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HomeMy WebLinkAbout1982-12-21; City Council; 7237; Health Maintenance OrganizationCIT, OF CARLSBAD — AGENDA BILL ARft 7<a 37 MTG. 12/21/82 DEPT. CM TITLE: APPROVAL OF HEALTH MAINTENANCE (JKCaAJNl NATION r OR CITY hjMPliOYJilliS nEPT HD. ^^ CITY ATTY V/Z5 CITY MGR._^*^_ O£ O5 OO RECOMMENDED ACTION: Adopt Resolution No. *J Q ^ ^ approving agreement with Kaiser Foundation Health Plan in concept. ITEM EXPLANATION: As a result of negotiations with employee groups and as part of the revised insurance program approved by the City Council in July 1982, the City agreed to investigate the feasibility of implementing a health maintenance organization (HMO) program for city employees. City staff, representatives of employee groups, and Mike Baker, the City's employee benefits consultant, have reviewed HMO programs available to the City. Based on this review, it is recommended by staff, employee representatives and the City's consultant that the City enter into an agreement with Kaiser Foundation Health Plan. The plan will be implemented on January 1, 1983. The Kaiser plan is a prepaid group practice HMO. The benefits provided under this approach are outlined in Exhibit 1 . The rates for calendar year 1983 are as follows: Employee Only $67.09 Employee + One Dependent $134.18 Employee + Two or More Dependents $191.10 The Kaiser plan does not provide the same level of dental and vision coverage available through the city indemnity program; however, the employee does not have to pay any deductibles or co-insurance under the Kaiser medical plan. The Kaiser plan is being offered as an alternative to the city indemnity plan, an employee would take one or the other. An annual open enrollment period would be provided allowing employees to switch from the HMO plan to the indemnity plan and vice versa. Although there are no Kaiser facilities in the immediate Tri- City area, a number of employees, some who live outside the Tri-City area, have expressed a strong interest in the Kaiser plan. Kaiser has established medical offices in Escondido. FISCAL IMPACT; The approval of the Kaiser program will not increase costs to the City. For police, fire and management employees, the City will contribute the same amount to the Kaiser plan that is contributed toward the City's indemnity plan. The cost of miscellaneous W employees will be paid out of the $115 a month provided to those employees for benefits. The rates quoted by Kaiser are for the 1983 calendar year. PAGE 2 of AB # 7337 December 21, 1982 EXHIBITS; 1. Resolution No. *7 O 9 -5"" approving agreement with Kaiser. 2. Analysis of monthly costs for Crown and Kaiser Programs. .2 1 RESOLUTION NO. 7095 2 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA, APPROVING AN AGREE- 3 MENT WITH KAISER FOUNDATION HEALTH PLAN. 4 5 WHEREAS, the City of Carlsbad desires to provide a 6 health maintenance organization plan for city employees, 7 and * 8 WHEREAS, city staff and representatives of the employees' 9 association have reviewed various alternative ways to provide 10 a health maintenance organization plan for city employees, and 11 WHEREAS, city staff and representatives of employees' 12 association recommend implementation of the Kaiser Foundation 13 Health Plan, 14 NOW, THEREFORE, BE IT RESOLVED by the City Council of the 15 City of Carlsbad as follows: 16 1. That the above recitations are true and correct. 17 2. That the health plan proposal submitted by Kaiser 18 Foundation Health Plan, Incorporated attached hereto as 19 .Exhibit A is hereby approved in concept. 20 // 21 // 22 // 23 // 24 // 25 // 26 // 27 // 28 ' 4 5 6 7 8 R. KUNDTZ, Deputy 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PASSED, APPROVED AND ADOPTED at a regular meeting- of the City Council of the City of Carlsbad held the 2lst day of Decernber / 1982, by the following vote to wit: AYES: Council Msntoers Casler, Lewis, Kulchin, Chick and Prescctt NOES : None ABSENT: None //W • MARY H. CASLER, Mayor ATTEST: (SEAL) •"" /•-:>-''•'- •'-"'"'' - / '•'; u-' '•'.•• 1 1 L/'i^M-f^^J^^i;!^>iK||'v>:--y>:^|^ Kaiser Foundation Health , California Region:S^S^^iP ;;.•>;-•-. ./-,/.,-,'r"": ;•-.' V^: .-.-v^f-- "•-••'. '--.:;.:.''-v :-. ''* :{•;,:•'•••:! J-.X.v.' "•-'"- -:^':'c''. -•"• ;.v -';V;;r '.^'.:. '•;•--"- ':>',' "•:":.- ':;:' -.EXHIBIT -A: .,': •'• .:;/>X-; r":\::;.^:: '.' - -r •:-.•"'':',! - ..,;-. --';-.:-'.-«~\- '• :. -'; "'-'\'V "'• •'.'<'•'-''. r .";,- '•_ ''•'. ]-'. T"J't>; .".'t'V'i^,\\', ,.-••' _ ' ; .' V..•*:• •" ...•/• ' -t . .'**'. •" '*'- . .' •s "'--,'' * • .'. ,'"y*" "' •*•'* .v' ;'_' • CITY OF CARLSBAD Date:.'.:''.,:'vr.•'.; Octobet 25, 1982 - ^ :-"V; Prepared by:'" ''~ '' Health Plan Representative -- ^.^-" ••••:•>-=•• '•'•'- -I' ".''"-.'o --.•'•••'•-: •:•' "::.-^- --*-" '^ Enrollment &' Group Relations' /. " .; :'^'-: v ^^ -'^^f--'^-. ;j.^': 1 : "(714) " 563;-2300 _- ; .. / •• •=: v i/.;: C..; : ..^^ ^ -'.- -^This proposal represents a commitment of our Program assuming •''.'•'.-•.'.•- ' ;- . ": •"""•'. •'''•• ""'• '-,'"•'.. ^'; ':^-':'«;'v: :: :•'••'"" • >., - ';:'"':-'v-''\''-"V? ' an effective date oc'curing during the first quarter of 1983. -' "" • . 4. f " • . • Vv- j ''. "• • -•^•••y-^i;^ • -" " '' '•.••' -*,-.•' • -v' • ' •' *r,' •,'-•• •.••"-''"."•__.",,..• *• .-.'•- -.'* V -•'".• j* "*-1 v-- ' ' .'X.' • "'"' -•'_-,"''.. .*\"'L••- ">,;• •",! .* :.«•"."* "• /'..'";". ^. * *? '.»r +1- \. v..^"\'/ -'T.-l-..'-'. 1 -t^ ''*..-< -~".. -. •!! *» ,„.•-'-•-„•'. - i. ^ '. ,....*"-*•*''--'*-•-:-!. -...A;•• • .,..-•',% ,-..'...'•-- ^ ••„-.* •' ' '-,•-;* - '••-'•' V --•...' •- v ' ••- '*••' ' • "^'*'*•*;''-' - r-''.'i"--^-.":•"* ..*'• '"•' ".;•;' '"; -'-/' ":-~.vX »; :"';-/>'"v' ; ,J;'">•- "• :'":- *''>/" •:"^"-A*'"'-^..; •*". --^';';'* '-•^•i "'-'• 'V>'-v.v^: V'*'- :y^."-;V.:r^V ^"l"':-;-:^:':V>v:V^;'^-':;:5^;'^ BENEFITS AND RATES INFORMATION Coverage for employee, spouse, dependents to 19, and students to 24 A Coverage* Single $ 67.09 Two-Party , $134.18 Three or More • $191.10 Each member (up to 3 per Family Unit) entitled to benefits under both Parts A and B of Medicare who has assigned Part B benefits to Health Plan: SUBTRACT $ 32.21 For each member age 65 or older who is (1) not entitled to benefits under Part B of Medicare, or (2) entitled to benefits under Part B of Medicare but has not assigned such benefits to Health Plan: ADD $ 14.58 *The proposed coverage includes all HMO required benefits including Mental Health and Alcoholism and Drug Dependency benefits. Fully prepaid Maternity coverage is included to comply with Public Law 95-555. Since coverage would be effective after July 1, 1980, the coverage includes the State of California required Post-Mastectomy benefit. Prepaid Injectables and Prescription Drug 3 are also in- cluded in the coverage. The rates included here are 1983 rates and apply only to contracts which will be effective during the first quarter of the 1983 calendar year. CARE IN MEDICAL OFFICES A COVERAGE Medical office visits for diagnosis and treatment, Including visits for vision and hearing examinations, family planning, infertility and well-baby care; emergency room visits No Charge Diagnostic test and procedures: laboratory tests including cytology examinations and venereal disease tests, X-rays, nuclear medicine procedures including radioisotopes, sonograms, cardiovascular studies, audiologic function studies, EEC, EKG, EMG, and other diagnostic studies using elecrrosrirnulation or electronic equipment or producing recordings, tracings, images or similar readings No Charge Nuclear medicine procedures (including radioisotopes used therewith) for the treatment of cancer; radiotherapy No Charge Nuclear medicine procedures (including radioisotopes used therewith) for the treatment of conditions other than cancer; dermatological black light treatment No Charge Inhalation therapy, short-term physical therapy and occupational therapy, and orthoptics No Charge Intravenous fluids and'medications, additives and nutrients administered through intravenous fluids; generally available immunizations except mass immunizations, allergy test materials; chemotherapy medications generally available in the Service Area when prescribed by a Permanente physician for the treatment of -cancer; dressings, casts No Charge Unexpected mass immunizations The lesser of Health Plan's cost or 50% of non-member rates Allergy treatment materials No Charge Injected medication No Charge for most Intertables; reasonable rates for certain newly developed injectables CARE WHILE HOSPITALIZED A-COVERAGE Physicians services in the hospital, including operations No Charge Room and board, general nursing, special duty nurse when prescribed; intensive care; use of operating room No Charge Drugs and medicines; dressings, casts; anesthesia No Charge Diagnostic tests and procedures: laboratory tests including cytology examinations and venereal disease tests. X-rays, nuclear medicine procedures including radioisotopes, sonograms. pulmonary function studies, cardiovascular studies, audiologic function studies, EEC, EKG, EMG. and other diagnostic studies using electrostimulation or electronic equipment or producing recordings, tracings, images or similar readings No Charge Therapeutic procedures: inhalation therapy, short-term physical therapy and occupational -therapy, nuclear medicine procedures (including radioisotopes used therewith), radiotherapy No Charge Blood for transfusions There is no charge for the transfusion procedure. Laboratory services associated with transfusions are covered as indicated under "diagnostic tests and procedures" No charge if replaced per blood bank rules; if covered by Medicare; if a family unit member has given blood in the preceding 12 months; or if no member of the family unit meets the medical criteria for blood donors ALCOHOLISM AND DRUG DEPENDENCY Treatment, including counseling for dependency and medical management of withdrawal symptoms, is provided in medical offices in group and Individual sessions without charge. When prescribed, hospitalization for medical management of withdrawal symptoms is provided on the same basis as hospitalization for any other condition. Home visits and methadone maintenance are not provided. AMBULANCE SERVICE Approved necessary ambulance service within Service Area No Charge CHRONIC KIDNEY CONDITIONS CARE Upon direction by a Permanente physician. Health Plan will arrange for hemodialysis for chronic kidney conditions or for kidney transplants at no charge, provided that the members condition meets the criteria of the facility to which referral is made EXTENDED CARE Physician's services No Charge 100 days of skilled Nursing Facility level of care per calendar year at designated facilities when prescribed by Permanente physicians; includes room and board, general nursing, drugs and biologicals For Part A and Medicare members the covered days of extended care services will be reduced and offset by all days covered in whole or in part by Medicare which were not prescribed or directed by a Permanente physician or which were received in facilities not designated by the Health Plan No Charge II HEALTH EDUCATION Heallh education services for specific conditions, such as diabetic counseling, post-coronary counseling and nutritional counseling No charge When available, general health education services not addressed to a specific condition, such as weight control classes and anti-smoking classes Reasonable rates Education in appropriate use of Plan services and printed health education publications with instructions on achieving and maintaining health No charge Recorded health education programs At Health Plan's cost HOME CARE Self-administered medications: Intravenous fluids and medications, nutrients and additives administered through intravenous fluids, and amino acid-modified dietary products used for treatment of inborn errors of amino acid metabolism obtained at a Kaiser-Permenante pharmacy are provided at no charge. Members not entitled to Medicare benefits: Home health services; prescribed part-time, intermittent services of registered nurses, home health aides and medical social workers are provided without charge. Prescribed inhalation therapy and short-term physical therapy and occupational therapy are provided without charge. Members entitled to Medicare benefits: Home health services; prescribed visiting nurse service; physical, occupational and speech therapy; part-time services of home health aides, social services and durable medical equipment when covered in whole or in part by Medicare are provided without charge. Physician's home visits for supervision of home health services are provided without charge. MATERNITY CARE Full care for mother after confirmation of pregnancy. This includes physicians services, hospitalization. X-ray and laboratory services, and, if necessary, cesarean section. Full care of child during mothers confinement. Thereafter coverage for the newborn continues only if the parent applies for enrollment of the newborn (and pays prepayment fees, if any) within 30 days of birth. No charge Interrupted pregnancy (spontaneous or induced termination of pregnancy) No charge • MEDICAL SOCIAL SERVICES Includes hospital discharge planning, counseling No charge OUT-OF-PLAN EMERGENCY CARE Emergency care is medically necessary health service that is generally available and customarily provided in Southern California and which is immediately required because of unforeseen illness or injury. This benefit applies only to care required before a members condition permits transfer to the nearest Kaiser-Permanente facility: continuing or follow-up,care is not covered. Medically necessary special transportation to such facility will be covered with prior Kaiser-Permanente approval. Payment will be made for Emergency Care Within the Service Area obtained from physicians and hospitals not associated with Kaiser-Permanente provided that: Kaiser-Permanente facilities were not used because to have done so would have entailed a delay which would have resulted in death, serious disability or significant jeopardy to the members condition, or because the choice of provider was beyond the control of the member or the members immediate family. Payment will be made for Emergency Care Outside the Service Area in the following circumstances: For members residing uiiihin the Service Area provided that: Emergency services were received outside the Service Area because the member became ill or was injured while outside the Service Area. For members residing outside the Service Area provided that: Emergency services were received outside the Service Area because the member became ill or was injured while outside the Service Area and: A. The member became ill or was injured and received emergency service while more than 30 miles from home or; B. The member was less than 30 miles from home and emergency services were needed to prevent death, serious disability, or significant jeopardy to the members condition, and it would have been unreasonable to expect the member to obtain emergency services from Kaiser-Permanente facilities: or if the choice of the provider was beyond the members control and that of the members immediate family. » Newborn deliveries occurring outside the Service Area are considered emergencies in situations of unexpected premature deliveries. Normal deliveries (after 8 months of gestation) are not considered emergencies unless Health Plan determines that the member was outside the Service Area because of circumstances beyond her control or because of extreme personal emergency. MEMBER PAYS Copayments The member must pay the amounts which would have been paid as supplemental charges at Kaiser- Permanente facilities for the emergency care. Health Plan's payment will be reduced by such amounts. If care is obtained within the Service Area or within 30 miles of the home of a member who resides outside the Service Area, the member must pay 50% of the first $100 in excess of the supplemental charges. Health Plan will pay only the reasohable cost of emergency care obtained from physicians or hospitals not associated with Kaiser-Permanente. The member is responsible for payment of that portion of any charges deemed not reasonable Such payments, if out of pocket to the member, are copayments under the Supplemental Charges Maximum provision. /3 OUT-OF-PLAN EMERGENCY CARE (continued) Reductions Payment will be reduced by any Other Benefits, which means all amounts paid or payable (or which would be paid or payable if there were no Health Plan benefits) under Medicare, any insurance policy or contract or any government programs except Medicaid (Medi-Cal). However, if a member notifies Health Plan that Other Benefits have not been paid within a reasonable time. Health Plan will make payment for the emergency care provided that the member (or the family member entitled to do so) assigns all Other Benefits to Health Plan and agrees to fully cooperate with Health Plan in obtaining such Other Benefits and allows Health Plan to obtain confirmation from the source of Other Benefits that they have not been paid. Any person claiming out-of-plan emergency care benefits shall furnish Health Plan with such information as may be rlecessary to implement these provisions. Any overpayment by-Health Plan may be recovered from the person to whom made or from any insurance company or organization that is obligated to pay for the care received. Payment under this benefit for emergency services required as the result of illness or injury caused by a third party is made if the member agrees in writing to reimburse Health Plan for any amount paid up to the amount of any settlement or judgment received and directs his or her attorney to pay such amount directly to Health Plan. This paragraph does not apply to Medicare members. POSTMAST1ECTOM_Y If all or part of a breast is removed for medically necessary reasons on or after July 1.1980. reconstructive surgery when medically feasible and prosthetic devices incident to that mastectomy are provided without charge. External prosthetic devices will be provided by designated sources. Replacement will be made when prosthesis is no longer functional. Custom made prostheses will be provided when necessary. SPEECH THERAPY^ ^^ ^Prescribed speech therapy, while hospitalized, in a medical office or as a home health service is provided on a groap or individual basis at a charge of $5 per visit for the first 30 visits for each condition. Additional prescribed visits are at non-member rates except that further treatment of articulation disorders associated with congenital abnormalities of the palate are provided at $5 per visit. Prescribed visits covered in whole or in part by Medicare are provided at no charge. An appointment which is broken will count as a visit unless properly canceled. MENTAL HEALTH 3 WHAT IS COVERED Mental health care specified below will be provided for acute psychiatric conditions which in the judgment of the Permanente physician are subject to significant Improvement through relatively short- term therapy. The calendar year maximums for office visits, days of hospitalization and day care/night care sessions Include services provided during the calendar year under this and any other enrollment in Health Plan. MENTAL HEALTH SERVICES IN MEDICAL OFFICES Diagnostic evaluation and individual and group therapy. Copayments Medicare Member pays: Nothing for first 20 visits each calendar year, $5 each visit thereafter. Other Members pay: $10 per visit for first 20 visits each calendar year, non-Member rates thereafter. Prescribed psychological testing is provided without charge. If you do not keep an appointment or do not give 24 hours' notice of cancellation by calling the appointment desk when you schedule the appointment you will be charged any copayment which would have applied to the visit and the number of covered visits will be reduced by one visit. MENTAL HEALTH HOSPITALIZATION AND DAY OR NIGHT CARE Up to 45 days each calendar year of psychiatric hospitalization, Including professional services. Two sessions of day care or night care may be provided in lieu of one day of psychiatric hospitalization. Copayments Member pays: Nothing for first 14 days, 25% of non- member rates for each of the next 31 days, except that Member pays nothing for days covered In whole or in part by Medicare. EXCLUSIONS B Care for chronic psychosis, organic psychosis and other conditions which a Permanente physician considers would not be responsive to therapeutic management O Care for the mentally retarded B Care as a condition of parole or probation B Court-ordered testing B Testing for intelligence, aptitude or interest STUDENTS/OVER AGE COVERAGE Coverage will be extended to age 24 for the unmarried dependent child of the subscriber or the subscriber's spouse provided that the child is attending an accredited school on a full time basis. Under these benefits, group coverage ceases at the end of the mon_h in which the stated age is attained. Exclusions, Limitations, Reductions on Benefits The following are excluded from coverage under this plan: • Financial responsibility for conditions covered by Workers' Compensation or for which care or reimbursement is available from a government agency or program other than Medicaid. • Military service -connected conditions, as defined by the Veterans Administration, for which care is reasonably available to the member from the Veterans Administration. • Physical examinations and related services for insurance, employment, licensing. • Dental care and dental X-rays (including injury to teeth). 4 • Service to reverse voluntary infertility. • Podiatry. • Chiropractic. • Experimental procedures and procedures not generally and customarily available in Southern California. • Plastic surgery or other services primarily for cosmetic purposes (except for reconstructive surgery as described under Post-Mastectomy Benefit). • Custodial, domiciliary, convalescent and intermediate care. • Corrective appliances and artificial aids (except for prosthesis as described under Post-Mastectomy Benefit). • Durable equipment (except for members entitled to Medicare benefits as described under Home Care). • Blood unless the conditions specified in chart for blood at no charge are satisfied. • Organ transplants, except kidney transplants. • Services related to sex changes. Limitations in Services Health Plan is not responsible for the following: • Delay or failure to render services due to a major disaster or epidemic affecting Kaiser-Permanente facilities or personnel. • Unusual circumstances, such as complete or partial destruction of facilities, war, riot, labor disputes not involving Plan organization, disability of a significant number . of personnel, or similar events which result in delay in providing services or inability to provide services; non-emergency care may be postponed in the event of labor disputes Involving Plan organizations. • Conditions for which member has refused recommended treatment for personal reasons, when Permanente physicians believe no professionally acceptable alternative treatment exists.- • Rehabilitative treatment is limited to conditions (including acute phases of chronic conditions) subject to significant improvement through relatively short-term therapy. • Mental Health services are limited as described under the Mental Health Benefit. • Services for Alcohol and Drug Dependency are limited as described under the Alcoholism and Drug Dependency Benefit. 17 Reductions • Services will be provided If you are injured through the fault of someone else, such as in an auto accident. However, tf you colled any amount from the other person or his or her insurance company, you must pay Health Plan non-member rates for all hospital and medical services paid for by Health Plan or provided by Kaiser- Permanente to care for your injuries. The amount collected from you will never exceed either the lower of non-member rates or the amount you collect from the other person or his or I ?.r insurance company. Payment of Out-of-Plan emergency benefits is made for the services of physicians, hospitals, and other providers not- contracting with Health Plan but only if the member executes an agreement (1) to reimburse Health Plan for any amount it pays up to the amount of any settlement or judgment the member received, and (2) directing his or her attorney to disburse such amounts directly to Health Plan. (This reduction does not apply to Medicare members.) Members will be charged non-member rates for services for which they are entitled to payment under Medicare and for which they have not made assignment. Effective 1/1/81 Supplemental Charges Maximum Registration charges, If any, for medical office, hospital emergency room or home visits and supplemental charges, If any, for maternity care, inhalation therapy, physical therapy, orthoptics, for services listed under diagnostic tests and procedures, nuclear medicine treatments and Isotopes, dermatological black light treatments, and charges, if any, for the first 20 mental health visits each calendar year, If a covered benefit, and out-of-plan emergency care claims copayments for these services, paid by the member, are subject to calendar year maximums. Please note that other payments, such as those for speech therapy and drugs and, if applicable, for occupational therapy and those made for services provided if you are injured through the fault of someone else, are excluded from this provision, as are out-of-plan emergency care payment reductions made because of other benefits. There is a maximum for these supplemental charges paid by each member and a maximum for the total supplemental charges paid by all the members of a family unit. Each year the supplemental charges maximum for a member and for family units will be announced for the following calendar year. When a member or a family unit has incurred the appropriate supplemental charges maximum, the member or family unit will be exempt from such supplemental charges for the remainder of the calendar year. It is the member's responsibility to obtain and keep receipts for such charges and to present them as proof that the copayment limitation has been reached. Identification will be provided to exempt members. Any exemption from supplemental charges will be effective only for the date proof of eligibility for the exemption is presented. Information regarding current supplemental charges maximums and procedures may be obtained from the Membership Service Department at each medical center. >T Temporary Identification Card Groups contracting with Kaiser Foundation Health Plan are now encouraged to take advantage of the Temporary Identification Card Program. The Temporary Identification Cards are issued by the group's representative and are designed to identify new members seeking care in our facilities prior to receiving the plastic Identification Cards. Temporary Identification Cards contain information which will assist the new member in registration, appointment making or admission to the hospital at one of our facilities. When issuing the Temporary Identification Card, we request that the group's representative (Benefits or Personnel officer) complete the following steps — • on the Temporary Identification Card, indicate the effective date of coverage and list all new members for the account — including birth dates for each new member • explain use of the Temporary Identification Card to the subscriber • request signature of subscriber Temporary Identification Cards will be provided to the Group by the Kaiser Foundation Health Plan Representative. The Group name, Group number and information concerning benefits will be preprinted on the Temporary Identification Card by Kaiser Foundation Health Plan, Temporary Identification Cards are effective for three months following the effective date of coverage. When a new member receives his permanent plastic Identification card, he should discontinue use of the Temporary Identification Card. Your Kaiser Foundation Health Plan Representative will supply detailed instructions on the use of the Temporary Identification Card. TEMPORARY IDENTIFICATION FOR NEW MEMBERS Dear Member NTekome to the Katscr Foundation Hcahh PUn. Enclosed is a temporary Identification Card which includes your group name, group number and the benefits provided under your coverage. Please use this card when scheduling appointments or receiving care until you receive a permanent, plastic Identification Card Vt look forward to being of service tu you and member* of your family. Sincerely, Mktud H Kjichor Vkc Prmdcnt Health PUn Mirny* USE OF THK CARD Thn r^rJ cunuins infurnutMjn mtiich will v rase rcguimiun and apfn»nirt>rnt yuur imual VCMU to «MJT fxiliim You and mcmhen u( >IMIT family «h»okJ tutT M mdrfy awilahlc »h«i scheduling or Ncciving care. This cjid can hr tk-t*chcd fmm this brochure along the pcrfi>nitcU ht>nlci and htkkd twice Tor mvnton m vnur »^lki I'v: of iha card »iU be matthcd ti> the jpplicaiu.n lorm you vjhmmcd to easurc vtxi are nut biBed for frrvice* received » Kauer Prrmanentc Medical Cenirn .w Medicai OiT.ors Ptene dwruniinue the use vt this icmpunr)' UeTMificaiiun Ord * hen you uxl mrmhrrt *rf yuur famih rcvtive your pcrnuncm. plauic Idcntiftcatiiin Cards. Wb«a you COOK Into our factlhle* for care, plcuc fkrnent thii card to tbc reccpitonlM or 10 m member of our Admitting; Department itaff. »Tx«« >cb«duUn| aa appolauneat by trlcphoac or la prr*on at one of our^cUltle*, pica** Indicate Uui you are * ar« .wenbcr. your employer'* DJUBC. gro«p •unbcf and coverage code (S, A, etc.^ rOM ffFECTtVl DATM The due «>ur covcnge hcfi>mes efTertive • MVJivjfciJ irnnr y»ur Empkivcr Rrprorrniiiivr'* MKAJIUIT Thu rDciinT «!HC iif «-<>iirrjfK MuctermineJ hy ><HJ> iTnrtk>>'cr Vimr cmpUntt» refirorniaiive mill vgn th» temp-no1 IdrruilVmon Cj»J *nd itvlnJW the rffevilve date of uivc-rage If the rfletiivc UMC uf cmrrape. thr n«me jnd due »f bmh of family memberi. or ihe Employer Repirtcnuiivci vgnaiurc have been MrmueiJ from ihi* card. pkAV cunijci youi employer's Ferwinel OfTice ai MKM ai pnuihle Thu tcmpiHary klennficiiMM Cird u valid f(>t three monitu from ihe date yuur covrtage u rfTecmre <u until you kwr coverage. whtchc*er occun fin* m m Southern C*Orr NAME: CIKX P Nt MM* CORKAGE REG LXP IN) AU MS MH DUG EFFECTIVE DATE . %K.NATL RE Or EMPLOYE* *IPRESENTATIVE I hjv* rumptnrU and tuNnntcil mr ^plmmin lu it* lUner Fuurnfciun Health Ftaft. l RE t* St BV NIBEJI M KiCIUBCR fAMtLV MtMBEU DATE or BIRTH DATE or BIRTH KAISER-PERMANENTE MEDICAL CARE PROGRAM SOUTHERN CALIFORNIA REGION PASADENA MONROVIA GLENDORA FOOTHILL FWY12101 gX \\ PARK \tOS ANGELES LONG SAN BEACH FACILITIES SAN DIEGOKAISER-PERMANENTE MEDICAL CENTER (Hospital ant) Medical Offices) 24-hour emergency services KAISER-PERMANENTE MEDICAL OFFICES KAISEH-PERMANENTE MENTAL HEALTH FACILITIES 2-3 ! BELLFLOWER AREA ; 1 BELLFLOWER Hospital i and Medical Offices | 9400 E. Rosecrans Avc., | Bellflower j 9333 E. Rosecrans Ave., ; Bellflower 1 2 BELLFLOWER : Medical Offices' ' 10251 Ariesia, Bellflower 3 CERRITOS Medical Offices | 10929-10945 South St., Cerritos 5 4 HUNTINGTON PARK | Medical Offices 1 2680 Saturn Ave., Huntington Park 5 NORWALK Medical Offices '• 12500 S. Hoxie Ave., Norwalk METROPOLITAN LOS ANGELES AREA 6 LOS ANGELES Kaiser Foundation Hospital : 4867 Sunset Blvd., Los Angeles 6 LOS ANGELES Medical Offices 1505 N. Edgemont St., Los Angeles 1510 N. Edgemont St., Los Angeles 1526 N. Edgemont St., Los Angeles 4900 Sunset Blvd., Los Angeles 4733 Sunset Blvd., Los Angeles 1515 N. Vermont Ave., Los Angeles 7 LOS ANGELES Health Evaluation Center 1530 Hillhurst Ave., Los Angeles 8 • DOWNTOWN Medical Offices 1000 W. 8th PI., Los Angeles 9 DOWNTOWN Mental Health Center 765 W. College St., Los Angeles 10 EAST LOS ANGELES Medical Offices 5220 Telford St., Los Angeles ORANGE COUNTY AREA 11 ANAHEIM Hospital and Medical Offices Canyon General Hospital 441 N. Lakeview Ave., Anaheim 411 N. Lakeview Ave., Anaheim 12 ANAHEIM Medical Offices 1184 N. Euclid Ave., Anaheim 1188 N. Euclid Ave., Anaheim 13 GARDEN GROVE Medical Offices 11900 Gilbert St., Garden Grove 14 HUNTINGTON BEACH Medical Offices 18081 Beach Blvd., Huntington Beach * 15 ORANGE Medical Offices 200 N. Lewis Ave., Orange INLAND COUNTIES AREA 16 FONTANA Hospital and Medical Offices 9961 Sierra Ave., Fontana 17 INDIAN HILL Medical Offices 250 W. San Jose St., Claremont 18 ONTARIO Medical Offices 1025 W. "1" St., Ontario 19 RIVERSIDE Medical Offices 3951 Van Buren Blvd., Riverside 20 SAN BERNARDINO Medical Offices 1717 Date PL, San Bernardino 21 UPLAND Mental Health Offices 222 Mountain Ave., Upland SAN DIEGO AREA 22 SAN DIEGO Hospital and Medical Offices 4647 Zion Ave., San Diego 23 BONITA Medical Offices 3955 Bonita Rd., Bonita 24 CLAIREMONT MESA Medical Offices 7060 Clairemont Mesa Blvd., San Diego 25 EL CAJON Kaiser Foundation Hospital 203 Travelodge Dr., El Cajon 26 LA MESA Medical Offices 8010 Fletcher Parkway Dr., La Mesa 27 MAPLE STREET Psychosoclal Services 328 Maple St., San Diego 28 MISSION BAY Medical Offices 3033 Bunker Hill St., San Diego 29 POINT LOMA Medical Offices 3420 Kenyon St., San Diego SAN FERNANDO VALLEY AREA 30 PANORAMA CITY Hospital and Medical Offices 13652 Cantara St., Panorama City 14600 Roscoe Blvd., Panorama City 31 ARLETA Medical Offices 9134 Woodman Ave., Arleta 32 GRANADA HILLS Medical Offices 10401 Balboa Blvd., Granada Hills 16800 Devonshire Blvd., Granada Hills 33 LANCASTER Medical Offices 43112 N. 15th St. W., Lancaster 34 PANORAMA CITY Medical Offices 8001 Ventura Canyon Ave., Panorama City 35 VAN NUYS Medical Offices 13746 Victory Blvd., Van Nuys 36 WOODLAND HILLS Medical Offices 21263 Erwin St., Woodland Hills 5855 De Soto Ave., Woodland Hills SAN GABRIEL VALLEY AREA 37 PASADENA Medical Offices 450 N. Lake Avc., Pasadena 38 WEST COVINA Medical Offices 1249 Sunset Ave., West Covina 39 WEST COVINA Mental Health Offices 1539 Garvcy Avc., West Covina SOUTH BAY AREA 40 HARBOR CITY Hospital and Medical Offices 25825 S. Vermont Avc., Harbor City 41 HARBOR CITY Medical Offices 25975 S. Normandie Ave., Harbor City 42 LOMITA Psychosocial Services 2075 Palos Verdes Drive N., Ste. 2081, Lomita 43 LONG BEACH Medical Offices 3820 Cherry Ave., Long Beach 44 CARSON Medical Offices 23701 S. Main St., Carson WEST LOS ANGELES AREA 45 WEST LOS ANGELES Hospital and Medical Offices 6041 Cadillac Ave., Los Angeles 5971 Venice Blvd., Los Angeles 5981 Venice Blvd., Los Angeles 46 INGLEWOOD Medical Offices 110 N. La Brea Ave., Inglewood A7 INGLEWOOD Skilled Nursing Facility 3425 W. Manchester Blvd., Inglewood 48 WEST LOS ANGELES Medical Offices 2310 S. La Cienega Blvd., Los Angeles 49 WEST LOS ANGELES Medical Offices 130 N. La Cienega Blvd., Los Angeles Kaiser Care Outside the Southern California Service Area Southern California members of Health Plan who are temporarily visiting the areas listed below may obtain medical and hospital services for accidents or unforeseen illnesses requiring immediate attention at Kaiser-Permanente or Kaiser/Prudential facilities. Benefits at. J supplemental charges may vary, but the coverage for care you receive in these facilities will approximate your Southern California coverage. *Kaiser-Permanente: Northern California: Antioch, Hayward. Martinez, Napa, Oakland, Redwood City, Richmond, Sacramento, San Francisco, San Jose, San Rafael, Santa Clara, South San Francisco, Sunnyvale, Vallejo, Walnut Creek Colorado: Denver, Lakewood, Westminster District of Columbia: Washington Hawaii: (Maui) Lahaina, Wailuku, (Oahu) Honolulu, Kaneohe, Maili, Niu Valley, Waipahu Maryland: Gaithersburg, Kensington Ohio: Cleveland, Parma Oregon: Beaverton, Clackamas, Portland, Salem Virginia: . Reston Springfield Washington: Vancouver Kaiser/Prudential Health Plan: Texas: Dallas-Fort Worth Members who move to another Health Plan region or to thegeographic area served by Kaiser/Prudential Health Plan must promptly apply to a Health Plan office in that region to transfer membership. The right to out-of-plan emergency benefits and to services in the service area of another Health Plan region or in the geographic area served by Kaiser/Prudential ends after a member has lived in the other area for 90 days, unless the member receives prior written authorization for continuation of these benefits and services from Health Plan. Kaiser Foundation Health Plan Southern California Region All new Membership in Kaiser Foundation Health Plan is limited to those individuals who reside within the zip codes listed below. 90000 through 90099 90101 through 90199 90200 through 90299 90300 through 90399 90400 through 90499 90500 through 90599 90600 through 90699 90700 through 90703 (Avalon excluded) 90705 through 90799 90800 through 90899 91000 through 91099 91100 through 91199 91200 through 91299 91300 through 91399 91400 through 91499 91500 through 91599 91600 through 91699 91700 through 91799 91800 through 91899 92100 through 92199 92400 through 92499 92500 through 92599 92600 through 92671 (San Clemente excluded) 92673 through 92699 92700 through 92799 92800 through 92899 In zip codes beginning with 920, 922, 923, 930 and 935, only the specific zip codes listed below are within the Enrollment Area. 92001 92002 92007 92008 92010 92011 92012 92014 92016 92017 92040 92041 92045 92047 92048 92050 92053 92054 92062 92063 92083 92220 92223 92305 92307 92314 92315 92316 92317 92318 92341 92343 92345 92346 92348 92352 92353 92354 92356 92358 92381 92382 92385 92386 92388 92391 92392 92395 92396 92397 93510 93532 93534 93543 93544 93550 93553 93563 92020 92021 92022 92024 92025 92026 92027 92031 92032 92035 92037 92038 92064 92065 92067 92069 92070 92071 92073 92075 92077 92078 92080 92082 92320 92321 92322 92324 92325 92326 92329 92330 92333 92335 92339 92340 92359 92360 92362 92367 92369 92370 92371 92372 92373 92376 92378 92380 92399 93010 93015 93021 93040 93060 93063 93064 93065 EXHIBIT 2 'ANALYSIS OF MONTHLY EMPLOYEE'S COST FOR CROWN AND KAISER PROGRAMS CROWN Police and Fire Total Premium Employee $ 51.87 Employee + one 118.77 Employee + two or more 183.32 City Pays $ 46.87 101.77 149.32 Employee Pays $ 5.00 17.00 34.00 Miscellaneous Employee 51.87 Employee + one 118.77 Employee + two or more 183.37 $115.00 115.00 115.00 0 3.77 68.37 KAISER Police and Fire (1)Total Premium Employee $ 67.09 Employee + one 134.18 Employee + two or more 191.10 City Pays $ 46.87 101.77 149.32 Employee Pays $20.22 32.41 41.78 Miscellaneous Employee $67.09 Employee + one 134.18 Employee + two or more 191.10 (1) $115.00 115.00 115.00 $ 0 19.18 76.10 City pays same amount for Kaiser as for Crown Medical, Dental, and Vision.