Careers > PDL Benefits

Who is Eligible for Benefits Coverage

The PDL benefits program is offered to:

  • Regular full-time employees (minimum 30 hours per week); and
  • Regular part-time employees (20-29 hours per week).

Actual hours scheduled are based on the department need.

If you’re eligible, you can elect medical and dental coverage for your:

  • Legal spouse
  • Registered same sex domestic partner
  • Dependent children up to the age of 19 (age 24 if the child is a full-time student who are dependent on your for financial support and for whom you are entitled to an income tax exemption
  • Dependent children of any age who are physically or mentally incapable of caring for themselves, who are chiefly dependent on you for financial support and for whom you are entitled to an income tax exemption.

When you cover dependents, PDL requires proof of dependent status, such as birth certificates and/or full-time student proof for children, and a marriage certificate if you are adding your spouse. Employees who wish to cover a domestic partner will need to complete an affidavit for coverage.

Generally, for employees and their dependents who are first eligible, benefits begin on the first day of the month after you complete 30 continuous days of PDL employment.

Medical Plan Choices

PDL offers eligible employees a choice of three medical/vision plans so you can choose the coverage that works best for your family. One is a Preferred Provider Organization (PPO) and the other two are Health Maintenance Organization (HMO) plans. If you enroll in a medical plan, you are automatically enrolled in vision coverage.

All medical coverage is provided through Anthem Blue Cross. Vision coverage is provided through Vision Service Plan (VSP). The three options are:

  • PPO $30 Copay

    This plan offers you the choice of seeing Anthem Blue Cross network providers or seeing providers outside the network. When you use the network providers, however, you pay less. You must satisfy a deductible before the plan begins to provide benefits. Although you have greater flexibility with the PPO, the coverage costs more than your other options.
  • Classic HMO

    This plan has dedicated Anthem Blue Cross local doctors and facilities. You must get all of your care through the local HMO to be covered, except in the event of an emergency. This plan option does not include a deductible.
  • Saver HMO

    The Saver HMO works the same way as the Classic HMO. The only difference is that the Saver HMO option has a lower employee contribution, but includes a deductible and higher out-of-pocket maximums.

Whichever plan you choose, be sure that all family members you want to cover live in a network service area. For example, a child away at college might not have convenient network providers nearby. In that case, the PPO option may make more sense for you and your family.

Please see the following page for a comparison chart of your three medical plan options.

Summary of Medical Plan Choices

This chart shows how the PPO $30 Copay Plan, Classic HMO Plan and Saver HMO Plan compare. Remember that if you elect medical coverage, you will automatically be enrolled in the vision plan. Your enrollment kit includes more detail about the medical plans and a summary of the vision benefits.

Plan Features PPO $30 Copay Plan Classic HMO Plan Saver HMO Plan
  In-Network Services Out-of-Network Services Network Services Only Network Services Only
Annual Plan Year Deductible $500 per member for all covered services except office visits None $1,500 per member
Annual Out-of-Pocket Maximum $4,000 per member, with a two-member maximum

Certain member payments do not apply
$10,000 per member $1,750 per member

$3,500 per family

Certain member payments do not apply
$2,250 per member

$4,500 per family

Certain member payments do not apply

Lifetime Covered Charges paid by Anthem Blue Cross $5,000,000 Unlimited Unlimited
Office Visit Copays Includes office visits for maternity $30 copay for initial 12 office visits per member; additional office visits cost 45% of negotiated rate 50% of negotiated fee, plus 100% of excess charges $20 copay $20 copay
Other Professional Services Includes maternity, diagnostic lab and x-rays 30% of negotiated fees after deductible 50% of negotiated fee, plus 100% of excess charges after deductible No charge No charge
Hospital Inpatient Facility Services 30% of negotiated fees after deductible All charges in excess of $650 per day after deductible $250 copay per admission No charge after deductible
Hospital Inpatient Professional Services Lab, physician, anesthesia 30% of negotiated fees after deductible 50% of negotiated fee, plus 100% of excess charges after deductible No charge No charge
Outpatient Facility Services 30% of negotiated fees after deductible All charges in excess of $380 per day after deductible 20% of negotiated fee No charge after deductible
Ambulatory Surgical Centers 30% of negotiated fees after deductible All charges in excess of $380 per day after deductible 20% copay No charge after deductible
Prescription Drugs

Generic Drugs

Brand-name if generic not available

Brand-name if generic is available
$15 copay

$25 copay after $150 annual brand-name deductible

$15 copay plus the difference between brand-name and generic-equivalent after $150 annual brand-name deductible
50% of drug limited fee schedule plus 100% of excess charges if filled within California after $150 brand-name deductible per network, in-network and out-of-network combined $10 copay

$25 copay after $150 annual brand-name deductible

$10 copay plus the difference between brand-name and generic-equivalent after $150 annual brand-name deductible
$10 copay

$25 copay after $150 annual brand-name deductible

$10 copay plus the difference between brand-name and generic-equivalent after $150 annual brand-name deductible

Dental Plan Choices

You can choose between two dental plans. One is a Preferred Provider Organization (PPO) and the other one is a prepaid dental plan. Coverage under both options is provided by Delta Dental.

  • PPO

    With this plan, you can go to any dentist you want, but you pay less if you go to a provider who is in the Delta Dental network. The plan provides greater flexibility than the Prepaid dental option, but it also costs more.
  • Prepaid

    This plan has dedicated DeltaCare local dentists and facilities. You must get all of your care through the local network service area to be covered. As with medical coverage, be sure that all family members you want to cover live in a network service area. For example, a child away at college might not have convenient network providers nearby. In that case, the PPO option may make more sense for you and your family.

Summary of Dental Plan Choices

This chart shows how the PPO Plan and the Prepaid Plan compare to each other. For more detailed information, please refer to the Summary of Features for each plan that is included in your enrollment kit.

Plan Features PPO Plan Prepaid Dental
  In-Network Services Based on the contracted fees Out-of-Network Services Based on the contracted fees Network Services only * Subject to reasonable and customary rates
Annual Deductible $50 per individual
$150 per family
$50 per individual
$150 per family
None
Annual Maximum Benefit $2,000 $1,500 None
Diagnostic/Preventive Services (Cleanings, exams, x-rays) 100% deductible waived 80% deductible waived Covered per scedule of services
Basic Resorative Care (Fillings, ectractions) 80% after deductible 80% after deductible Covered per schedule of services
Major Resorative Care (Bridges, dentures, crowns) 50% after deductible 50% after deductible Covered per schedule of services
Orthodontia (Adult and Children) 50% to $1,000 lifetime maximum 50% to $1,000 lifetime maximum Covered per schedule of services

Employee Contributions

The following outlines your per pay check cost for the PDL medical and dental plans effective August 1, 2009. If you choose to decline coverage for these benefits you will receive additional taxable income. The contributions for your benefits are deducted on a pre-tax basis 26 times per year.

Medical Plan
Plan Employee Only Employee + Spouse

Or

Employee + Domestic Partner
Employee + Children Employee + Family

Or Employee + Domestic Partner + Children
  Full Time Part Time Full Time Part Time Full Time Part Time Full Time Part Time
PPO $11.54 $47.54 $72.68 $102.48 $68.35 $99.12 $120.00 $158.40
Classic HMO $6.92 $34.62 $63.45 $95.18 $59.12 $92.82 $94.40 $124.05
Savor HMO $0.00 $27.69 $54.22 $91.63 $51.08 $90.93 $80.55 $124.05
Decline Coverage ($9.62) ($9.62)


Dental Plan
Plan Employee Only Employee + Spouse

Or

Employee + Domestic Partner
Employee + Children Employee + Family

Or Employee + Domestic Partner + Children
  Full Time Part Time Full Time Part Time Full Time Part Time Full Time Part Time
PPO $2.31 $4.62 $12.36 $14.67 $20.30 $22.61 $32.66 $37.27
Prepaid DeltaCare $0.00 $2.31 $6.93 $6.93 $6.98 $6.98 $10.06 $10.06
Decline Coverage ($1.92) ($1.92)

Flexible Spending Accounts

PDL offers you the chance to save on taxes through two flexible spending accounts (FSAs):

  • The Health Care Spending Account, which you can use to reimburse yourself tax-free for eligible out-of-pocket health care expenses like deductibles and copayments, and
  • The Dependent Care Spending Account, which you can use to reimburse yourself for eligible dependent day care expenses.

The minimum amount you may direct into either FSA is $130 per year; the maximum is $5,000 per year.

How you save with FSAs

When you enroll in one or both FSAs, you authorize PDL to direct a portion of your pay into your FSAs on a pre-tax basis—that is, before taxes are withheld. You save on taxes two ways:

  • You don’t pay payroll taxes and Social Security taxes on the amount of salary that goes into your FSA, and
  • You don’t pay taxes on the money when you reimburse yourself for eligible expenses.

Administration of the plans is performed by Conexis.

If you have eligible out-of-pocket expenses during the plan year, the FSA tax savings typically results in lower out-of-pocket costs to you. Lower contributions to Social Security may result in a slightly lower Social Security benefit when you retire. Please check with your tax adviser before you enroll in an FSA.

Important: The "use it or lose it" rule

Plan your expenses to the FSAs carefully. You must use all of the money in your account by the end of the plan year or the Internal Revenue Service requires that unused balances must be forfeited.

Life and Accidental Death and Dismemberment (AD&D) Insurance

Life and AD&D insurance provides a level of financial security for your loved ones in the event an illness or accident results in your death or serious injury. Beginning August 1, PDL will provide basic life and AD&D insurance coverage in the amount of $50,000 at no cost to you. Life insurance benefits are payable in the event of your death. If an accident causes your death, AD&D benefits are payable to you beneficiary in addition to life insurance. If you suffer a loss of limbs or senses as the result of an accident, all or part of the AD&D coverage amount may be payable. The coverage includes an accelerated benefit that allows you to receive a portion of your life insurance benefit before death if you have been diagnosed as having a terminal illness.

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