically necessary. Benefits for chiropractic and acupuncture services are provided through Anthem and the American Specialty Health Plans of California (ASH). You do not need a referral from your PCP to schedule your first visit, but make sure you schedule with an acupuncturist or chiropractor in the plan’s network. Remember to bring your member ID card to the appointment. If you need help finding an ASH chiropractor or acupuncturist in your plan’s network, please call Anthem at 855-839-4524 . No claim forms. Forms aren’t needed when you see a doctor or other healthcare professional in the plan’s network. You only pay a copay — if one is required.

Picking a primary care physician If you enroll in the Select HMO plan, you need to choose a primary care physician (PCP). This is your main doctor when you have a health issue or need personal help to reach your health goals. A PCP also provides preventive care, such as a yearly checkup; makes referrals to specialists; and helps you make choices about your health. To see if a doctor is in the Select HMO plan network, go to anthem.com/ca/calpers and select Menu in the upper-left corner. Choose Find Care . Next, select PERS Select HMO . Pick a type of doctor and location. You can also search for a doctor by name. Choose Search to see doctors in your plan. If you need help finding a doctor, call Anthem Customer Service at 855-839-4524 .

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Anthem Blue Cross Select HMO 2022 health premiums — state only

Single

Two-party

Family

State only

$848.08

$1,696.16

$2,205.01

Anthem Blue Cross Select HMO 2022 health premiums — regional

Contracting agencies only

Basic premium rates

Single

Two-party

Family

Your coverage travels with you As a Select HMO member, you will always have coverage for urgent and emergency care outside of your service area. If you travel outside California , you have access to urgent or emergency care through the BlueCard program . 2 You will save money and avoid having to fill out claim forms when you see a doctor or use a hospital through the BlueCard program. If you take a trip overseas , the Blue Cross Global Core program will give you access to doctors and hospitals in 190 countries and territories around the world for urgent or emergency care. 2 If you need assistance or have questions about the BlueCard program or Blue Cross Global Core program, call the Blue Cross Blue Shield Global Core Service Center toll free at 800-810-BLUE (2583) 24/7. If you plan to live in another state for 90 days or more, you can set up an Away From Home guest membership. It is useful when you or a covered dependent goes to college in another state, for example. For questions or to learn more about Away From Home guest membership benefits, call 800-827-6422. Region 1 Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tuolumne, Yolo, and Yuba Select HMO $1,015.81 $2,031.62 $2,641.11 Region 2 Fresno, Imperial, Inyo, Kern, Kings, Madera, Orange, San Diego, San Luis Obispo, Santa Barbara, Tulare, and Ventura Select HMO $712.43 $1,424.86 $1,852.32 Region 3 Los Angeles, Riverside, and San Bernardino Select HMO $676.48 $1,352.96 $1,758.85 Out of state Select HMO Not available Note: Premiums shown do not reflect any potential employer contributions.

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Extra help to stay your healthiest Anthem offers tools and programs to help you find the care and support you need:

Sydney Health The Sydney Health SM mobile app provides access to your health plan information — all in one place. Sydney Health can help you navigate your benefits with greater ease, improve your health, and save money. You can use the Sydney Health app to: } Search for doctors, hospitals, labs, and other healthcare providers in your plan’s network. } Check costs for care before you see a doctor. } Pull up your digital member ID card. } See what your plan covers. } Find your deductible, copay, and share of costs. } Access your spending account balance. Discover how Sydney Health simplifies healthcare To start using the app: } Download the Sydney Health app from the App Store® or Google Play™. } Register or log in to your account using your Anthem username and password.

LiveHealth Online If you have the flu, a sinus infection, a cold, a fever, or other common health issue, you can have a video visit 24/7 with a board-certified doctor by using LiveHealth Online. 3 A doctor can send a prescription to your pharmacy. 4 All you need is a smartphone, tablet, or computer with a camera. Visits cost $15 each . LiveHealth Online is available for mental health issues, too. If you feel anxious or stressed, make an appointment with a licensed therapist and have a video visit in four days or less. 5 Appointments are available seven days a week and cost $15 for each visit . ConditionCare Find support if you have a condition such as asthma, chronic obstructive pulmonary disease (COPD), coronary artery disease, diabetes, or heart failure. A nurse coach helps you make a plan to stay on the right track with your health. Future Moms We want you and your baby to have the best possible start. This program provides resources and screening during and after pregnancy. You are able to talk with a nurse coach 24/7 about your pregnancy and get answers to questions you may have.

24/7 NurseLine Speak with a registered nurse anytime of the day or night if you have a question about a health issue.

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Learn more about how your benefits can support you

Once you are enrolled in the Select HMO plan and have your member ID card, use anthem.com/ca/calpers to: } Review your benefits. } Download a digital ID card or request a replacement ID card. } Find a doctor in your plan’s network.

} Reach the CalPERS-dedicated Anthem Customer Service staff.

We want to make sure you have a plan that meets your needs. Call us toll free at 855-839-4524 .

1 Benefits for chiropractic and acupuncture services are provided through Anthem and the American Specialty Health Plans of California (ASH). 2 GeoBlue: More than 20 years as a leader in international healthcare (accessed June 2021): about.geo-blue.com. 3 Prescription availability is defined by physician judgment and state regulations. 4 Members must be 10 years or older to access LiveHealth Online.

5 Appointments are subject to the availability of a therapist. Psychologists or therapists using LiveHealth Online cannot prescribe medications. Online counseling is not appropriate for all issues. If you are in crisis or having suicidal thoughts, it is important that you seek help immediately. Please call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255), or 911 for help. If it is an emergency, call 911 or go to your nearest emergency room. LiveHealth Online does not offer emergency services. Prescriptions determined to be a “controlled substance” (as defined by the Controlled Substances Act under federal law) cannot be prescribed using LiveHealth Online. Psychiatrists on LiveHealth Online will not offer counseling or talk therapy.

LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of Anthem Blue Cross.

Sydney Health SM is offered through an arrangement with CareMarket, Inc. ©2020-2021.

Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

2022 PERS Gold Benefit guide

The most cost-effective CalPERS PPO plan offered

SC14341 BV Rev. 05/21

How the PERS Gold plan can help you

Your benefits should fit your needs. This booklet is designed to help, with an overview of what the PERS Gold plan has to offer. To see more plan details, go to anthem.com/ca/calpers and download an Evidence of Coverage (EOC) booklet. One important advantage of the PERS preferred provider organization (PPO) plans is that they empower you with the freedom to choose high-quality doctors without a referral. The PERS Gold plan offers you: Cost-effective health coverage with low premiums and flat copays for office visits. See the next page for a list of premiums by area and county. The ability to earn credits to lower your deductible by participating in programs such as ConditionCare and Virtual Second Opinion, which can help you meet your health goals and are available to you at no extra charge. 100% coverage for preventive care. You do not pay coinsurance or a deductible when you see a doctor in the PERS Gold plan network (Select PPO Preferred Providers). 1 Access to the doctors and hospitals you want to use. You have the freedom to select local providers you may already know. If you travel out of state or overseas, you have access to special programs when you need care. See Your coverage travels with you on page 7 for more information. Enhanced benefits. You can have up to 20 combined visits each year with an acupuncturist or chiropractor in the plan’s network. No deductible or coinsurance when having a baby if you sign up for Future Moms with Digital Maternity Support and participate before the end of your 36th week of pregnancy. See page 7 for additional details about this program.

Find out if your doctor is part of the PERS Gold plan network To see if a doctor is in the PERS Gold PPO plan network (Blue Cross Select PPO), go to anthem.com/ca/calpers and select Menu in the upper-left corner. Choose Find Care . Next, select PERS Gold (Select PPO Preferred Providers) . Pick a type of doctor and location. You can also search for a doctor by name. Choose Search to see doctors in your plan. If you need help finding a doctor, call Anthem Customer Service at 877-PERSPPO (877-737-7776) .

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CalPERS 2022 health premiums — state only

Basic premium rates

Single

Two-party

Family

PERS Gold

$650.38

$1,300.76

$1,690.99

CalPERS 2022 health premiums — regional Contracting agencies only

Basic premium rates

Single

Two-party

Family

Region 1 Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tuolumne, Yolo, and Yuba PERS Gold $701.23 $1,402.46 $1,823.20 Region 2 Fresno, Imperial, Inyo, Kern, Kings, Madera, Orange, San Diego, San Luis Obispo, Santa Barbara, Tulare, and Ventura PERS Gold $587.78 $1,175.56 $1,528.23 Region 3 Los Angeles, Riverside, and San Bernardino PERS Gold $575.56 $1,151.12 $1,496.46 Out of state PERS Gold Not available Note: Premiums shown do not reflect any potential employer contributions.

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2022 PERS Gold plan benefit summary

2022 PERS Gold In-network benefits for a common medical issue (for example, visiting a PCP for a rash, being screened for diabetes, a visit to the ER, or being treated for appendicitis)

In-network benefits

Coinsurance (plan/member)

Plan pays 80%/you pay 20%

Deductible 2

Individual: $1,000 3 Family: $2,000 3 Incentives reduce deductible to:

} Individual: $500. } Family: $1,000.

Designated primary care physician (PCP)

$10 copay

Specialist/all other primary care doctors

$35 copay 4

LiveHealth Online

$10 copay

Urgent care

$35 copay

Emergency room (ER) (waived if admitted)

$50 copay

Laboratory tests

No copay for preventive 20% coinsurance

Inpatient maternity (delivery)

Inpatient coinsurance covered in full when enrolled and participate in the Future Moms program before the end of your 36th week of pregnancy 20% coinsurance (without enrollment)

X-ray/imaging

20% coinsurance

Mental health/behavioral health/ substance abuse physician visit

$10 copay

Inpatient mental health

20% coinsurance (preferred provider) 40% coinsurance (nonpreferred provider)

Inpatient

20% coinsurance (preferred provider) 40% coinsurance (nonpreferred provider)

Maximum coinsurance out of pocket 5

Individual: $3,000 Family: $6,000

Out-of-network coverage 6

Plan pays 60% of allowable amount/you pay 40%

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2022 PERS Gold plan benefit summary

Prescription drug benefits OptumRx manages your prescription drug coverage. If you need more information about home delivery, maintenance medications, or the step-therapy program, call OptumRx at 855-505-8110 or visit optumrx.com/calpers .

Please see the plan’s Evidence of Coverage booklet for the terms and conditions of coverage.

Preferred brand

Non-preferred brand

Prescription drug benefits

Generic

$50 ($40 at preferred pharmacy if partial copay waiver is approved) $100 ($70 at preferred pharmacy if partial copay waiver is approved)

Retail pharmacy (short-term use)

$5

$20

Optum home delivery or Preferred 90 pharmacies (up to a 90-day supply of maintenance medications)

$10

$40

Brand-name drugs with generic options (member pays the difference)

Difference is cost between the brand-name drug and generic drug + applicable copay

50% coinsurance for erectile or sexual dysfunction drugs applies to retail and mail order (Refer to EOC for details.)

Note: A $1,000 maximum copay for each person each calendar year applies (only includes generic, preferred brand, and specialty medication copays on Optum home delivery or at Preferred 90 pharmacies).

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Save money by taking care of yourself Every year that you are enrolled in the PERS Gold plan, you can earn up to $500 in credits to lower your deductible . Think of it as a discount on your deductible. To collect each of the $100 credits shown below, complete healthy activities like receiving a flu shot and health screening. There is no extra cost for these activities. Here is what you need to do:

Activity:

You need to:

Keep this credit:

Receive a flu shot at a pharmacy in your plan’s network or at your doctor’s office.

$100

Flu shot 7

Let us know you do not smoke by completing the health assessment on Sydney Health SM .

Nonsmoking certification

$100

If you do smoke, complete a quit smoking program.

Do the test at your doctor’s office or one of the 2,200 Quest Diagnostics Patient Service Centers. If a center is not near you, order an at-home test kit. The test checks your blood pressure, cholesterol level, glucose, and A1C, as well as your height and weight for body mass index (BMI). You will receive your screening results both online and in the mail. 8 Call 888-361-3944 (Monday to Friday, 5:30 a.m. to 8 p.m. PT) if you are having nonurgent and nonemergency scheduled surgery in 2022. They will see if you need a second opinion. You can also receive a second opinion from a PERS Gold plan doctor. Take part in the ConditionCare program if you have asthma, diabetes, chronic obstructive pulmonary disease (COPD), heart failure, or coronary artery or vascular disease. If you receive a letter or call from the ConditionCare team that you qualify to participate, call 866-962-0957 and join the program to earn your credit.

Biometric screening

$100

Virtual Second Opinion program 9

$100

ConditionCare certification 10

$100

The savings add up If you qualify for all five credits, your 2022 deductible is reduced to:

} $500 for an individual (instead of $1,000). } $1,000 for a family (instead of $2,000).

To see your deductible credits, use the Sydney Health app. You can learn more about the Sydney Health app on the next page. Dependents (other than spouse or domestic partner), regardless of age, will automatically receive all five credits applied at the beginning of the year.

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Take your benefits with you — at home or on the go

Sydney Health

LiveHealth Online is available for mental health issues, too. If you feel anxious or stressed, make an appointment with a psychologist or licensed therapist, and have a video visit in four days or less. 13 Appointments are available seven days a week and cost $10 for each visit .

The Sydney Health mobile app provides access to your health plan information — all in one place. Sydney Health can help you navigate your benefits with greater ease, improve your health, and save money. You can use the Sydney Health app to: } Search for doctors, hospitals, labs, and other healthcare providers in your plan’s network. } Check costs for care before you see a doctor. } Pull up your digital member ID card. } See what your plan covers. } Find your deductible, copay, and share of costs. } Access your spending account balance. } Take a short health assessment that can usually be completed in 3 to 5 minutes. Part of this assessment asks if you smoke. If you don’t, you are eligible for a $100 deductible credit. To start using the app: } Download the Sydney Health app from the App Store® or Google Play™. } Register or log in to your account using your Anthem username and password.

Future Moms with Digital Maternity Support

If you are pregnant or planning to have a baby, the Future Moms program with Digital Maternity Support provides 24/7 support by phone for your pregnancy-related questions. There is no deductible or coinsurance for delivering your baby when you sign up; plus, you will receive support before and after you have your baby. As soon as you see a doctor for your pregnancy, you will receive an invitation to join Future Moms by email, text, or phone call. Through the program’s app, powered by My Advocate Helps , you can: } Use the pregnancy calendar. } Live chat with registered nurses. } Personalize to-do lists. } Receive timely resources. A nurse case manager will reach out if you have health risks and will help you create a plan to meet your health and pregnancy goals. After your baby arrives, you can have no-cost video visits with a certified lactation consultant, counselor, or registered dietitian using Future Moms with Breastfeeding Support on LiveHealth Online. These professionals provide personalized support to help you with breastfeeding.

LiveHealth Online

If you have the flu, a sinus infection, a cold, a fever, or other common health issue, you can have a video visit 24/7 with a board-certified doctor using LiveHealth Online. 11 A doctor can even send a prescription to your pharmacy. 12 All you need is a smartphone, tablet, or computer with a camera. Visits cost $10 each .

Your coverage travels with you As a PERS Gold member, you have benefit access outside California when traveling, through the BlueCard program . You will save money and avoid having to fill out claim forms when you see a doctor or use a hospital through the BlueCard program. If you travel overseas, the Blue Cross Global Core program will give you access to doctors and hospitals in 190 countries and territories around the world for urgent or emergency care. 14 If you need assistance or have questions about the BlueCard program or Blue Cross Global Core program, call the Blue Cross Blue Shield Global Core Service Center toll free at 800-810-BLUE (2583) 24/7.

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Save with the Value-based Purchasing Design Site of Care program If you need a procedure, such as arthroscopy or a colonoscopy, you can save money by going to an ambulatory surgical center (ASC) instead of a hospital. By using an ASC that is part of this program, you will have little to no out-of-pocket costs, other than the plan’s deductible and your coinsurance. Other procedures that are part of the program include gall bladder removal, sigmoidoscopy (a test that examines your large intestine, similar to a colonoscopy), hernia repair, and nasal or sinus corrective surgery. To learn more, or to make sure a center is part of the program, call Customer Service at 877-PERSPPO (877-737-7776) .

Learn more about how your benefits can support you Once you’re enrolled and have your member ID card, use anthem.com/ca/calpers to:

} Review your benefits. } Look at your claims. } Download a digital ID card or request a replacement ID card. } Find a doctor in your plan’s network. } Reach the CalPERS-dedicated Anthem Customer Service staff. We want to make sure you have a plan that meets your needs. Call us toll free at 877-PERSPPO (877-737-7776) .

1 Preventive care is covered 100% when you see a doctor in your plan’s network, and you do not have to pay the deductible for this care. 2 Services received from a doctor in your plan’s network are not subject to the calendar-year deductible. 3 A $1,000 maximum copay for each person each calendar year applies (only includes generic and preferred brands). 4 There is a $10 copay when the member sees an assigned PCP; $35 for all other primary care doctors or specialists in the plan. 5 Does not include plan deductible or copays. 6 You may be responsible for the cost difference between the allowable and billed amount. 7 If you cannot have a flu shot due to health, personal, or religious reasons, you are eligible to receive the $100 deductible credit. Call Anthem Customer Service at 877-PERSPPO (877-737-7776) for more information. 8 If you use a Quest Diagnostics Center, log in at anthem.com/ca/calpers and select Quest Biometric Screening to see your results.

9 If you do not need a nonemergency, urgent surgery in 2022, you are eligible to receive the $100 deductible credit. 10 If you do not require support from the ConditionCare program, you are eligible to receive the $100 deductible credit. 11 Members must be 10 years or older to access LiveHealth Online. 12 Prescription availability is defined by physician judgment and state regulations. 13 Appointments are subject to the availability of a therapist. Psychologists or therapists using LiveHealth Online cannot prescribe medications. Online counseling is not appropriate for all problems. If you are in crisis or having suicidal thoughts, it is important that you seek help immediately. Please call the National Suicide Prevention Lifeline at 800-273 TALK (800-273-8255), or 911 for help. If it is an emergency, call 911 or go to your nearest emergency room. LiveHealth Online does not offer emergency services. Prescriptions determined to be a “controlled substance” (as defined by the Controlled Substances Act under federal law) cannot be prescribed using LiveHealth Online. Psychiatrists on LiveHealth Online will not offer counseling or talk therapy. 14 GeoBlue: More than 20 years as a leader in international healthcare (accessed June 2021): about-geo-blue.com.

LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of Anthem Blue Cross.

Sydney Health SM is offered through an arrangement with CareMarket, Inc. ©2020-2021.

Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

Quality care for a healthy life

We are here to help you find the care you need, when you need it, from the doctors and hospitals you trust. As a CalPERS Monterey member, you can select from a variety of Anthem’s flexible plans and receive healthcare services at Salinas Valley Memorial Hospital and the Community Hospital of Monterey Peninsula.

With an Anthem plan, CalPERS Monterey members have: } An extensive network of healthcare providers — including doctors, specialists, and hospitals — to choose from. } Benefits you expect, such as low copays for primary care physician (PCP) visits, and preventive care at no cost to you. } Competitive copays for specialist visits. } Hospital visit benefits at budget-friendly rates.

See a side-by-side comparison of your plan options on the back of this flyer. For complete information about your personal benefits, check your health plan documents, or call us at the numbers on the back of this flyer. We are here when you need help.

Mark your calendar for open enrollment: September 20 – October 15, 2021

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Which Anthem health plan is right for you? We want you to have the information you need to choose a plan that works best for you and your family. Insurance contracts and plans have limitations, and exclusions may apply.

New for 2022! Our PPO plans have new names, PERS Platinum and PERS Gold.

Benefit

PERS Platinum (formerly PERSCare)

PERS Gold (formerly PERS Select)

Select Basic (HMO)

Deductible Member/Family

$500/$1,000

$1,000/$2,000 1

None

Out-of-pocket maximum Member/Family

$2,000/$4,000

$3,000/$6,000

$1,500/$3,000

Preventive care

$0

$0

$0

$10 copay (PCP) 2 $35 copay

Primary care physician (PCP)

$20 copay

$15 copay

(all other primary care doctors or specialists) 2

Specialist

$35 copay

$35 copay

$15 copay

LiveHealth Online

$20 copay

$20 copay

$15 copay

Urgent care

$35 copay

$35 copay

$15 copay

$50 copay; 20% coinsurance after deductible is met 3

$50 copay; 10% coinsurance after deductible is met 3

Emergency room

$50 copay 3

Outpatient hospitalization

10% coinsurance

20% coinsurance

No charge

$250 deductible per admission; then 10% coinsurance

Inpatient hospitalization

No charge

20% coinsurance 4

Please reach out if you have questions For PPO plan questions, call us toll free at 877-737-7776. For HMO plan questions, call us toll free at 855-839-4524.

1 Member can earn deductible credits up to $500 for individual or $1,000 for family. 2 $10 copay when member sees the assigned PCP; $35 for all other primary care doctors or specialists in the plan. 3 Copay is waived if patient is admitted. 4 Waived for inpatient maternity stays for members who complete the Future Moms program. Note: Enrollment in the Future Moms program must be within the first 36 weeks of pregnancy to qualify for the waived coinsurance benefit. LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of Anthem Blue Cross.

Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

2022 PERS Platinum Benefit guide

Access to our full PPO network, offering the highest level of coverage

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How the PERS Platinum PPO plan can help you

Your benefits should fit your needs. This booklet is designed to help you by providing an overview of what the PERS Platinum plan has to offer. To see more plan details, go to anthem.com/ca/calpers and download an Evidence of Coverage (EOC) booklet. The PERS Platinum preferred provider organization (PPO) plan empowers you with the freedom to choose high-quality doctors without a referral. The PERS Platinum plan offers you: Cost-effective health coverage. The plan includes low copays and deductibles, and in certain cases, you pay nothing out of pocket for care. See the next page for a list of premiums by area and county. 100% coverage for preventive care. You do not pay coinsurance or a deductible when you see a doctor in the PERS Platinum plan network (Prudent Buyer Plan Providers). 1 Access to the doctors and hospitals you want to use. You have the freedom to choose local providers you may already know. If you travel out of state or overseas, you have access to special programs when you need care. See Your coverage travels with you on page 7 for more information. Enhanced benefits. You can have up to 20 combined visits each year with an acupuncturist or chiropractor in the plan’s network. No claim forms. Forms aren’t needed when you see a doctor or other healthcare professional in the plan’s network. You only pay a copay or coinsurance if it is required.

Find out if your doctor is part of the PERS Platinum PPO plan network To see if a doctor is in the PERS Platinum PPO plan network, go to anthem.com/ca/calpers and select Menu in the upper-left corner. Choose Find Care . Next, select PERS Platinum (Prudent Buyer Plan Providers) . Pick a type of doctor and location. You can also search for

a doctor by name. Choose Search to see doctors in your plan. If you need help finding a doctor, call Anthem Customer Service at 877-PERSPPO (877-737-7776) .

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CalPERS 2022 health premiums — state only

Basic premium rates

Single

Two-party

Family

PERS Platinum

$946.78

$1,893.56

$2,461.63

CalPERS 2022 health premiums — regional Contracting agencies only

Basic premium rates

Single

Two-party

Family

Region 1 Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Glenn, Humboldt, Lake, Lassen, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tuolumne, Yolo, and Yuba

PERS Platinum

$1,057.01

$2,114.02

$2,748.23

Region 2 Fresno, Imperial, Inyo, Kern, Kings, Madera, Orange, San Diego, San Luis Obispo, Santa Barbara, Tulare, and Ventura

PERS Platinum

$882.18

$1,764.36

$2,293.67

Region 3 Los Angeles, Riverside, and San Bernardino

PERS Platinum

$863.37

$1,726.74

$2,244.76

Out of state

PERS Platinum

$847.71

$1,695.42

$2,204.05

Note: Premiums shown do not reflect any potential employer contributions.

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2022 PERS Platinum plan benefit summary

2022 PERS Platinum In-network benefits for a common medical issue (for example, visiting your PCP for a rash, being screened for diabetes, a visit to the ER, or being treated for appendicitis)

In-network benefits

Deductible

Individual: $500 Family: $1,000

General/family practice doctor (non-specialist)

$20 copay 2

Specialist

$35 copay

Urgent care

$35 copay

Emergency room (ER) (waived if admitted)

$50 copay

Laboratory tests

No copay for preventive 10% coinsurance

Inpatient maternity (delivery)

10% coinsurance

X-ray/imaging

10% coinsurance

Mental health/behavioral health/ substance abuse physician visit

$20 copay

Inpatient mental health (precertification required)

10% coinsurance

$250 hospital deductible applies per admission

Inpatient

10% coinsurance

$250 hospital deductible applies per admission

Maximum coinsurance out of pocket 3

Individual: $2,000 Family: $4,000

Out-of-network coverage 4

Plan pays 60% of allowable amount/you pay 40%

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2022 PERS Platinum PPO plan benefit summary

Prescription drug benefits OptumRx manages your prescription drug coverage. If you need more information about home delivery, maintenance medications, or the step-therapy program, call OptumRx at 855-505-8110 or visit optumrx.com/calpers .

Please see the plan’s Evidence of Coverage booklet for the terms and conditions of coverage.

Preferred brand

Non-preferred brand

Prescription drug benefits

Generic

$50 ($40 at preferred pharmacy if partial copay waiver is approved) $100 ($70 at preferred pharmacy if partial copay waiver is approved)

Retail pharmacy (up to a 30-day supply)

$5

$20

Optum home delivery or Preferred 90 pharmacies (up to a 90-day supply of maintenance medications)

$10

$40

Brand-name drugs with generic options (member pays the difference)

Difference is cost between the brand-name drug and generic drug + applicable copay

50% coinsurance for erectile or sexual dysfunction drugs applies to retail and mail order (Refer to EOC for details.)

Note: A $1,000 maximum copay for each person each calendar year applies (only includes generic, preferred brand, and specialty medication copays on Optum home delivery or at Preferred 90 pharmacies).

5

Extra help to stay your healthiest Anthem offers tools and programs to help you find the care and support you need:

Sydney Health With the Sydney Health SM app, you can make informed decisions about your care. All of your benefit information is organized in one place, which means you can spend less time looking for information and more time focused on your health and your priorities. The app is designed to help you quickly find what you need, with access to Member Services, LiveHealth Online video doctor visits, wellness resources, and an interactive chat feature. Make the most of your benefits and stay connected to your health plan anytime, anywhere, by downloading the Sydney Health app on the App Store® or Google Play TM .

ConditionCare Find support if you have a condition such as asthma, chronic obstructive pulmonary disease (COPD), coronary artery disease, diabetes, or heart failure. A nurse coach helps you make a plan to stay on the right track with your health. Future Moms with Digital Maternity Support If you are pregnant or planning to have a baby, the Future Moms program with Digital Maternity Support provides 24/7 support by phone for your pregnancy-related questions. There is no deductible or coinsurance for delivering your baby when you sign up; plus, you will receive support before and after you have your baby. As soon as you see a doctor for your pregnancy, you will receive an invitation to join Future Moms by email, text, or phone call.

24/7 NurseLine Speak with a registered nurse anytime of the day or night if you have a question about a health issue.

Through the program’s app, powered by My Advocate Helps , you can: } Use the pregnancy calendar. } Live chat with registered nurses. } Personalize to-do lists. } Receive timely resources.

LiveHealth Online If you have the flu, a sinus infection, a cold, a fever, or other common health issue, you can have a video visit 24/7 with a board-certified doctor using LiveHealth Online. 5 A doctor can send a prescription to your pharmacy. 6 All you need is a smartphone, tablet, or computer with a camera. Visits cost $20 each . LiveHealth Online is available for mental health issues, too. If you feel anxious or stressed, make an appointment with a psychologist or licensed therapist and have a video visit in four days or less. 7 Appointments are available seven days a week and cost $20 for each visit .

A nurse case manager will reach out if you have health risks and will help you create a plan to meet your health and pregnancy goals. After your baby arrives, you can have no-cost video visits with a certified lactation consultant, counselor, or registered dietitian using Future Moms with Breastfeeding Support on LiveHealth Online. These professionals provide personalized support to help you with breastfeeding.

6

Your coverage travels with you

As a PERS Platinum member, you have benefit access outside California when traveling, through the BlueCard program . You will save money and avoid having to fill out claim forms when you see a doctor or use a hospital through the BlueCard program.

If you travel overseas, the Blue Cross Global Core program will give you access to doctors and hospitals in 190 countries and territories around the world for urgent or emergency care. 8

If you need assistance or have questions about the BlueCard program or Blue Cross Global Core program, call the Blue Cross Blue Shield Global Core Service Center toll free at 800-810-BLUE (2583) 24/7.

Save with the Value-based Purchasing Design Site of Care program

If you need a procedure, such as arthroscopy or a colonoscopy, you can save money by going to an ambulatory surgical center (ASC) instead of a hospital. By using an ASC that is part of this program, you will have little to no out-of-pocket costs, other than the plan’s deductible and your coinsurance. Other procedures that are part of the program include gall bladder removal, sigmoidoscopy (a test that examines your large intestine, similar to a colonoscopy), hernia repair, and nasal or sinus corrective surgery. To learn more or make sure a center is part of the program, call Customer Service at 877-PERSPPO (877-737-7776) .

7

Learn more about how your benefits can support you Once you are enrolled and have your member ID card, use anthem.com/ca/calpers to: } Review your benefits. } Look at your claims. } Download a digital ID care or request a replacement ID card.

} Find a doctor in your plan’s network. } Reach the CalPERS-dedicated Anthem Customer Service staff. We want to make sure you have a plan that meets your needs. Call us toll free at 877-PERSPPO (877-737-7776) .

1 Preventive care is covered 100% when you see a doctor in your plan’s network, and you do not have to pay the deductible for this care. 2 Services received from a doctor in your plan’s network are not subject to the calendar-year deductible. 3 Does not include plan deductible or copays. 4 You may be responsible for the cost difference between the allowable and billed amount. 5 Members must be 10 years or older to access LiveHealth Online. 6 Prescription availability is defined by physician judgment and state regulations. 7 Appointments are subject to the availability of a therapist. Psychologists or therapists using LiveHealth Online cannot prescribe medications. Online counseling is not appropriate for all kinds of problems. If you are in crisis or having suicidal thoughts, it is important that you seek help immediately. Please call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255), or 911 for help. If it is an emergency, call 911 or go to your nearest emergency room. LiveHealth Online does not offer emergency services. Prescriptions determined to be a “controlled substance” (as defined by the Controlled Substances Act under federal law) cannot be prescribed using LiveHealth Online. Psychiatrists on LiveHealth Online will not offer counseling or talk therapy. 8 GeoBlue: More than 20 years as a leader in international healthcare (accessed June 2021): about.geo-blue.com.

Sydney Health SM is offered through an arrangement with CareMarket, Inc. ©2020-2021.

LiveHealth Online is the trade name of Health Management Corporation, a separate company, providing telehealth services on behalf of Anthem Blue Cross. Anthem Blue Cross is the trade name of Blue Cross of California. Independent licensee of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.