• Processes more than 2.6 million dental claims each year. The accuracy of processed claims exceeds 99% and we have a claims processing turnaround time of 5-10 working days.
• Has a high-tech electronic claims system designed specifically for processing dental claims.
• Consistently earns high ratings from the industry's leading independent insurance analysts for its outstanding financial strength and operating performance.

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• Choice of six HMO plans: CalChoice^® 15, CalChoice^® 25, CalChoice^® 25 Value , CalChoice^® 30, CalChoice^® 40 and CalChoice^® 40 Value
• No annual deductibles
• No charge for preventive care
• Physician office visits for a fixed copayment of $15, $25, $30, or $40 depending on the HMO plan you choose
• No annual benefit maximums for prescription drugs
• No lifetime maximum on plan benefits
• An easy and efficient way to manage your health care and your costs with virtually no claim forms

• Lifepath Advisers^SM: Blue Shield members get expert advice on health and life issues by phone or via the Internet. Lifepath Advisers resources are available 24 hours a day through a single toll-free number and online at MyLifePath.com.
• Lifepath Decision Guide^SM: designed for member facing an important medical decision, the guide includes tools to create reports on treatment alternatives, hospital comparison tool and pharmacy consultation services
• MyLifePath.com: the award-winning Blue Shield member Web site for health and personalized plan information allows members to check their claim status, order ID cards and change doctors
• Health management programs aiming to keep member well: self-care guidance for members living with chronic conditions such as diabetes, congestive heart failure and asthma
• Discount programs: get at least 25 percent off alternative care services – acupuncture, chiropractic and massage therapy – and a 20 percent discount off vision care and supplies from participating practitioners

• Blue Shield is the only health plan carrier that offers PPO-type plans through CaliforniaChoice^®.
• Choice of three PPO plans with different annual deductibles: CalChoice^® PPO 750, CalChoice^® PPO 1000 and CalChoice^® PPO 2400*
• Choice of two HSA-eligible high-deductible health plans: CalChoice^® PPO Savings Plan 1500 and CalChoice^® PPO Savings Plan 2400
• CalChoice^® Active Choice^SM Plan 500* features first dollar benefits for professional services, immediate coverage for inpatient services and emergency services, and flexible drug coverage.
• Maximum choice and personal control over your care: you decide which physician or hospital to use every time you need medical care
• Preventive care services such as routine physical exams, immunizations, well-baby care and annual gynecological exams are available for a fixed copayment before meeting the annual deductible or are covered under the first dollar benefits for the Active Choice plan
• For inpatient and outpatient medical services, you pay only a low percentage of the cost for these services after you meet the plan's annual deductible - from 10% to 30% depending on which PPO plan and which network you choose
• Generic prescription drugs are covered with a fixed copayment and no annual deductible
• Calendar-year copayment maximums help contain your out-of-pocket costs
• Out-of-state coverage with the BlueCard^(R) Program: when you travel for work or pleasure, your health coverage goes with you

• Among California's largest PPO provider networks: Blue Shield of California has more than 52,000 doctors and 360 hospitals throughout the state and Blue Shield of California Life & Health Insurance Company (Blue Shield Life) has more than 46,000 doctors and 350 hospitals

• Accreditation from the Utilization Review Accreditation Commission (URAC) for PPO care management program
• Blue Shield of California received a financial strength rating upgrade to "A" from "A-" from Standard & Poor's in May 2005 and an affirmed financial strength rating of "A" from A.M. Best in June 2005

• No claim forms for in-network services
• Customer service representatives available seven days a week
• Freedom to choose from a wide selection of providers in California and across the country
• Additional discounts on non-covered items, laser vision correction surgery and replacement contact lenses by mail

• Committed to empowering member choice through delivering informational tools that allow members to be active players in receiving quality health care, including:
  • Evidence-Based Medicine Online: up-to-date information on medical terms, treatment and options, searchable by condition.
  • Hospital Comparison Report: interactive hospital comparisons to evaluate and determine which hospital scores highest, in key categories, for a particular condition or surgery.
  • Medical Group Comparison Report: this online tool allows Health Net members to compare HMO medical groups based on the quality of care and service the groups provide members.
• Committed to bringing simplicity to the delivery of health care.
• Award-winning website, www.HealthNet.com, provides a portal for members and other stakeholders to perform administrative functions, gather information and learn about Health Net wellness initiatives.
• Delivers simple, affordable and comprehensive products that provide our members with access to high quality health care services.
• Provides employers with options that provide comprehensive benefits - at appropriate costs - while giving consumers a greater voice in their health care decisions.
• Our customer service is designed to offer members, physicians and providers the highest quality of support and information. On an average day, our Customer Service representatives answer more than 35,000 calls from members and providers throughout the country.
• In 2002, our Claims representatives processed approximately 20 million physician and hospital claims - 97 percent in less than 30 days.
• Within Health Net's National Health Plan Operations team, initiatives to improve our ability to resolve customer issues on the first call are beginning to take hold. Our goal is resolving 85 percent of our customers' inquiries on the first call.
• We devote significant resources every year to programs that help members with specific chronic conditions such as diabetes, heart disease, asthma and depression. Through intense member education, telephone counseling and medication compliance monitoring, we've also seen significant improvements in the treatment and health of our members who suffer from rare diseases such as multiple sclerosis and cystic fibrosis. In addition to elevating their health status, we have seen 25 percent fewer hospital admissions for members enrolled in these programs.
• Health Net has been a wellness pioneer for many years. By offering reminders and information on the importance of getting preventive health screenings, our prevention programs help members maintain better health.
• Nearly quarter-century history of health coverage.
• Network of nearly 49,000 contracted physicians, 570 physician group locations and 4,400 pharmacies.
• Solid base of 2.5 million members
• A.M. Best Rating of A- (Excellent).

• Elect Open Access is a good in between plan that is priced like an HMO but gives you access to PPO doctors.
• You first select a PCP (your doctor).
• Self referrals to the Health Net PPO network are for doctor and specialist office visits only
• You have unlimited self-referral to any physician in the Health Net PPO network (over 44,000 doctors) for a $40 per visit copay
• All major services (such as hospitalization and surgery) are managed by your PCP

• We provide health care in nine states and the District of Columbia.
• We serve 8.7 million members nationwide, including 6.5 million members in California.
• In California, more than 9,000 physicians provide care at over 300 medical offices and 50 medical centers.

• Physicians have the final say on your prescriptions for medically necessary drugs.
• You can choose or change your personal physician for any reason.
• Your Kaiser Permanente physician can easily refer you to a Plan specialist.

• We're selective about the physicians we hire. In California, only one of every ten applicants is chosen to become a Kaiser Permanente physician.
• A number of our physicians have national reputations, and some teach at leading universities.
• Kaiser Permanente's of California Regions earned "Excellent" ratings from the National Committee for Quality Assurance (NCQA), the nation's leading reviewer of health plan quality for consumers and employers. "Excellent" is the top rating granted by NCQA, which reviews satisfaction surveys, preventive measures, physician credentialing, member services, and improvement initiatives.*

• A special Los Angeles County doctor and hospital network through Health Net
• A $25 co-pay HMO plan with lower premiums
• Rates starting at $138
• Dependents living in Baja can enroll in the SIMNSA network which features a $5 copay in Mexico

Western Health Advantage
1-888-563-2250
Monday-Friday 8:00 a.m.-5:00 p.m.
English/Spanish/Hmong
www.WesternHealth.com