CCPOA Medical Plan

Rank & File / Supervisor

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The CCPOA Medical Plan provides you and your family a great plan with good rates and extensive care. We have added more providers and resources including the complete Sutter Health network, and providing members with network Chiropractic benefits. For complete information on the CCPOA Medical Plan, please see the Evidence of Coverage. As of January 1, 2006, The CCPOA Medical Plan is administered by Blue Shield of California.

For a complete, easy to read summary of plan benefits, refer to the Plan Summary.   

CCPOA Medical Plan – Summary of Covered Services
Category Description	Member Copayment & Limitations
Hospital
Inpatient (includes blood and blood products - collection and storage of autologous blood)	$100 per admission
Outpatient (other than surgery)	No Charge
Outpatient surgery (surgery performed in a Hospital or Outpatient Surgical Center)	$50
Physician Services
Office Visits	$15
Home Visits	$15
Allergy Testing/Treatment	No Charge
Inpatient Hospital Visits	No Charge
Surgery/Anesthesia	No Charge
Preventive Health	No Charge
Diagnostic X-ray/Lab	No Charge
Durable Medical Equipment (including orthoses and prostheses)	No Charge
Pregnancy & Maternity
Prenatal and Postnatal Physician Office Visits Family Planning Counseling	No Charge
Infertility Testing & Treatment	50% of Allowed Charges
Ambulance Services	No Charge
Emergency Care/Services	$75/visit – does not apply if hospitalized or kept for observation - if admitted, $100 per admission fee will apply
Urgent Services	$15/visit, $25 outside service area
Home Health Services	$15/visit - up to 100 visits per calendar year
Physical/Occupational/Speech Therapy	No Charge
Skilled Nursing Care	No Charge - up to 100 days per calendar year.
Hospice	No Charge
Biofeedback	$15/visit
Perscriptions
Prescription Drugs	$50 calendar year brand name drug deductible per Member, not to exceed $150 per family
Prescription Drugs Obtained at a Pharmacy	$10 generic, $25 brand name, $50 non- Formulary/prescription - not to exceed a 30- day supply for short-term or acute illness.
Mail Service Prescription Drugs	$20 generic, $50 brand name, $100 non- Formulary/prescription - not to exceed a 90- day supply for mail order drugs which are taken over long periods of time (maintenance drugs).
Specialty Drugs	$50 per prescription
Chiropractic Services
Chiropractic Examination	$15/visit - up to 20 visits per calendar year.
Diagnostic Services for Chiropractic Care	No Charge
Chiropractic Appliances (up to a maximum of $50 is covered during a calendar year)	No Charge

 

ADDITIONAL LINKS & RESOURCES

Teladoc. Talk to a doctor, perscriptions and more. 24/7/365

Find a Doctor

2013 Rate Chart

To find a Chiropractor in the provider network call 1-800-678-9133

This CCPOA Medical Plan is available only to full dues paying CCPOA members.

Join the CCPOA today: 1-800-821-6443

Don't forget to visit www.blueshield.com/hlr for more information on the Healthy Lifestyle Rewards Program.

CCPOA Medical Plan

If you have questions or need assistance, please call CCPOA Medical Plan at:
1-800-257-6213
or the Trust at:
1-800-IN-UNIT-6

If you have any specific questions regarding the medical plan's benefits or coverage areas, please contact Debbie at the Trust.