What Is It?
The CCPOA Medical Plan provides you and your family a great plan with good rates and extensive care. The CCPOA Medical Plan has affordable rates, Teladoc®, 24/7 Nurseline®, the Wellvolution® reward program and a large network of providers – including Sutter in the greater Sacramento region, and providing members with network Chiropractic benefits.
The CCPOA Medical Plan is available only to CCPOA members and administered through Blue Shield of California.
Sign-up for the Medical Plan occur once a year during Open Enrollment, or upon graduation from the Academy as a new Correctional Officer.
Who Can Apply?Rank and File; Supervisor; Retired
What Does It Cover?
Complete CCPOA Medical Plan documentation is available here, on our website.
- E-Z Plan Summary. A quick, easy to read overview of the Medical Plan
- The Evidence of Coverage (EOC). The complete medical plan document.
- Prescription Drug Plan (PDP) for Medicare
For a complete description of plan benefits, refer to the Evidence of Coverage - Medicare.Which Medical Plans are available to Retirees?
As a CCPOA retired chapter member living in a covered area, you are eligible for the CCPOA Medical Plan. After age 65, you can participate in the CCPOA Medical Plan’s Medicare Supplement.
Enrollment in medical is through CalPERS during either Open Enrollment or at the time of retirement.
If you don’t reside in a covered area or need information on vesting and state contributions, please visit or call CalPERS.
About Medicare Part D
Medicare requires that a Notice of Creditable Coverage (NoCC) be provided to all Medicare eligible individuals to help beneficiaries make a decision about enrolling or not enrolling in Medicare Part D prescription drug coverage.
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.
Medical Plan Highlights
For a complete, easy to read summary of plan benefits, refer to the E-Z Plan Summary.
|CCPOA Medical Plan – Summary of Covered Services|
|Category Description||Member Copayment & Limitations|
(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|
|Allergy Testing/Treatment||No Charge|
|Inpatient Hospital Visits||No Charge|
|Preventive Health||No Charge|
|Diagnostic X-ray/Lab||No Charge|
|Durable Medical Equipment
(including orthoses and prostheses)
|Pregnancy & Maternity|
|Prenatal and Postnatal Physician Office Visits
Family Planning Counseling
|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.|
|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 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)