Section 5 (b). Personal Care Account (PCA)

		Important things you should keep in mind about your Personal Care Account: All eligible health care expenses (except in-network preventive care) are paid first from your Personal Care Account (PCA). Traditional Health Coverage (under CDHP Section 5(c)) will only start once your Personal Care Account is exhausted. Note that in-network preventive care covered under CDHP Section 5(a) does NOT count against your PCA. The Personal Care Account provides full coverage for both in-network and out-of-network providers. However your Personal Care Account will generally go much further when you use network providers because network providers agree to discount their fees. You have flexibility about how to spend your PCA, and the Plan provides you with the resources to manage your PCA. You can track your PCA on your personal private Web site, by telephone at 866/333-4648 (toll-free), or with monthly statements mailed directly to you at home. If you join this Plan during Open Season, you receive the full PCA ($1,200 per Self Only or $2,400 per Self and Family enrollment) as of your effective date of coverage. If you join at any other time during the year, your PCA for your first year will be prorated at a rate of $100 per month for Self Only or $200 per month for Self and Family for each full month of coverage remaining in that calendar year. Unused PCA benefits are forfeited when leaving this Plan. If PCA benefits are available in your account at the time a claim is processed, out-of-pocket expenses will be paid from your PCA regardless of the date the expense was incurred. Please remember that all benefits are subject to the definitions, limitations and exclusions in this brochure and are payable only when we determine they are medically necessary. Under the Consumer Driven Option, there is no calendar year deductible Be sure to read Section 4, Your costs for covered services, for valuable information about how cost sharing works, with special sections for members who are age 65 or over. Also read Section 9 about coordinating benefits with other coverage, including with Medicare. YOU MUST GET PRECERTIFICATION FOR HOSPITAL STAYS; FAILURE TO DO SO WILL RESULT IN A MINIMUM $500 PENALTY. Please refer to the precertification information shown in Section 3 to confirm which services require precertification.
Benefit Description			You Pay
NOTE: There is no calendar year deductible under the Consumer Driven Health Plan.
A Personal Care Account (PCA) is provided by the plan for each enrollment. Each year the plan adds to your account: $1,200 per year for a Self Only enrollment or $2,400 per year for a Self and Family enrollment The Personal Care Account covers eligible expenses at 100%. For example, if you are ill and go to a network doctor for a $60 visit, the doctor will submit your claim and the cost of the visit will be deducted automatically from your PCA; you pay nothing. Balance in PCA for Self Only   $1,200 Less: Cost of visit   -60 Remaining Balance in PCA   $1,140			In-network and Out-of-Network: Nothing up to $1,200 for a Self Only enrollment or $2,400 for a Self and Family enrollment

Benefit Description	You Pay
There are two types of eligible expense covered by your PCA. Basic PCA Expenses are the same medical, surgical, hospital, emergency, mental health and substance abuse, and prescription drug services and supplies covered under the Traditional Health Coverage (see CDHP Section 5(c) for details). Extra PCA Expenses include: Dental and/or vision services up to a combined maximum of $400 per Self Only enrollment or $800 per Self and Family enrollment each calendar year, including: Vision exam performed by an optometrist or ophthalmologist Eyeglasses and contact lenses Dental treatment (including examinations, cleanings, fillings, restorative treatment, endodontics, and periodontics) In-network preventive care services not included under CDHP Section 5(a) - In-network Preventive Care benefits Out-of-network preventive care limited to services shown as covered under CDHP Section 5(a) Amounts in excess of the Plan allowance for services received out-of-network and covered under Basic PCA Expenses Note: Both Basic and Extra PCA Expenses are covered at 100% as long as you have not used up your Personal Care Account. Note: Extra PCA Expenses are covered under your PCA only and are combined with your Basic PCA Expenses up to the PCA account limit. These expenses are not covered under Traditional Health Coverage and, when used for other than dental and/or vision services, will increase your Member Responsibility. To make the most of your Personal Care Account, you should: Use network providers wherever possible; Use generic prescriptions wherever possible; and Only use your PCA for Extra PCA Expenses if you expect to have an unused balance in your PCA at the end of the calendar year.	In-network and Out-of-Network: Nothing up to $1,200 for a Self Only enrollment or $2,400 for a Self and Family enrollment
Not covered: Orthodontia Dental treatment for cosmetic purposes including teeth whitening Out-of-network preventive care services not included under CDHP Section 5(a) Services or supplies shown as not covered under Traditional Health Coverage (see CDHP Section 5(c)) and not included under Extra PCA Expenses above	All charges
PCA Rollover Any unused, remaining balance in your PCA at the end of the calendar year may be rolled over to subsequent years, as long as you remain in this Plan, up to a maximum PCA account of $5,000 per Self Only enrollment or $10,000 per Self and Family enrollment, thereby increasing your PCA in the following year(s).

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