Health Insurance - cagov/ODI-Onboarding-and-State-of-CA-Benefits GitHub Wiki
Table of Contents
- Health Insurance Overview
- Terms You Need to Know
- Health Insurance Plans
- HMO Plans
- PPO Plans
- EPO Plans
Health Insurance
Health Insurance becomes effective the 1st day of the following month. (Example: If you are hired on October 5th, then your health insurance becomes effective November 1st)
2024 Health insurance Plans Overview
- See which plans are available in your area. Enter your zip code here
- View & compare contribution amounts with the Benefits Calculator
- If you were hired as any of the following, select "Excluded":
- Exempt
- CEA
- Supervisor
- Manager
- Information Technology Specialist III
- Information Officer II
- ODI employees who do not fall in one of the categories above will be in Bargaining Unit (BU) 1
- If you were hired as any of the following, select "Excluded":
civil service classification listed under "excluded" are specific to the roles we have at ODI, there may be other civil service classifications that fall under "excluded".
Terms You Need to Know
Some terms are common across health insurance plans — and they’re important to know as you’re deciding which plan to choose:
- Premium: The amount you pay monthly for health insurance coverage.
- Copayment: The upfront cost you pay for doctor visits, tests, prescriptions, etc.
- Deductible: The amount you must pay every year before your health insurance kicks in and starts covering some or all of the costs.
- Coinsurance (also called “Patient Responsibility”): This is the portion of your bill that health insurance doesn’t cover. When reviewing health insurance plans, you may see something like “20% coinsurance”. That means you’re responsible for 20% of the bill. So, for example, if a bill for a hospital stay comes to $10,000, you’re responsible for paying $2,000.
Health Insurance Plans
California offers three types of Health Insurance Plans: HMOs, PPOs & EPOs HMO - A Health Maintenance Organization (HMO) requires you to select a primary care provider (PCP) who oversees all aspects of your care, including referring you out for tests and care from specialists. HMOs cover you for care from providers within a network. There are no deductibles and you do not need to file claims. You cover most or all costs for care you receive from providers outside the network. HMOs are generally among the most affordable insurance plans when you add up monthly premiums, copayments and other out-of-pocket costs, however, you are geographically restricted to a service area Note: HMOs provide some coverage for urgent care or emergency care when you’re traveling outside your area, but be sure to check what they cover if you travel often. PPO - A Preferred Provider Organization (PPO) is similar to a traditional "fee-for-service" plan, but you must use doctors in the PPO provider network or pay higher co-insurance (percentage of charges). You must usually meet an annual deductible before some benefits apply. You're responsible for a certain co-insurance amount and the plan pays the balance up to the allowable amount. PPOs are the most flexible insurance plans. Rather than requiring you to get a PCP referral for specialty care, PPOs let you schedule appointments with specialists directly. Depending on your healthcare needs, PPOs are generally the most expensive plans when you add up monthly premiums, copayments and other out-of-pocket costs. EPO - The Exclusive Provider Organization (EPO) plans are similar to PPOs, in that they let you self-refer to specialists within the network. However, like an HMO, EPO plans do not cover you for care you receive from providers who are not part of the network, except in life-threatening emergencies. A narrow-network plan offers lower premiums but limits you to receiving care from fewer doctors and at a smaller number of facilities.