Medical – Cooperative of American Physicians

Which Medical Plan is Right?

You have a choice of medical plan options to help you and your family take charge of your health care and find the right fit. These plans have different copayments, coinsurance, deductibles, and out-of-pocket limits.

Evaluate Your Needs. Consider your prior health care usage and select plans and options that fit your lifestyle and needs.

· Do you take regular prescription medications?

· Are you anticipating surgery or non-preventive dental care?

· Did you experience a qualifying life event this year?

· Review your current plans to ensure you have the coverage you need.

Review this benefits website to learn about your new and existing plan options.

A little bit of planning will help you select the best plans, coverage levels, and financial programs for your unique situation.

Medical Plan Comparison - HMO

	California Care HMO Value Deductible	Priority Select HMO Classic	Vivity HMO Value Deductible
Annual Medical Deductible (calendar year)
(Individual/Family)	$250 / $500	None	$500/$1,000
Annual Out-of-Pocket Limit (calendar year)
(Individual / Family)	$3,500 / $7,000	$2,500/$5,000	$3,500/$7,000
Office Visit
Annual Preventative Visit	$0	$0	$0
Primary Care Physician	$20	$20	$20
Specialist	$40	$40	$40
Urgent Care (Within Area*)	$20	$20	$20
Virtual Care Services***	$0	$0	$0
Diagnostic Services
Routine Lab & X-Ray	$0	$0	$0
Complex Imaging	$125	$125	$125
Hospital Services
Inpatient Stays	10% Coinsurance**	$500 Per Admission	20% coinsurance**
Outpatient Surgery	10% Coinsurance**	$250	20% coinsurance**
Emergency Room (Waived if admitted)	$200 and 10% Coinsurance**	$200	$200 and 20% Coinsurance**
Ambulance	$150	$150	$150
Mental Health and Substance Abuse
Inpatient	10% Coinsurance**	$500 Copay	20% coinsurance**
Outpatient	$0	$20	$20
Chiropractic Services
20 Visits Per Year	$20	$20	$20

*Urgent care services provided within the geographic area served by your medical group. Please consult your physician website or office for available urgent care facilities within the area served by your medical group.
**After deductible has been met.
***Benefits are available only when services are delivered through a Designated Virtual Network Provider. You can find a Designated Virtual Visit Network Provider by contacting Anthem at www.anthem.com or by calling the number on the back on your ID card.

Medical Plan Comparison - PPO

	Prudent Buyer PPO 1500	Prudent Buyer PPO HSA
Annual Medical Deductible (calendar year)
(Individual/Family)	$1,500/$3,000	$3,300/$6,600
Coinsurance	20%	20%
Annual Out-of-Pocket Limit (calendar year)
(Individual / Family)	$5,000/$10,000	$5,000/$11,200
Office Visit
Annual Preventative Visit	$0	$0
Primary Care Physician	$20	20% after deductible
Specialist	$40	20% after deductible
Urgent Care	$20	20% after deductible
Virtual Care Services*	$0	20% after deductible
Diagnostic Services
Routine Lab & X-Ray¹	20% after deductible	20% after deductible
Complex Imaging ¹	20% after deductible	20% after deductible
Hospital Services
Inpatient Stays ¹	20% after deductible	20% after deductible
Outpatient Surgery¹	20% after deductible	20% after deductible
Emergency Room (copay waived if admitted)	$150 copay and then 20% after deductible	20% after deductible
Mental Health and Substance Abuse
Inpatient¹	20% after deductible	20% after deductible
Outpatient¹	$20 Copay	20% after deductible
Chiropractic Services
30 Visits Per Year	$40 Copay	20% after deductible

Benefits shown are assuming in-network providers are utilized
1Prior Authorization Required
*Benefits are available only when services are delivered through a Designated Virtual Network Provider. You can find a Designated Virtual Visit Network Provider by contacting Anthem at www.anthem.com or by calling the number on the back on your ID card.