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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.