Benefits

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: Anthem (Blue Cross Prudent Buyer): CA only; First Health: NM and all other states other than CA and WA; First Choice: WA only
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:

 

Name Brand:

Generic:

Compound:

 

Express Scripts – Use your Express Scripts card when you go to the pharmacy or enroll in the Mail Order Program for ongoing prescriptions.

20% Coinsurance

10% Coinsurance

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

Dental

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

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: 01/01/2017

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
$10​
Prescription Glasses ​$25
Frame
  • ​$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​
Lenses
  • ​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 www.vsp.com/specialoffers 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 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