California Water Service Group and its subsidiaries offer medical, dental, and vision insurance to employees. General health benefit information is provided below. Additional and/or alternate benefits are available in some locations.


Plan Name: California Water Service Medical Plan
Plan Administrator: Benefits & Risk Management Services (BRMS) 1-844-886-2400
PPO Networks:
  In-Network Benefits Out-of-Network Benefits
Calendar Year Deductible: $100 per person;

$300 per family (for families with 3 or more people)

$200 per person;

$600 per family (for families with 3 or more people)

Out-of-Pocket Max: $3,100 per person; $9,300 per family (amount includes deductible) $6,200 per person; $18,600 per family (amount includes deductible)
Physician Office Visits: Deductible and 20% Coinsurance Deductible and 30% Coinsurance
Preventative Care & Wellness Visits (Covered based on USPTF guidelines and subject to age and gender restrictions): Covered at 100% Deductible and 30% coinsurance
In-Patient Hospitalization (including Maternity): Deductible and 20% Coinsurance Deductible and 30% Coinsurance
Emergency Room: Deductible and 20% Coinsurance Deductible and 30% Coinsurance
Mental Health (In-Patient & Out-Patient): Deductible and 20% Coinsurance Deductible and 30% Coinsurance
Out-Patient Hospital Surgery (including Surgical Expense): Deductible and 20% Coinsurance Deductible and 30% Coinsurance
Diagnostic X-Ray & Labs: Deductible and 20% Coinsurance Deductible and 30% Coinsurance
Chiropractic & Acupuncture (each benefit has 46 visits max per year, in- and out-of-network combined): First visit: Deductible and 20% Coinsurance (max coverage $150); $30 coverage for each subsequent visit First visit: Deductible and 30% Coinsurance (max coverage $150); $30 coverage for each subsequent visit
Prescriptions (including birth control)  
Managed by: Express Scripts – Use your Express Scripts card when you go to the pharmacy or enroll in the Mail Order Program for ongoing prescriptions.
Name Brand: 20% Coinsurance
Generic: 10% Coinsurance
Compound: Not covered through Express Scripts. Submit to Cal Water Medical Plan for reimbursement. Coverage is limited to:

  1. Hormone replacement therapies; and
  2. If there are problems with FDA approved version of a prescription drug (e.g. You are unable to take the FDA approved drug in the form that is available or you are allergic to an ingredient in the FDA approved drug);

*Compound topical pain creams are not covered


Plan Administrator: Delta Dental of California

Group Number: 16001

Effective Date: 01/01/2017

Claims Address: P.O. Box 997330, Sacramento, CA 95899-7330

Customer Service: 1-800-765-6003

Eligibility Primary enrollee, spouse, and eligible dependent children to age 26
Deductibles $50 per person/$150 per family each calendar year. Any deductible applied during the last 3 months of the year will carry forward to next year’s deductible.
Deductibles waived for Diagnostic & Preventative? Yes
Maximums $1,500 per person each calendar year
Diagnostic & Preventative counts towards maximum? No
Waiting Period(s)

Basic Benefits


Major Benefits






Benefits and Covered Services Delta Dental PPO Dentists Non-Delta Dental PPO Dentists
Diagnostic & Preventative Services

Exams, cleanings, bitewing x-rays, and sealants





Basic Services

Fillings, simple tooth extractions, full mouth and panoramic x-rays



Endodontics (root canals)

Covered under Basic Benefits





Periodontics (gum treatments)

Covered under basic services





Oral Surgery

Covered under Basic Services





Major Services

Crowns, inlays, onlays, and cast restorations






Bridges, dentures, and implants



Orthodontic Benefits

Adults and dependent children





Orthodontic Maximums $2,000 Lifetime $2,000 Lifetime



To view vision claim status, details on claims already processed, or more specific information about benefits for you or a covered dependent, visit VSP online.

Plan Administrator: VSPĀ® Vision Care.


Effective Date: 01/01/2017

VSP Provider Network: VSP Choice

Customer Service: 1-800-877-7195

Benefit Description Copay
WellVision Exam
  • Focuses on your eyes and overall wellness
  • Every calendar year
Prescription Glasses $25
  • $150 allowance for a wide selection of frames
  • $170 allowance for featured frame brands
  • 20% savings on the amount over your allowance
  • $80 allowance at Costco
  • Every other calendar year
Included in Prescription Glasses
  • Single vision, lined bifocal, and lined trifocal lenses
  • Polycarbonate lenses for dependent children
  • Every calendar year
Included in Prescription Glasses
Lens Enhancements
  • Standard progressive lenses
  • Premium progressive lenses
  • Custom progressive lenses
  • Average savings of 20-25% on other lens enhancements
  • Every calendar year
  • Anti-Reflective Coating
  • $55
  • $95 – $105
  • $150 – $175
  • $35
Contacts (instead of glasses)
  • $150 allowance for contacts; copay does not apply
  • Contact lens exam (fitting and evaluation)
  • Every calendar year
Up to $60
Additional Coverage
  • Primary Eyecare
Extra Savings

Glasses & Sunglasses

  • Extra $20 to spend on featured frame brands. Go on for details
  • 20% savings on additional glasses and sunglasses, including lens enhancements, from any VSP provider within 12 months of your last WellVision Exam

Retinal Screening

  • No more than a $39 copay on routine retinal screening as an enhancement to a WellVision Exam

Laser Vision Correction

  • Average 15% off the regular price or 5% off the promotional price; discounts only available from contracted facilities

Your Coverage with Out-of-Network Providers

Visit for details, if you plan to see a provider other than a VSP network provider

Exam………………………….up to $45 Lined Trifocal Lenses………………………….up to $65

Frame………………………..up to $70 Progressive Lenses……………………………..up to $50

Single Vision Lenses…….up to $30 Contacts……………………………………………up to $105

Lined Bifocal Lenses……up to $50