2020 Plan Highlights and Summary of Benefits (SBC's)

What the plans cover and what it costs

The information is a SUMMARY of what the plan covers and what it costs. More detailed information can be received directly from the carrier. Please refer to the Summary of Benefits and Coverage for each plan to find out how to contact the provider for complete terms in the policy or plan document.

Definition of Terms

Co-payments are fixed dollar amounts (for example, $15) you pay for covered health care, usually when you receive the service.

Co-insurance is your share of the costs of a covered service, calculated as a percent of the allowed amount for the service. For example, if the plan's allowed amount for an overnight hospital stay is $1,000, your co-insurance payment of 20% would be $200. This may change if you haven't met your deductible.

The amount the plan pays for covered services is based on the allowed amount. If an out-of-network provider charges more than the allowed amount, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and the allowed amount is $1,000, you may have to pay the $500 difference. (This is called balance billing.) The plan may encourage to use participating providers by charging you lower deductibles, co-payments and co-insurance amounts.

Medical - Actives and Early Retirees

Dental & Voluntary Vision Plan - Actives, Early Retirees, and Medicare Retirees

Dental & Voluntary Vision Plan
Plan Highlights
Evidence of Coverage
Delta Dental Premier PPO $1800 Annual Max
Plan Highlights (PDF)
N/A
Delta Dental Premier PPO $1600 Annual Max With Ortho (DSA & DAIA only)
Plan Highlights (PDF)
N/A
Delta Dental Premier PPO $1600 Annual Max
Plan Highlights (PDF)
N/A
DeltaCare HMO
N/A EOC (PDF)
VSP Voluntary Vision Plan (Active Employees Only)
Plan Highlights (PDF)
N/A

Medical - Medicare Retirees                                                                                                    

Medical Plan
Plan Highlights
Summary of Benefits and Coverage
Contra Costa COB Health Plan A
Plan Highlights (PDF)
Summary of Benefits and Coverage (PDF)
Contra Costa COB Health Plan B
Plan Highlights (PDF)
Summary of Benefits and Coverage (PDF)
Health Net COB HMO Plan A                            
Plan Highlights (PDF)
Summary of Benefits and Coverage (PDF)
Health Net COB HMO Plan B
Plan Highlights (PDF)
Summary of Benefits and Coverage (PDF)
Health Net Seniority Plus Plan A
Plan Highlights (PDF)
Summary of Benefits and Coverage (PDF)
Health Net Seniority Plus Plan B
Plan Highlights (PDF)
Summary of Benefits and Coverage (PDF)
Health Net SmartCare COB HMO Plan A (New Plan)
Plan Highlights (PDF)
Summary of Benefits and Coverage (PDF)
Health Net SmartCare COB HMO Plan B (New Plan)
Plan Highlights (PDF) Summary of Benefits and Coverage (PDF)
KPSA Plan A
Plan Highlights (PDF)
Summary of Benefits and Coverage (PDF)
KPSA Plan B
Plan Highlights (PDF)
Summary of Benefits and Coverage (PDF)