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.
Medical
Plan Name | California Water Service Medical Plan | |
Plan Administrator | Benefits & Risk Management Services (BRMS) 1-844-886-2400 www.vbas.com | |
PPO Networks |
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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 | $3,000 per person; $6,000 per family (amount includes deductible) | $6,000 per person; $12,000 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:
*Compound topical pain creams are not covered |
Dental
Plan Administrator: Delta Dental of California
Group Number: 16001
Effective Date: 01/01/2022
Claims Address: P.O. Box 997330, Sacramento, CA 95899-7330
Customer Service: 1-800-765-6003
Group Number: 16001
Effective Date: 01/01/2022
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 | $2,000 per person each calendar year | |
Diagnostic & Preventative counts towards maximum? | No | |
Waiting Period(s) | Basic Benefits: None | |
Major Benefits: None | ||
Prosthodontics: None | ||
Orthodontics: None | ||
Benefits and Covered Services | Delta Dental PPO Dentists | Non-Delta Dental PPO Dentists |
Diagnostic & Preventative Services Exams, cleanings, bitewing x-rays, and sealants |
100% | 100% |
Basic Services Fillings, simple tooth extractions, full mouth and panoramic x-rays |
80% | 80% |
Endodontics (root canals) Covered under Basic Benefits |
80% | 80% |
Periodontics (gum treatments) Covered under basic services |
80% | 80% |
Oral Surgery Covered under Basic Services |
80% | 80% |
Major Services Crowns, inlays, onlays, and cast restorations |
80% | 80% |
Prosthodontics Bridges, dentures, and implants |
80% | 80% |
Orthodontic Benefits Adults and dependent children |
50% | 50% |
Orthodontic Maximums | $2,000 Lifetime | $2,000 Lifetime |
Vision
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: VSP® Vision Care.
Website: vsp.com
Effective Date: 01/01/2022
VSP Provider Network: VSP Choice
Customer Service: 1-800-877-7195
Benefit | Description | Copay |
WellVision Exam |
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$10 |
Prescription Glasses | $25 | |
Frame |
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Included in Prescription Glasses |
Lenses |
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Included in Prescription Glasses |
Lens Enhancements | Standard progressive lenses | $0 |
Premium progressive lenses | $95–$105 | |
Custom progressive lenses | $150–$175 | |
Anti-Reflective Coating | $35 | |
Average savings of 20-25% on other lens enhancements | ||
Every calendar year | ||
Contacts (instead of glasses) |
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Up to $60 |
Additional Coverage |
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Extra Savings | ||
Glasses & Sunglasses |
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Retinal Screening |
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Laser Vision Correction |
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Coverage with Out-of-Network Providers | Visit www.vsp.com 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 |