HomeMy WebLinkAboutCity Council - 2002-122 RESOLUTION NO. 2002 - 122
A RESOLUTION OF THE CITY COUNCIL OF THE
CITY OF HUNTINGTON BEACH APPROVING AND
IMPLEMENTING THE MEMORANDUM OF UNDERSTANDING
BETWEEN THE HUNTINGTON BEACH FIRE MANAGEMENT
ASSOCIATION (FMA) AND THE CITY OF HUNTINGTON BEACH
FOR 12/21/02 THROUGH 12/19/03
The City Council of the City of Huntington Beach does resolve as follows:
The Memorandum of Understanding between the City of Huntington Beach and the
Huntington Beach Fire Management Association, a copy of which is attached hereto as Exhibit
"A"and by reference made a part hereof, is hereby approved and ordered implemented in
accordance with the terms and conditions thereof; and the City Administrator is authorized to
execute this Agreement. Such Memorandum of Understanding shall be effective for the term
December 21, 2002 through December 19, 2003.
PASSED AND ADOPTED by the City Council of the City of Huntington Beach at a
regular meeting thereof held on the 18rh day of November , 2002.
ATTESTCCNNIE BROCKWAY
r�City lerk �Oe L Mayor
OT
REVIEWED AND APPROVED: APPROVED AS TO FORM:
Cit Administrator City Attorney
1NITIAT APP VED:
Director o dministrativ ervices
02reso/fma/11/14/02
FIRE MANAGEMENT ASSOCIATION Res. No. 2002-122
MEMORANDUM OF UNDERSTANDING
TABLE OF CONTENTS
Page
PREAMBLE.................................................................................................................................................................I
ARTICLEI—TERM OF MOU.................................................................................................................................I
ARTICLE H—REPRESENTATIONAL UNIT........................................................................................................I
ARTICLE III—SEVERABILITY..............................................................................................................................1
ARTICLE IV—SALARY SCHEDULES AND RETIREMENT.............................................................................2
A. MONTHLY COMPENSATION...................................................................................................................................2
B. PUBLIC EMPLOYEES RETIREMENT SYSTEM PICKUP..............................................................................................2
C. SELF FUNDED SUPPLEMENTAL RETIREMENT BENEFIT..........................................................................................2
D. MEDICAL INSURANCE UPON RETIREMENT............................................................................................................2
E. Pumc EMPLOYEES'RETIREMENT SYSTEM .........................................................................................................3
1. Level IV Survivors Benefits..............................................................................................................................3
2. Pre-Retirement Optional Settlement 2 Death Benefit......................................................................................3
F. DIRECT DEPOSIT...................................................................................................................................................3
ARTICLEV—SPECIAL PAY...................................................................................................................................3
A. EDUCATIONAL TUITION.........................................................................................................................................3
B. HOLIDAY PAY-IN-LIEU.........................................................................................................................................4
C. BILINGUAL SKILL PAY...........................................................................................................................................4
D. PROFESSIONAL ACHIEVEMENT AWARD.................................................................................................................5
ARTICLEVI—UNIFORMS......................................................................................................................................5
ARTICLE VII—WORK SCHEDULE/COMPENSATORY PAY/TIME OFF......................................................5
A. WORK SCHEDULE.................................................................................................................................................5
B. COMPENSATORY PAY............................................................................................................................................5
ARTICLE VIII—HEALTH AND OTHER INSURANCE BENEFITS..................................................................6
A. HEALTH................................................................................................................................................................6
B. ELIGIBILITY CRITERIA AND COST..........................................................................................................................6
I. City Paid Medical, Dental and Vision Insurance—Employee and Dependents.............................................6
2. City's Contribution to Health Insurance Premiums........................................................................................6
3. Section 125 Plan..............................................................................................................................................7
C. LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT.........................................................................................7
D. LONG TERM DISABILITY INSURANCE....................................................................................................................7
1. City Paid Premiums While on Medical Disability...........................................................................................8
2. Insurance and Benefits Advisory Committee...................................................................................................8
3. Health Plan Over-Payments............................................................................................................................8
F. EMPLOYEE COST SHARING....................................................................................................................................9
G. JOINT CAFETERIA PLAN STUDY.............................................................................................................................9
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FIRE MANAGEMENT ASSOCIATION Res. No. 2002-122
MEMORANDUM OF UNDERSTANDING
TABLE OF CONTENTS
Page
ARTICLEIX-LEAVE BENEFITS..........................................................................................................................9
A. GENERAL LEAVE...................................................................................................................................................9
1. Accrual.................................................................................................................................................................9
2. Eli i�bili and Approval.....................................................................................................................................10
3. Conversion to Cash............................................................................................................................................10
4. Family Sick Leave..............................................................................................................................................10
B. SICK LEAVE........................................................................................................................................................11
C. BEREAVEMENT LEAVE........................................................................................................................................12
D. PATERNITY LEAVE..............................................................................................................................................13
ARTICLEX—CITY RULES...................................................................................................................................13
A. PERSONNEL RULES..............................................................................................................................................13
ARTICLE XI--MISCELLANEOUS......................................................................................................................28
A. VEHICLE POLICY.................................................................................................................................................28
B. DEFERRED COMPENSATION LOAN PROGRAM......................................................................................................28
C. ASSOCIATION BUSINESS......................................................................................................................................28
ARTICLE XII—CITY COUNCIL APPROVAL....................................................................................................29
LISTOF MOU EXHIBITS.......................................................................................................................................30
EXHIBIT A-FIRE MANAGEMENT ASSOCIATION SALARY SCHEDULE................................................31
EXHIBIT B—RETIREE SUBSIDY MEDICAL PLAN.........................................................................................32
EXHIBIT C—EMPLOYEE HEALTH PLAN BROCHURE................................................................................40
EXHIBIT D—DELTA CARE(PMI)DENTAL PLAN BROCHURE..................................................................41
EXHIBIT E—DELTA DENTAL PLAN BROCHURE..........................................................................................42
EXHIBIT F—VISION(VSP)PLAN BROCHURE................................................................................................43
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Res. No. 2002-122
MEMORANDUM OF UNDERSTANDING
BETWEEN
THE CITY OF HUNTINGTON BEACH, CALIFORNIA
(Herein Called CITY)
AND
THE HUNTINGTON BEACH FIRE MANAGEMENT ASSOCIATION
(Hereinafter Called ASSOCIATION)
PREAMBLE
WHEREAS, the designated representative of the City of Huntington Beach and the
Huntington Beach Fire Management Association have met and conferred in good faith
with respect to salaries, benefits and other terms and conditions of employment for the
employees represented by the Association;
Except as expressly provided herein, the adoption of this Memorandum of
Understanding (MOU) shall not change existing terms and conditions of employment,
which have been established for the classification represented by the Huntington Beach
Fire Management Association.
NOW THEREFORE, this Memorandum of Understanding is made, to become effective
December 21, 2002 and it is agreed as follows:
ARTICLE I — TERM OF MOU
This Agreement shall be in effect for a period of one (1) year commencing December
21, 2002 and ending at midnight on December 19, 2003.
ARTICLE II — REPRESENTATIONAL UNIT
It is recognized that the Huntington Beach Fire Management Association is the
employee organization which has the right to meet and confer in good faith with the city
on behalf of represented employees of the Huntington Beach Fire Department within
the classification titles of Fire Division Chief and Fire Battalion Chief as outlined in
Exhibit A attached hereto and incorporated herein.
ARTICLE III — SEVERABILITY
If any section, subsection, sentence, clause, phrase or portion of this MOU or any
additions or amendments thereof, or the application thereof to any person, is for any
reason held to be invalid or unconstitutional by the decision of any court of competent
jurisdiction, such decision shall be affect the validity of the remaining portions of this
resolution or its application to other persons. The City Council hereby declares that it
would have adopted this MOU and each section, subsection, sentence, clause, phrase
or portion, and any additions or amendments thereof, irrespective of the fact that any
one or more sections, subsections, sentences, clauses, phrases or portions, or the
application thereof to any person, be declared invalid or unconstitutional.
MEMORANDUM OF UNDERSTANDING Res. No. 2002-122
HUNTINGTON BEACH FIRE MANAGEMENT ASSOCIATION
ARTICLE IV— SALARY SCHEDULES AND RETIREMENT
A. Monthly Compensation
Employees shall be compensated at hourly rates by job type and pay grade
during the term of this Agreement as set out in Exhibit A attached hereto and
incorporated herein unless expressly provided for in other articles of this
Memorandum of Understanding.
B. Public Employees Retirement System Pickup
Each employee covered by this Agreement shall be reimbursed bi-weekly in an
amount equal to 9% of the employee's base salary and special pay as a pickup
of the employee's contribution, or portion of such contribution, to the Public
Employees' Retirement System (PERS). The above PERS pickup is not base
salary but is done pursuant to Section 414(h)(2) of the Internal Revenue Code.
C. Self Funded Supplemental Retirement Benefit
Employees hired prior to August 17, 1998 are eligible for the Self Funded
Supplemental Retirement Benefit, which provides that:
1. In the event a member elects Option #2 (Section 21456) or Option #3
(Section 21457) of the Public Employees' Retirement Law, the city shall
pay the difference between such elected option and the unmodified
allowance which the member would have received for his or her life
alone. This payment shall be made only to the member, shall be
payable by the city during the life of the member, shall be payable by the
city during the life of the member, and upon that member's death, the
city obligation shall cease. The method of funding this benefit shall be
at the sole discretion of the city. This benefit is vested for employees
covered by this agreement. (Note: The options provide the allowance is
payable to the member until his or her death and then either the entire
allowance (Option #2) or one-half of the allowance (Option #3) is paid to
the beneficiary for life).
2. Employees hired on or after August 17, 1998 shall not be eligible for this
benefit referenced in A.1.a. herein above.
D. Medical Insurance Upon Retirement
Upon retirement, whether service or disability, each employee shall have the
following options in regards to medical insurance under city sponsored plans:
With no change in benefits, retirees can stay in any of the plans offered by
the city, at the retiree's own expense, for the maximum time period required
by Federal Law the Consolidated Omnibus Budget Reconciliation Act
(COBRA), or
Retirees retiring after approval of this MOU may participate in the Retiree
Medical Plan, attached hereto as Exhibit B, or the Health Maintenance
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HUNTINGTON BEACH FIRE MANAGEMENT ASSOCIATION
Organization (HMO) Plan currently being offered to retirees, based upon the
eligibility requirements described in Exhibit B.
E. Public Employees' Retirement System
1. Level IV Survivors Benefits
Unit employees shall be covered by the 1959 PERS Level IV Survivor
Benefit.
2. Pre-Retirement Optional Settlement 2 Death Benefit
Employees shall be covered by the Pre-Retirement Optional Settlement
2 Death Benefit as identified in Section 21548 when approved by the
City Council.
F. Direct Deposit
All FMA represented employees shall be required to utilize direct deposit of
payroll checks.
ARTICLE V— SPECIAL PAY
A. Educational Tuition
1. Upon approval of the Department Head and the Human Resources
Manager, permanent employees may be compensated for courses from
accredited educational institutions. Tuition reimbursement shall be limited
to job related courses or job related educational degree objectives and
requires prior approval by the Department Head and Human Resources
Manager.
2. Education costs shall be reimbursed to permanent employees on the basis
of a full refund for tuition, books, parking (if a required fee) and any other
required fees upon presentation of receipts. However, the maximum
reimbursement shall be not more than one thousand five hundred dollars
($1,500) in any fiscal year period.
3. If a permanent employee was enrolled in an a degree with approval from
their Department Head and the Human Resources Manager prior to April
15, 2002. Education costs shall be paid to employees on the basis of full
refund for tuition, fees, books and supplies; provided, however, that
maximum reimbursement shall be at the rates currently in effect in the
University of California System. Employee may be compensated for actual
cost of tuition, books, fees, at accredited educational institutions that charge
higher rates than the University of California, if it can be demonstrated by
the employee that said educational institutional presents the only accredited
course or program within a reasonable commuting distance of the
employee.
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4. Reimbursements shall be made when the employee presents proof to the
Human Resources Manager that he/she has successfully completed the
course with a grade of "C" or better; or a "Pass" if taken for credit.
B. Holiday Pay-In-Lieu
Employees shall be compensated by the city in lieu of the ten listed holidays at
the rate of 3.0768 hours multiplied by the employee's hourly salary rate set forth
in Exhibit A, payable each and every pay period. The following are the
recognized legal holidays under this MOU:
1. New Year's Day (January 1)
2. Martin Luther King's Birthday (third Monday in January)
3. President's Day (third Monday in February)
4. Memorial Day (last Monday in May)
5. Independence Day (July 4)
6. Labor Day (first Monday in September)
7. Veteran's Day (November 11)
8. Thanksgiving Day (fourth Thursday in November)
9. Friday after Thanksgiving
10. Christmas Day (December 25)
Any day declared by the President of the United States to be a national
holiday, or by the Governor of the State of California to be a state holiday,
and adopted as an employee holiday by the City Council of Huntington
Beach.
Holidays which fall on Sunday shall be observed the following Monday, and
those falling on Saturday shall be observed the preceding Friday.
Employees designated by the Fire Chief who are required to work regular
shifts on the above listed holidays as set forth in this Article, shall not be
entitled to time off or overtime.
Subject to State Law and Regulations, compensation paid as a result of
Article V.B. shall be reportable to PERS as salary.
C. Bilingual Skill Pay
Permanent employees who are qualified to use Spanish, Vietnamese, or Sign
Language skills shall be paid an additional five-percent (5%) of their basic hourly
rate in addition to their regular bi-weekly salary. Permanent employees may
accept assignments utilizing bilingual skills in other languages on a short-term
assignment with approval by the City Administrator. Such employees shall
receive the additional five percent (5%) for every bi-weekly pay period that the
assignment is in effect. In order to be qualified for said compensation,
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employee's language proficiency will be tested and certified by the Human
Resources Manager or designee.
D. Professional Achievement Award
Upon presenting a certificate of completion from the United States Fire
Administration's National Fire Academy for the Executive Fire Officer Program to
the Human Resources Manager, the employee will receive a one-time award of
two thousand five hundred ($2,500) dollars. The award shall be subject to all
applicable state and federal taxes.
ARTICLE VI — UNIFORMS
The city agrees to provide uniforms to employees on active duty who are required to
wear uniforms to the same extent as in the past.
ARTICLE VII —WORK SCHEDULE/COMPENSATORY PAY/TIME OFF
A. Work Schedule
Members assigned to suppression assignments shall work an average of fifty-six
(56) hours per week pursuant to the current schedule of five (5) twenty-four (24)
hour shifts in a fifteen (15) day period with six (6) consecutive days off. Total
hours worked in a calendar year will equal 2912 hours.
Members assigned to non-suppression staff assignments shall work four (4)
days per week, ten (10) hours each day, meal times to be included during the ten
hour shift. Total hours worked in a calendar year will equal 2080 hours.
B. Compensatory Pay
1. Members working suppression duties earn compensatory pay or
compensatory time off, on an hour for hour basis, for hours worked in
addition to their regular schedule, subject to the limitations contained in
Article VII.13.3. below.
2. Members shall work thirty-five (35) hours of non-suppression overtime in a
calendar year, before earning compensatory pay or compensatory time off,
on an hour for hour basis, for hours worked in excess of their regular
normal work schedule.
3. Compensatory Pay
a. Compensatory pay is paid at the 40 hours straight time rate for each
hour.
b. Compensatory time earned can be converted to cash at the
member's 40-hour straight time rate.
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c. Maximum accrual shall be 120 hours.
ARTICLE VIII — HEALTH AND OTHER INSURANCE BENEFITS
A. Health
The city shall continue to make available group medical, dental and vision
benefits to all FMA employees.
The City Administrator is authorized until September 30, 2003 to modify the level
of contributions (e.g. the "caps" described below), the level of benefits, co-pays,
out-of-pocket maximums, and/or other components (the "benefits") of the group
medical, dental and vision plans to reflect changes necessary to make the
benefits comparable to the benefits provided to employees in the Huntington
Beach Firefighters Association at the Fire Management Associations request.
B. Eligibility Criteria and Cost
1. City Paid Medical, Dental and Vision Insurance — Employee and
Dependents
The city will assume payment for employee and dependents medical, dental
and vision insurance effective the first of the month following one complete
calendar month of employment.
2. City's Contribution to Health Insurance Premiums
a. Year 2003 Premiums
The city "caps" its contributions for 2003 premiums at the level set forth
in the chart below (subject to employee cost sharing provisions in Article
VIII.F.)
Monthly Dental Dental
Premium City Plan HMO' (PPO) (PMI) Vision
EE $ 341.62 $ 225.32 $46.97 $ 23.00 $ 18.07
EE + 1 675.54 493.75 89.74 39.11 18.07
EE + 2 or more 827.10 650.80 127.46 59.81 18.07
b. Future Premiums
The city "caps" its contributions toward monthly group medical, dental
and vision plan premiums, by category (EE, EE + 1, and EE + 2 or
more) and plan, at the Year 2003 level (subject to employee cost
sharing provisions in Article VIII.F.)
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c. Medical Cash-Out:
Employees covered by a medical program outside of a city provided
program (evidence of which must be supplied to Administrative Services
Department), may elect to discontinue city medical coverage and
receive ninety-two dollars and thirty-one cents ($92.31) bi-weekly to
deposit into their deferred compensation account or any other pre-tax
program offered by the city.
3. Section 125 Plan
Employees may utilize this plan, which allows employees to use pre-tax
salary to pay for regular childcare, adult dependent care and/or medical
expenses.
C. Life and Accidental Death and Dismemberment
Each employee shall be provided with $45,000 life insurance and $45,000
accidental death and dismemberment insurance paid for by the city. Each
employee shall have the option, at his or her own expense, to purchase
additional amounts of life insurance and accidental death and dismemberment
insurance to the extent provided by the city's current providers. Evidence of
insurability is contingent upon total participation in additional amounts.
D. Long Term Disability Insurance
This program provides, for each incident of illness or injury, a waiting period of
thirty (30) calendar days, during which the employee may use accumulated sick
leave, general leave, or the employee may elect to be in a non-pay status.
Subsequent to the thirty (30) day waiting period, the employee will be covered by
an insurance plan paid for by the city, providing 66 2/3 percent of the first
$12,500 of the employee's basic monthly earnings.
The maximum benefit period for disability due to accident or sickness shall be to
age 65.
Days and months refer to calendar days and months. Benefits under the plan
Y
are integrated with sick leave, Worker's Compensation, Social Security and other
non-private program benefits to which the employee may be entitled. Disability
is defined as: "The inability to perform all of the duties of regular occupation
during two years, and thereafter the inability to engage in any employment or
occupation, for which he is fitted by reason of education, training or experience."
Rehabilitation benefits are provided in the event the individual, due to disability,
must engage in another occupation. Survivor's benefit continues plan payment
for three (3) months beyond death. A copy of the plan is on file in the
Administrative Services Department.
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E. Miscellaneous
1. City Paid Premiums While on Medical Disability
When an employee is off work without pay for reason of medical disability,
the city shall maintain the city paid employee's insurance premiums during
the period the employee is in a non-pay status for the length of said leave,
not to exceed twenty-four (24) months.
2. Insurance and Benefits Advisory Committee
The city and the Association agree to participate in a citywide joint labor and
management insurance and benefits advisory committee to discuss and
study issues relating to insurance benefits available for employees.
3. Health Plan Over-Payments
Unit members shall be responsible for accurately reporting the removal of
ineligible dependents from health plan coverages. The city shall have the
right to recover any premium paid by the city, including premiums to its self-
insured plan, on behalf of ineligible dependents. Recovery of such over-
payments shall be made as follows:
a. Reduction of Employee's Bi-Weekly Salary Warrant
The employee's bi-weekly salary warrant shall be reduced by one-half of
the amount of the bi-weekly over-payment. Such reduction shall continue
until the entire amount of the over-payment is recovered.
b. Notice of Ineligible Dependents
The city shall use its best efforts to advise all unit members of their
obligation to report changes in the status of dependents, which affect their
eligibility.
c. Twelve Month Recovery Period
The city shall be entitled to recover a maximum of twelve (12) months of
premium over-payments. Neither the employee nor the dependent shall be
liable to the city other than as provided herein.
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F. Employee Cost Sharing
Starting January 4, 2003 employees will share in the city's total cost of providing
benefits (medical, dental, vision, life, and accidental death & dismemberment)
with a bi-weekly pre-tax payroll deduction in the amounts below based on the
employee's usage category of the medical benefit.
Employee Cost Per Pay Annual
Sharing Period
EE $ 6.75 $ 175.50
EE + 1 14.00 364.00
EE + 2 or more 18.90 491.40
Until the City Council approves a successor to this Memorandum-of-
Understanding, the city's 2003 contribution caps will remain in place in 2004 and
beyond, even if premium increases result in these additional costs being borne
by the employee.
G. Joint Cafeteria Plan Study
The city and one FMA employee will convene an ad-hoc committee to study a
cafeteria plan for employee benefits. The ad-hoc committee will finalize its
report by June 30, 2003. The resulting report may have an effect on 2004
benefit costs.
ARTICLE IX - LEAVE BENEFITS
A. General Leave
1. Accrual
Employees accrue general leave at the accrual rates outlined below.
General leave may be used for any purpose, including vacation, sick leave,
and personal leave. Employees shall accrue general leave at their
appropriate assigned work schedule rate, either 40-hour or 56-hour
workweek. In the event of a change in work schedules, which must be at
the beginning of a pay period, payroll shall change the accrued general
leave balance and accrual rate based on the new schedule using the
conversion factor of .7143. Personnel who change from a fifty-six (56) hour
schedule to a forty (40) hour schedule shall multiply the existing general
leave by .7143. Personnel who change from a forty (40) hour schedule to a
fifty-six (56) hour schedule shall divide their existing general leave by .7143.
40
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General Leave General Leave
Years of Service Accrual Accrual
40-Hour Rate 56-Hour Rate
First through Fourth Year 176 Hours 246.4 Hours
Fifth through Ninth Year 200 Hours 280.0 Hours
Tenth through Fourteenth Year 224 Hours 313.6 Hours
Fifteenth Year and Thereafter 256 Hours 358.4 Hours
2. Eligibility and Approval
General leave must be pre-approved; except for illness, injury or family
sickness, which may require a physician's statement for approval. Accrued
general leave may not be taken prior to six (6) months' service except for
illness, injury or family sickness. General leave accrued time is to be
computed from hiring date anniversary. Members shall not be permitted to
take general leave in excess of actual time earned. Members on a 40-hour
schedule shall not accrue general leave in excess of six hundred hours
(600), 56-hour members shall not accrue general leave in excess of eight
hundred and forty hours (840). Employees may not use their general leave
to advance their separation date on retirement or other separation from
employment.
3. Conversion to Cash
Once during each fiscal year, each employee shall have the option to
convert into a cash payment or deferred compensation up to a total of one
hundred twenty (120) hours of earned general leave benefits. The
employee shall give two (2) weeks advance notice of his/her desire to
exercise such option.
4. Family Sick Leave
As required by law, employees will be allowed to use up to one-half of their
annual General Leave accrual for family sick leave, pursuant to the
provisions of California Labor Code Section 233.
The city will provide family and medical care leave for eligible employees
that meet all requirements of State and Federal law. Rights and obligations
are set forth in the Department of Labor Regulations implementing the
Family Medical Leave Act (FMLA), and the regulations of the California Fair
Employment and Housing Commission implementing the California Family
Rights Act (CFRA).
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B. Sick Leave
1. Accrual
No employee shall accrue sick leave.
2. Credit
Employees assigned to FMA shall carry forward their sick leave balance
and shall no longer accrue sick leave credit.
3. Usage
Employees may use accrued sick leave for the same purposes for which it
was used prior to the employee's assignment to FMA.
4. Family Sick Leave
The city will provide family and medical care leave for eligible employees
that meet all requirements of State and Federal law. Rights and obligations
are set forth in the Department of Labor Regulations implementing the
Family Medical Leave Act (FMLA), and the regulations of the California Fair
Employment and Housing Commission implementing the California Family
Rights Act (CFRA).
5. Pay Off At Termination
a. Employees covered by this agreement and on the payroll on
November 20, 1978 shall be entitled to the following sick leave payoff
plan:
At involuntary termination by reason of industrial or non-industrial
disability, or by death, or by retirement, employees shall be
compensated at their then current rate of pay for seventy-five percent
(75%) of all unused sick leave accumulated as of July 1, 1972, plus
fifty percent (50%) of unused sick leave accumulated subsequent to
July 1, 1972, up to a maximum of 720 hours of unused, accumulated
sick leave, except as provided in paragraph 4 below.
Upon termination for any other reason, employees shall be
compensated at their current 40-hour equivalent rate of pay for fifty
percent (50%) of all unused, accumulated sick leave. The maximum
number of hours paid off at termination will be a total of 720 hours.
Example:
Employee has 1920 hours of accured sick leave. 1920 hours
multiplied by 50% equals 960 hours. Maximum pay off is 720 hours.
Pay off equals 720 hours multiplied by the employee's current 40-hour
equivalent pay rate.
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b. Employees hired after November 20, 1978 shall be entitled to the
following sick leave payoff plan:
Upon termination, all employees shall be paid, at their then current 40-
hour equivalent rate, for twenty-five percent (25%) of unused, earned
sick leave to 480 hours accrued, and for thirty-five percent (35%) of all
unused, earned sick leave in excess of 480 hours, but not to exceed
720 hours, except as provided in paragraph 4 below.
c. Except as provided in paragraph 4 below, no employee shall be paid
at termination for more than 720 hours of unused, accumulated sick
leave. However, employees may utilize accumulated sick leave on the
basis of "last in, first out" meaning that sick leave accumulated in
excess of the maximum for payoff may be utilized first for sick leave,
as defined in Personnel Rule 18-8.
d. Employees who had unused, accumulated sick leave in excess of 720
hours as of July 5, 1980, shall be compensated for such excess sick
leave remaining on termination under the formulas described in
paragraphs 1 and 2 above. In no event shall any employee be
compensated upon termination for any accumulated sick leave in
excess of the "cap" established by this paragraph (i.e., 720 hours plus
the amount over 720 hours existing on July 5, 1980). Employees may
continue to utilize sick leave accrued after that date in excess of such
"cap" on a "last in, first out" basis.
e. To the extent that any "capped" amount of excess sick leave over 720
hours is utilized, the maximum compensable amount shall be
correspondingly reduced. (Example: Employee had 1,000 hours
accumulated. Six months after July 5, 1980, employee has
accumulated another 48 hours. Employee is then sick for 120 hours.
Employee's maximum sick leave "cap" for compensation at termination
is now reduced by 72 hours to 928 hours.)
C. Bereavement Leave
Employees shall be entitled to bereavement leave not to exceed thirty (30) work
hours in each instance of death in the immediate family. Immediate family is
defined as father, mother, sister, brother, spouse, children, grandfather,
grandmother, stepfather, stepmother, step grandfather, step grandmother,
grandchildren, stepsisters, stepbrothers, mother-in-law, father-in-law, son-in-law,
daughter-in-law, brother-in-law, sister-in-law, stepchildren, or wards of which the
employee is the legal guardian.
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Employees assigned to suppression assignments "56-hour workweek" shall be
entitled to bereavement leave not to exceed forty-eight (48) work hours in each
instance of death in the immediate family, as defined above.
D. Paternity Leave
The city will provide family and medical care leave for eligible employees that
meet all requirements of State and Federal law. Rights and obligations are set
forth in the Department of Labor Regulations implementing the Family Medical
Leave Act (FMLA), and the regulations of the California Fair Employment and
Housing Commission implementing the California Family Rights Act (CFRA).
ARTICLE X— CITY RULES
A. Personnel Rules
The city and the Association agree to implement the following rules and
accordingly revise the Personnel Rules as described herein:
1. Rule 5 — Recruitment and Examination Procedure
a) 5-4 — Order of Certification
Whenever certification is to be made, the eligibility lists, if active and
not exhausted shall be used in the following order'
1) Re-employment list
2) Promotional list
3) Employment List
If fewer than five (5) names of persons willing to accept appointment
are on the list from which certification is to be made, then additional
eligibles shall be certified from the various lists next lower in order of
preference until five (5) names are certified. If there are fewer than
five (5) names on such lists, there shall be certified the number
thereon. In such case, the appointing authority may demand
certification of five (5) names and examinations shall be conducted
until five (5) names may be certified. In the event the appointing
authority does not choose to appoint from the five (5) names certified,
a new examination may be requested. In the event another
examination is conducted, those names shall be merged with others
already on the list in order of scores.
b) 5-14 — Promotional Exams
Promotional examinations may be conducted whenever, in the opinion
of the Human Resources Manager, after consultation with the
department head, the need of the service so requires; provided,
however, a promotional examination may not be given unless there are
two (2) or more candidates eligible. Only employees who meet the
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requirements for the vacant position may compete in promotional
examinations. Promotional examinations may include any of the
selection techniques, or any combination thereof, mentioned in Section
5-13. Additional factors including, but not limited to, performance rating
and length of service may be considered. A promotional employment
list shall be established after the administration of a promotional
examination, and such list shall contain the name(s) of those that
passed the examination.
2. Rule 7 — Discipline
a) 7-2 — Causes for Discipline
12) Possession, use or sale of illegal narcotics or habit-forming
drugs, while on-duty or on city property.
14) Conviction of any felony or a misdemeanor with a job nexus. A
plea or verdict of guilt, or a conviction following a plea of nolo
contendere, is deemed to be a conviction within the meaning of
this section.
15) Participating in an unlawful strike, work stoppage, slowdown, or
using or attempting to use sick leave to accomplish the same
purpose as a strike, work stoppage, or slowdown.
3. Rule 8 —Termination
a) 8-1 — Medical Examination. Evaluation of Employee's Work Capacity.
Demotion, Transfer or Termination of Appointment
At any time a department head has reasonable cause to believe that
an employee may not be able to perform the duties of his/her position
for physical or psychological reasons, such department head shall
consult with the Human Resources Manager regarding such belief. If
the Human Resources Manager concurs, the department head may
order the employee to submit to a medical or psychological
examination. The employee shall be offered the opportunity, in writing,
to select from a panel of three to five physicians or psychologists to
conduct the examination. The cost of such examination shall be paid
by the city and, to the extent practicable, shall be scheduled during the
work hours with no loss of pay.
The department
p ent head shall review the medical or psychological report
and shall consult with the Human Resources Manager regarding the
physician's assessment of the employee's ability to perform the duties
of his/her position. Any decision regarding such employee shall be
made in accordance with the Americans with Disabilities Act.
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Notwithstanding any other provision of this rule, an employee being
evaluated for medical or psychological fitness to perform the duties of
his/her position may apply for another position in the competitive
service for which he/she has qualified. If such employee is qualified
and can perform the duties of a lower paying vacant position for which
he/she has applied, he/she will be placed in such position, without
competitive examination, subject to the approval of the department
head.
(The city and Association agree to meet biannually to discuss the 8-1
process).
b) 8-3 — Layoff in Accordance with Length of Service
The city and the Association agree that the first sentence in Personnel
Rule 8-3 shall be modified to read as follows: Layoff shall be made in
accordance with the relative length of the last period of continuous
service of the employees in the class of layoff, provided, however, that
no permanent employee shall be laid off until all temporary, acting and
probationary employees in the competitive service holding positions in
the same class are first laid off.
c) 8-11 — Re-Employment
With the approval of the Human Resources Manager, an employee
who has resigned in good standing from the competitive service may
be re-employed to his/her former position, if vacant, or to a vacant
position in the same or comparable class within one (1) year from date
of resignation in accordance with Rule 5-21. If such re-employment
commences within ninety days of the effective date of resignation, the
employee shall not be considered a new employee for vacation and
seniority purposes.
4. Rule 12 — Classification Plan
a) 12-10 —Temporary Employees
Employment on a basis other than permanent or probationary to a
permanently budgeted position not to exceed 1000 hours in any twelve
(12) month period. Employees occupying temporary positions shall
not be included in the competitive service and shall not be subject to
these rules and regulations.
5. Rule 14 —Additional Pay and Pay Adjustments
a) 14-6 — Salary Advancements to Meet Recruiting Problems or to Give
Credit for Prior Service. Application for Other Advancements
The Department Head, through the Human Resources Manager and
with the approval of the City Administrator may make an appointment
at any step above the minimum salary rate to classes or positions in
order to meet recruiting problems to obtain a person who has
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extraordinary qualifications, or to give credit for prior city service in
connection with appointments, promotions, reinstatements, transfers,
reclassifications, or demotions. Salary adjustments within the salary
range for the class, other than merit salary adjustments authorized by
Section 14-1, may be approved by the City Administrator, upon
recommendation of the department head through the Human
Resources Manager. Such recommendation shall include the
reason(s) for the adjustment, whether the advancement is to be
permanent or temporary, and an effective date.
6. Rule 18 — Attendance and Leaves
a) 18-16 — Industrial Accident Leave
In the event a permanent employee, who is a miscellaneous member
of the Public Employees' Retirement System (PERS), is temporarily
totally disabled as a result of an injury or illness arising out of and in
the course of employment and covered by the State of California
Workers' Compensation Insurance and Safety Act, resulting light duty
assignments due to the injury or illness or absences from work shall be
considered Industrial Accident Leave as that term is defined by this
rule.
A permanent employee eligible for Industrial Accident Leave shall
receive compensation from the city in an amount equal to the
employee's regular rate of salary during such period of temporary total
disability. Benefits received under this rule shall be in lieu of statutory
Workers' Compensation benefits. Industrial Accident Leave shall
continue during all absences resulting from the injury or illness,
including those absences attributable to doctor's appointments,
therapy, or other follow-up medical visits, but in no case exceeding one
year of accumulated absences attributable to the same injury or
illness. In the event an employee is temporarily, totally disabled by
coinciding qualifying injuries or illnesses, periods of absences shall be
applied concurrently to all qualifying injuries or illnesses.
Industrial Accident Leave compensation shall begin on the first day an
eligible employee is absent due to a qualifying injury or illness as
defined above. Industrial accident Leave compensation will terminate
on the earliest of the following:
1) The date upon which the injury or illness giving rise to eligibility
for compensation under this rule is declared permanent and
stationary by a treating or examining physician; or
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2) The date PERS approves an application for disability retirement
benefits filed by the employee or by the city; or
3) The employee receives thirty (30) days advance notice and
refuses to submit to a medical examination ordered by PERS
pursuant to Government Section 21154 or otherwise refuses to
cooperate with PERS in determining whether the employee is
incapacitated for the performance of duty; or
4) The employee receiving Industrial Accident Leave Compensation
applies for service-connected retirement benefits; or
5) The employment of the affected employee is otherwise
separated.
If an injured worker remains temporarily disabled after receiving one
year of Industrial Accident Leave for accumulated absences or light
duty work attributable to the same injury or illness, the employee will
receive temporary total disability benefits as specified by the State of
California Workers' Compensation Insurance and Safety Act. Any
period of time during which an employee is absent from work by
reason of injury or illness for which he or she is entitled to receive
Industrial Accident Leave compensation will not constitute a break in
continuous service for the purposes of salary adjustments, sick leave,
vacation accruals, and length of service computation.
In the event an employee who is receiving or has received Industrial
Accident Leave compensation makes a claim or initiates legal action
against a third party for allegedly causing or contributing to the injury or
illness resulting in the inability to work, the employee is required to
notify in writing the city's Risk Management Division of the claim or
commencement of such action within ten (10) days of the claim or
such commencement. The city retains its rights of subrogation in all
such instances.
b) 18-19 — Maternity Leave
The city and the Association agree to modify the present Personnel
Rule 18-19 Maternity Leave to read as follows: "A permanent
employee shall be entitled to a leave of absence without pay due to
inability to work due to pregnancy. The employee will be entitled to use
available sick leave during this period. Said leave must be requested in
writing from the Department Head and must include written notification
from the employees physician stating the last day the employee may
work and the estimated duration of leave. The employee must obtain
written authorization to return to work from the attending physician.
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Said authorization must be filed with the Department Head and the
Human Resources Manager."
c) 18-20 — Leave of Absence without Pay
The city and the Association agree that the following sub-paragraph
"C" shall be added to Personnel Rule 18-20. Leave of Absence without
Pay: Leave of absence without pay, for medical disability reasons,
shall be restricted to six (6) months.
7. Rule 19 — Grievance Procedure Non-Disciplinary Matters
a) 19-5 Grievance Procedure
1) Step 4 — City Administrator
If the grievance is not settled under Step 3, the grievance may
be presented to the City Administrator in accordance with the
following procedure: Within fifteen (15) days after the time the
decision is rendered under Step 3 above, a written statement of
the grievance shall be filed with the Human Resources Manager
who shall act as hearing officer and shall set the matter for
hearing within fifteen (15) days thereafter and shall cause notice
to be served upon all interested parties. The Human Resources
Manager, or his representative, shall hear the matter de novo
and shall make recommended findings, conclusions and
decision in the form of a written report and recommendation to
the City Administrator within five (5) days following such
hearing. The City Administrator may, in his discretion, receive
additional evidence or argument by setting the matter for
hearing within ten (10) days following his receipt of such report
and causing notice of such hearing to be served upon all
interested parties.
Within five (5) days after receipt of report, or the hearing
provided for above, if such hearing is set by the city
Administrator, the City Administrator shall make written decision
and cause such to be served upon the employee or employee
organization and the Human Resources Manager.
2) Step 5 — Personnel Board Hearing
Hearing. As soon as practicable thereafter, the Human
Resources Manager shall set the matter for hearing before a
hearing officer either selected by mutual consent of the parties
or from a list provided by the Personnel Commission.
Ratification of the hearing officer selected by mutual consent of
the parties, if from a list approved by the Personnel
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Commission, shall not require separate approval or-ratification
by the Personnel Commission. The hearing officer shall hear
the case and make recommended findings, conclusions and
decision in the form of a written report and recommendation to
the Personnel Commission. In lieu of the hearing officer
process, the Personnel Commission may agree to hear a case
directly upon submission of the case by mutual consent of the
parties.
8. Rule 20 — Disciplinary Procedure and Appeal
a) 20-1 — Purpose
The purpose of this rule is to provide a procedure for recommending
and imposing discipline against city employees, and a means by which
an employees may administratively appeal any such disciplinary
action.
b) 20-2 — Disciplinary Procedures
1) Notice of Proposed Adverse Action
For disciplinary demotions, suspensions or dismissals, an
employee shall be served a written Notice of Proposed Adverse
Action by the employee's department head, or his/her designee,
or by certified mail, prior to the proposed disciplinary action
taking effect. The notice shall state the reasons for and
charges upon which the proposed action is based, and the
effective date of the action the right to respond and the
employer's right to representation. A copy of all materials upon
which the proposed action is based shall be attached to the
notice.
2) Employee's Right to Respond
The employee shall be given a minimum of ten (10) calendar
days to respond orally and/or in writing to the charges upon
which the proposed action is based. The employee's response
shall be made to and/or before his/her department head.
3) Time Off
The employee shall be given reasonable time off with pay to
attend disciplinary meetings.
4) Final Notice of Decision
After an employee has responded to or waived his/her right to
respond to the proposed adverse action, the employee shall be
served with a final Notice of Decision from his/her department
head. The final written Notice of Decision shall state whether or
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not the proposed action shall be taken or modified, and the
reasons therefore and effective date or the action.
c) 20-3 —Appeal to Personnel Commission
Disciplinary action involving the termination, suspension, demotion or
other reduction in pay may be appealed to the Personnel Commission
for de novo hearing and final determination in accordance with the
following procedure:
1) Request for Appeal
Within five (5) days after the employee's receipt of a final Notice
of Discipline, a written request for an appeal to the Personnel
Commission shall submitted to the Human Resources Manager.
2) Hearin
As soon as practicable thereafter, the Human Resources
Manager shall set the matter for hearing before a hearing
officer. The hearing officer shall hear the case without the
Board and shall make recommended findings, conclusions and
decision in the form of a written report and recommendation to
the Board.
3) Final Decision
The Board shall consider the written report and
recommendations of the hearing officer and after due
deliberation in executive session, shall render a decision in the
matter which shall be final and binding on all parties, and from
which there shall be no further appeal.
d) 20-4 — Supplemental Hearing by Personnel Board
1) The Board may, in its sole discretion, after it has received the
written report and recommendation of the hearing officer, set
the matter for private hearing for the purpose of receiving
additional evidence or argument. In the event the Board sets a
private hearing for such purposes, the Human Resources
Manager shall give written notice to all parties concerned in
such matter.
2) The Board, following a consideration of the hearing officer's
written report and recommendation and deliberation thereon
and any supplemental hearing before the Board, shall make
findings, conclusions and decisions which shall be final and
binding on all parties and from which there shall be no further
appeal.
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e) 20-5 — Employee Status on Pending Appeal
Notwithstanding the provisions of Rule 7, Section 7-4 (Suspension with
Pay), the disciplinary action an appeal to the Personnel Commission.
9. Rule 21 — Grievance Procedures - General
a) 21-7 Hearing Officer
The hearing officer provided for in Rules 19 and 20 shall be from a list
provided by the Personnel Commission or one selected by mutual
consent of the parties.
b) 21-12 Time. Extension of
The city and the employee, or employee organization may, by mutual
consent, extend the time period within which an act must occur in the
processing of grievances.
c) 21-13, Time Extension, Grievances
The city and the employee, or employee organization may, by mutual
consent, extend the time periods within which an act must occur in the
processing of grievances.
C. Rules Governing Layoff, Reduction in Lieu of Layoff and Re-Employment
1. Part 1 — Layoff Procedure
a) General Provisions
1) Whenever it is necessary, because of lack of work or funds to
reduce the staff of a city department, employees may be laid off
pursuant to these rules.
2) Whenever an employee is to be separated from the competitive
service because the tasks assigned are to be eliminated or
substantially changed due to management-initiated changes,
including but not limited to automation or other technological
changes, it is the policy of the city that steps be taken by the
Personnel Division on an interdepartmental basis to assist such
employee in locating, preparing to qualify for, and being placed in
other positions in the competitive service. This shall not be
construed as a restriction on the city government in effecting
economies or in making organizational or other changes to
increase efficiency.
3) A department shall reduce staff by identifying which positions
within the department are to be eliminated.
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4) The employee who has the least city-wide service credit in the
class within the department shall have city-wide transfer rights in
the class pursuant to Part 1, Section 3, Transfer or Reduction to
Vacancies in Lieu of Layoffs, or within the occupational series
pursuant to Part 2, Bumping Rights.
5) If a deadline within this procedure falls on a day that City Hall is
closed, the deadline shall be the next day City Hall is open.
b. Service Credit
1) Service credit means total time of full-time continuous service
within the city at the time the layoff is initiated, including probation,
paid leave or military leave. Permanent part-time employees earn
service credit on a pro-rata basis.
2) Except as required by law, leaves of absence without pay shall not
earn service credit.
3) As between two or more employees who have the same amount
of service credit, the employee who has the least amount of
service in class shall be deemed to be the least senior employee.
c. Transfer or Reduction to Vacancies in Lieu of Layoff
1) In lieu of layoff, a transfer within class shall be offered to an
employee(s) with the least amount of service credit in the class
designated for staff reduction within a department subject to the
following:
a) The employee has the necessary qualifications to perform the
duties of the position.
b) The employee shall be given the opportunity, in order of
service credit, to accept a transfer to a vacant position in the
same class within the city, provided the employee has the
necessary qualifications to perform the duties of the position.
c) If no position in the same class is vacant, the employee shall
be given the opportunity, in order of service credit, to transfer
to the position in the same class that is held by an incumbent
in another department with the least amount of service credit
whose position the employee has the necessary qualifications
to perform.
2) If an employee(s) is not eligible for transfer within the employee's
class, the employee shall be offered, in order of service credit, a
reduction to a vacant position in the next lower class within the city
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in the occupational series in lieu of layoff provided the employee
has the necessary qualifications to perform the duties of the
position.
3) If the employee refuses to accept a transfer or reduction pursuant
to A. or B., above, the employee shall be laid off.
d) If the employee(s) in the class with the least amount of service credit is
in the position(s) to be eliminated or displaced by transfer, the
employee shall be offered bumping rights, pursuant to Part 2, Service
Credit.
e) Any employee who takes a reduction to a position in a. lower class
within the occupational series in lieu of layoff shall be placed on the
reinstatement/reemployment list(s) pursuant to Part 3.,
Reemployment.
2. Order of Layoff
a) Prior to implementing a layoff, vacant positions that are authorized to
be filled shall be identified by citywide occupational series. If the
employee refuses to accept a position pursuant to Section 3., above,
the employee shall be laid off.
b) No promotional probationary employee or permanent employee within
a class in the department shall be laid off until all temporary,
nonpermanent part-time and non-promotional probationary employees
in the class are laid off. Permanent employees whose positions have
been eliminated may exercise citywide bumping rights to a lower class
in the occupational series pursuant to Part 2.
c) When a position in a class and/or occupational series is eliminated,
any employee in the class who is on authorized leave of absence or is
holding a temporary acting position in another class shall be included
for determining order of service credit and be subject to these layoff
procedures as if the employee was in his or her permanent position.
3. Notification of Employees
a) The Personnel Division shall give written notice of layoff to the
employee by personal service or by sending it by certified mail to the
last known mailing address at least fifteen (15) calendar days prior to
the effective date of the layoff. Normally notices will be served on
employees personally at work.
b) Layoff notices may be initially issued to all employees who may be
subject to layoff as a result of employees exercising voluntary
reduction/bumping rights.
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c) The notice of layoff shall include the reason for the layoff, the effective
date of the layoff, the employee's hire date and the employee's service
credit ranking. The notice shall also include the employee's right to
bump the person in a lower class with the least service credit within the
occupational series provided the employee possesses the necessary
qualifications to successfully perform the duties in. the lower class and
the employee has more service credit than the incumbent in the lower
class.
d) The written layoff notice given to an employee shall include notice that
he or she has seven (7) calendar days from the date of personal
service, or date of delivery of mail if certified, to notify the Human
Resources Manager in writing if the employee intends to exercise the
employee's bumping rights, if any, pursuant to Part 2, Bumping Rights.
e) Whenever practicable, any employee with the least amount of service
credit in a lower class within an occupational series which is identified
for work force reduction shall also be given written notice that such
employee may be bumped pursuant to Part 2. This notice shall include
the items referred to in C., above.
f) If an employee disagrees with the City's computation of service credit
or listed date of hire, the employee shall notify the Human Resources
Manager as soon as possible but in no case later than five (5)
calendar days after the personal service or certified mail delivery.
Disputes regarding date of hire or service credit shall be jointly
reviewed by the Human Resources Manager and the employee and/or
the employee's representative as soon as possible, but in no case later
than five (5) calendar days from the date the employee notifies the
Human Resources Manager of the dispute. Within five (5) calendar
days after the dispute is reviewed, the employee shall be notified in
writing of the decision.
4. Part 2 — Bumping Rights
a) Voluntary Reduction or Bumping in Lieu of Layoff
1) A promotional probationary employee or permanent employee
who receives a layoff notice may request a reduction to a position
in a lower class within the occupational series provided the
employee possesses the necessary qualifications to perform the
duties of the position.
2) Employees electing reduction under A above, shall be reduced to
a position authorized to be filled in a lower class within the
employee's occupational series. The employee may reduce to a
lower class in his/her occupational series by: 1) filling a vacancy in
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that class, or 2) if no vacancy exists, displacing the employee in
the class with the least service credit whose position the employee
has the necessary qualifications to perform. A displaced
employee shall have bumping rights.
3) An employee who receives a layoff notice must exercise bumping
rights within seven (7) calendar days of receipt of the notice as
specified in Part 1. Failure to respond within the time limit shall
result in a reputable presumption that the employee does not
intend to exercise any right of reduction or bumping to a lower
class. The employee must carry the burden of proof to show that
the employee's failure to respond within the time limits was
reasonable. If the employee establishes that failure to respond
within the time limit was reasonable, to the Human Resources
Manager's satisfaction, the employee shall be permitted to
exercise bumping rights but shall not be reinstated to a paid
position until the employee to be bumped has vacated the
position. If the employee disagrees with the Human Resources
Manager's decision, the employee may appeal pursuant to the
provisions of Sections 3 and 4 below.
b) Reinstate ment/Re-employment Lists
Any employee who takes a reduction to a position in a lower class
within the occupational series in lieu of layoff shall be placed on the
reinstatement/re-employment list pursuant to Part 3, Re-employment.
c) Qualifications Appeal
Any employee who is denied a reduction to a position in a lower class
within the occupational series on the basis that the employee does not
possess the necessary qualifications to successfully perform the duties
of the lower position may appeal the decision. The appeal shall be
filed with the Human Resources Manager within five (5) calendar days
of the employee's receipt of written notice of the decision and
reason(s) for denial. The employee's appeal shall be in writing and
shall include supporting facts or documents supporting the appeal.
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d) Qualifications Appeal Hearing
1) Upon receipt of an appeal, the Human Resources Manager shall
contact a mediator from the California State Mediation and
Conciliation Service to schedule a hearing within two (2) weeks
after receipt of the appeal. If the California State Mediation and
Conciliation Service is not available within that time frame, the
parties shall mutually select a person who is available within the
time frame. If the California State Mediation and Conciliation
Service and the person mutually selected are not available within
tile time frame, the parties shall select the earliest date either is
available to conduct the hearing. The parties shall split the cost, if
any, of the hearing officer. In addition, the parties shall meet within
three (3) workdays to attempt to resolve the dispute. If the dispute
remains unresolved, the parties shall endeavor in good faith to
submit to the hearing officer a statement of all agreed upon facts
relevant to the hearing.
2) Appeal hearings shall be limited to two (2) hours, except as
otherwise agreed by the parties or directed by the hearing officer.
3) The hearing officer shall attempt to resolve the dispute by mutual
agreement if possible. If no agreement is reached, the hearing
officer shall render a decision at the conclusion of the hearing
which shall be final and binding
5. Part 3 — Re-employment
a) Re-employment
1) Employees who are laid off or reduced to avoid layoff shall have
their names placed .upon a reemployment list, for each class in
the occupational series, in seniority order at or below the level of
the class from which laid off or reduced.
2) Names of persons placed on the reemployment lists shall remain
on the list for two (2) years from the date of layoff or reduction.
3) Vacancies shall be filled from the reemployment list for a class,
starting at the top of the list, providing that the person meets the
necessary qualifications for tile position.
4) Names of persons are to be removed from the reemployment list
for a class if on two (2) occasions they decline an offer of
employment or on two (2) occasions fail to respond to offers of
employment in a particular class within five (5) calendar days of
receipt of written notice of an offer. Any employee who is
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dismissed from the city service for cause shall have his or her
name removed from all re-employment lists.
5) Re-employment lists shall be available to FMA and affected
employees upon reasonable request,
6) Qualification appeals involving reemployment rights shall be
resolved in the same manner as that identified in Part 2.,
Section 4.
b) Status on Re-employment
1) Persons re-employed from layoff within a two (2) year period from
the date of layoff shall receive the following considerations and
benefits:
a) Service credit held upon layoff shall be restored, but no credit
shall be added for the period of layoff.
b) Prior service credit shall be counted toward sick leave and
vacation accruals.
c) Employees may cash in sick leave upon layoff or at any time
after layoff in the manner and amount set forth in existing
Memoranda of Understanding for that employee's unit. Sick
leave shall be paid to an employee when the reemployment
list(s) expire(s), if not previously paid.
d) Upon reinstatement the employee may have his or her sick
leave re-credited by repayment to the city the cashed amount.
Sick leave accumulation of less than 480 hours shall be
restored upon reemployment.
e) The employee shall be returned to the salary step of the
classification held at the time of the layoff and credited with
the time previously served at that step prior to being laid off.
f) The probationary status of the employee shall resume if
incomplete.
2) Employees who have been reduced in class to avoid layoff and
are returned within two (2) years to their former class shall be
placed at the salary step of the class they held at the time of
reduction and have their merit increase eligibility date recalculated.
2003 FMA MOU Final.doc 27 04/02/02 7:54 AM
Res. No. 2002-122
MEMORANDUM OF UNDERSTANDING
HUNTINGTON BEACH FIRE MANAGEMENT ASSOCIATION
ARTICLE XI -- MISCELLANEOUS
A. Vehicle Policy
1. Approval is required by the City Administrator or his designee for any city
vehicle to be taken home by a FMA employee.
2. The auto allowance for qualifying members shall be one-hundred sixty-one
dollars and fifty-three cents ($161.53) bi-weekly.
3. The monthly automobile allowance shall not be reduced during the term of
this agreement.
4. Eligibility for automobile allowance shall be determined in accordance with
the Administrative Regulation, Vehicle Use Policy and the city's Fleet
Management Program.
5. Unit members agree to all provisions of the city's Fleet Management
Program dated August 1999.
B. Deferred Compensation Loan Program
Unit members may borrow up to 50% of their deferred compensation funds for
critical needs such as medical costs, college tuition, or purchase of a home,
pursuant to program standards and regulations.
C. Association Business
An allowance of fifty (50) hours per year shall be established for the purpose of
allowing authorized representatives of the Association to represent members in
their employment relations.
2003 FMA MOU Final.doc 28 04/02/02 7:54 AM
MEMORANDUM OF UNDERSTANDING Res. No. 2002-122
HUNTINGTON BEACH FIRE MANAGEMENT ASSOCIATION
ARTICLE XII — CITY COUNCIL APPROVAL
It is the understanding of the city and the Association that this Memorandum of
Understanding is of no force or effect whatsoever unless and until adopted by
Resolution of the City Council of the City of Huntington Beach.
IN WITNESS WHEREOF, the parties hereto have executed this Memorandum of
Understanding this/JZ-61day of November, 2002.
HUNTINGTON BEACH
CITY OF HUNTINGTON BEACH FIRE MANAGE NT ASSOCIATION
Ray SilvaK Jac<ues P. Pelletier
City Ad r inistrator FMA President
William P. Workman R bert M. Bro
Assistant Admini r Bargaining Committee
Clay Marti
Director Administrative Services
APPROVED AS TO FORM:
Gail Hutton` 1J,�j 1!-1�4&z_
City Attorney
2003 FMA MOU Final.doc 29 04/02/02 7:54 AM
FIRE MANAGEMENT ASSOCIATION Res. No. 2002-122
MEMORANDUM OF UNDERSTANDING
FMA
LIST OF MOU EXHIBITS
EXHIBITS SUBJECT
A Class/Salary Schedule
B Retiree Medical Plan and Subsidy Program
C Employee Health Plan
D Delta Care (PMI) Dental Plan
E Delta Dental — Dental Plan
F Vision Service Plan
Res. No. 2002-122
MEMORANDUM OF UNDERSTANDING
HUNTINGTON BEACH FIRE MANAGEMENT ASSOCIATION
EXHIBIT A - FIRE MANAGEMENT ASSOCIATION SALARY SCHEDULE
Effective December 21, 2002
Step
Job Code Classification Range A B C D E
0031 Fire Battalion Chief 583 39.93 42.13 44.45 46.90 49.48
0026 Fire Division Chief 615 46.84 49.42 52.14 55.01 58.04
2003 FMA MOU Final.doc 31 04/02/02 7:54 AM
Res. No. 2002-122
MEMORANDUM OF UNDERSTANDING
HUNTINGTON BEACH FIRE MANAGEMENT ASSOCIATION
EXHIBIT B — RETIREE SUBSIDY MEDICAL PLAN
An employee who has retired from the city shall be entitled to participate in the city sponsored
medical insurance plans and the city shall contribute toward monthly premiums for coverage in
an amount as specified in accordance with this plan, provided:
A. At the time of retirement the employee has a minimum of ten (10) years of continuous
city service or is granted an industrial disability retirement; and
B. At the time of retirement, the employee is employed by the city; and
C. Following official separation from the city, the employee is granted a retirement
allowance by the California Public Employees' Retirement System.
The city's obligation to pay the monthly premium as indicated shall be modified
downward or cease during the lifetime of the retiree upon the occurrence of any one of
the following:
1. During any period the retired employee is eligible to receive or receives
health insurance coverage at the expense of another employer, the
payment will be suspended. "Another employer" as used herein means
private employer or public employer or the employer of a spouse. As a
condition of being eligible to receive the premium contribution as set forth
in this plan, the city shall have the right to require any retiree to annually
certify that the retiree is not receiving or eligible to receive any such health
insurance benefits from another employer. If it is later discovered that a
misrepresentation has occurred, the retiree will be responsible for
reimbursement of those amounts inappropriately expended and the
retiree's eligibility to receive further benefits will cease.
2. On the first of the month in which a retiree or dependent reaches age 65
or on the date the retiree or dependent can first apply and become
eligible, automatically or voluntarily, for medical coverage under Medicare
(whether or not such application is made) the city's obligation to pay
monthly premiums may be adjusted downward or eliminated. Benefit
coverage at age 65 under the city's medical plans shall be governed by
applicable plan document.
3. In the event of the death of any employee, whether retired or not, the
amount of the retiree medical insurance subsidy benefit which the
deceased employee was receiving at the time of his/her death would be
eligible to receive if he/she were retired at the time of death, shall be paid
on behalf of the spouse or family for a period not to exceed twelve (12)
months.
MEMORANDUM OF UNDERSTANDING Res. No. 2002-122
HUNTINGTON BEACH FIRE MANAGEMENT ASSOCIATION
EXHIBIT B — RETIREE SUBSIDY MEDICAL PLAN CONTINUED
SCHEDULE OF BENEFITS
A. Minimum Eligibility for Benefits -- With the exception of an industrial disability
retirement, eligibility for benefits begin after an employee has completed ten (10) years
of continuous service with the City of Huntington Beach. Said service must be
continuous unless prior service is reinstated at the time of his/her rehire in accordance
with the city's Personnel Rules.
B. Disability Retirees -- Industrial disability retirees with less than ten (10) years of service
shall receive a maximum monthly payment toward the premium for health insurance of
$121. Payments shall be in accordance with the stipulations and conditions, which
exist for all retirees. Payment shall not exceed dollar amount, which is equal to the full
cost of premium for employee only.
C. Maximum Monthly Subsidy Payments -- All retirees, including those retired as a result
of disability whose number of years of service prior to retirement exceeds ten (10),
shall be entitled to maximum monthly payment of premiums by the city for each year
of completed city service as follows:
Maximum Monthly Payment
for Retirements After:
Years of Service Subsidy
10 $ 121
11 136
12 151
13 166
14 181
15 196
16 211
17 226
18 241
19 256
20 271
21 286
22 300
23 315
24 330
25 344
2003 FMA MOU Final.doc 04/02/02 7:54 AM
Res. No. 2002-122
MEMORANDUM OF UNDERSTANDING
HUNTINGTON BEACH FIRE MANAGEMENT ASSOCIATION
EXHIBIT B - RETIREE SUBSIDY MEDICAL PLAN CONTINUED
Note: The above payment amounts may be reduced each month as dependent eligibility ceases due to death,
divorce or loss of dependent child status. However, the amount shall not be reduced if such reduction
would cause insufficient funds needed to pay the full premium for the employee and the remaining
dependents. In the event no reduction occurs and the remaining benefit premium is not sufficient to pay
the premium amount for the employee and the eligible dependents, said needed excess premium amount
shall be paid by the employee.
2003 FMA MOU Final.doc Rd 04/02/02 7:54 AM
Res. No. 2002-122
MEMORANDUM OF UNDERSTANDING
HUNTINGTON BEACH FIRE MANAGEMENT ASSOCIATION
INDEMNITY HEALTH PLAN, EMPLOYEES/RETIREES
This summary lists only those benefit provisions that differ between active and subsidized
Retiree Plans. The Employee Health Plan Document should be consulted for detailed
questions about specific benefits. Benefits are subject to modification through the meet and
confer process.
YEAR 2003
Benefits City Plan - Employees City Plan - Subsidized
Non-Subsidized Retirees Retirees
COBRA-eligibles
Deductible $250 per person $250 per person
$500 per family $500 per family
Maximum Out of Pocket $2,000 per person $2,000 per person
$4,000 per family $4,000 per family
Co-Insurance:PPO 90% of UCR 90% of UCR
Non-PPO 50% of UCR 50% of UCR
Note: Retirees who elect to participate in HMO shall be entitled to benefits of the program chosen. This summary
has been used to list only those benefit provisions that differ between active and subsidized Retiree Plans.
Currently, there are no differences, however, this exhibit is not intended to require that future changes to
active employee benefits be applied to retirees as well. The Employee Health Plan Document should be
consulted for detailed questions about specific benefits. Benefits are subject to modification through the
meet and confer process.
Res. No. 2002-122
MEMORANDUM OF UNDERSTANDING
HUNTINGTON BEACH FIRE MANAGEMENT ASSOCIATION
RETIREE SUBSIDY MEDICAL PLAN/MISCELLANEOUS PROVISIONS
A. Eligibility:
1. The effective start-up date of the Retiree Subsidy Medical Plan for the
various employee groups shall be the first of the month following retirement
date.
2. A retiree may change plans, add dependents, etc., during annual open
enrollment. Employee Benefits shall notify covered retirees of this
opportunity each year.
3. Years of service computed for the Retiree Subsidy Medical Plan are actual
years of completed service with the City of Huntington Beach.
4. When a retiree is eligible for medical plan coverage at the expense of
another employer due to post-retirement employment of the retiree or
spouse of the retiree, the retiree and his/her spouse must take that
coverage regardless of benefit level and shall be deleted from any City Plan
coverage. Exceptions to this requirement are limited to the following:
a. A retiree is not required to enroll in such `other" medical plan coverage
if there is significant disparity between the benefits provided by the
"other' medical plan and the Retiree Subsidy Medical Plan as defined
below. "Significant disparity" means coverage available under the
"other" medical plan is restrictive or limited in one or more of the
following ways:
1) No in-patient hospitalization coverage.
2) No major medical benefits
3) Annual deductible is $1,000 or greater per person.
4) Major medical benefits are paid at 60% or less of covered
expenses.
b. The Risk Manager will have the authority to provide additional
exceptions following review of the "other" medical plan policy.
Exceptions will be made only if the "other' medical plan benefit
provisions are comparable to the guidelines under B above.
Res. No. 2002-122
MEMORANDUM OF UNDERSTANDING
HUNTINGTON BEACH FIRE MANAGEMENT ASSOCIATION
EXHIBIT B — RETIREE SUBSIDY MEDICAL PLAN CONTINUED
c. Miscellaneous Provisions:
1. Benefits provided under the Retiree Subsidy Medical Plan will
be coordinated with the "other" medical plan as the primary
carrier.
2. The city shall have the right to require any retiree to provide a
copy of the "other' medical plan policy for review by the
Risk Manager.
5. When a retiree becomes eligible for the other group coverage and then
becomes no longer eligible, he/she may have the subsidy reinstated and
regain Retiree Subsidy Medical Plan coverage.
6. Dependents of a retiree may follow him/her into the Retiree Subsidy
Medical Plan or they may choose to exercise COBRA rights along with the
retiree.
7. When a retiree becomes 65 and has eligible dependents under 65, said
dependents are eligible to exercise COBRA rights.
8. When a retiree is under 65 and his/her spouse is over 65, the spouse is not
covered.
B. Benefits:
1. Retiree Subsidy Medical Plan includes Managed Health Network (MHN),
Prescription Card System (PCS), Orange County Foundation for Medical
Care (OCFMC).
2. City Plans are the primary payer for active employees age 65 and over, with
Medicare the secondary payer. Retirees age 65 and over have no city Plan
options and are eligible only for Medicare.
3. Premium payments are to be received at least one month in advance of the
coverage period.
C. Subsidies:
1. The subsidy payments will pay for:
a. Retiree Subsidy Medical Plan.
2003 FMA MOU Final.doc 17 04/02/02 7:54 AM
Res. No. 2002-122
MEMORANDUM OF UNDERSTANDING
HUNTINGTON BEACH FIRE MANAGEMENT ASSOCIATION
EXHIBIT B — RETIREE SUBSIDY MEDICAL PLAN CONTINUED
b. HMO.
c. Part A of Medicare for those retirees not eligible for paid Part A.
2. Subsidy payments will not pay for:
a. Part B Medicare.
b. Regular City Employee Indemnity Plan.
c. Any other employee benefit plan.
d. Any other commercially available benefit plan.
e. Medicare supplements
D. Medicare:
1. All persons are eligible for Medicare coverage at age 65. Those with
sufficient credit quarters of Social Security will receive Part A of Medicare at
no cost. Those without sufficient credited quarters are still eligible for
Medicare at age 65, but will have to pay for Part A of Medicare if the
individual elects to take Medicare. In all cases, Part B of Medicare is paid
for by the participant.
2. When a retiree and his/her spouse are both 65 or over, and neither is
eligible for paid Part A of Medicare, the subsidy shall pay for Part A for each
of them or the maximum subsidy, whichever is less.
3. When a retiree at age 65 is eligible for paid Part A of Medicare and his/her
spouse is not eligible for paid Part A, the spouse shall not receive subsidy.
When a retiree at age 65 is not eligible for paid Part A of Medicare and
his/her spouse who is also age 65 is eligible for paid Part A of Medicare, the
subsidy shall be for the retiree's Part A only.
E. Cancellation:
1. For retirees/dependents eligible for paid Part A of Medicare, the following
cancellation provisions apply:
a. Coverage for a retiree under the Retiree Subsidy Medical Plan will be
eliminated on the first day of the month in which the retiree reaches
age 65. If such retiree was covering dependents under the Plan,
2003 FMA MOU Final.doc 04/02/02 7:54 AM
Res. No. 2002-122
MEMORANDUM OF UNDERSTANDING
HUNTINGTON BEACH FIRE MANAGEMENT ASSOCIATION
EXHIBIT B — RETIREE SUBSIDY MEDICAL PLAN CONTINUED
dependents will be eligible for COBRA continuation benefits effective
as of the retiree's 65th birthday.
b. Dependent coverage will be eliminated upon whichever of the following
occasions comes first:
1) After 36 months of COBRA continuation coverage, or
2) When the covered dependent reaches age 65 in the event
such dependent reaches age 65 prior to the retiree reaching
age 65.
c. At age 65 retirees are eligible to make application for Medicare. Upon
being considered "eligible to make application", whether or not
application has been made for Medicare, the Retiree Subsidy Medical
Plan will be eliminated.
2. See provisions under "Benefits", "Subsidies", and "Medicare" for those
retirees/dependents not eligible for paid Part A of Medicare.
3. Retiree Subsidy Medical Plan and COBRA participants shall be notified of
non-payment of premium by means of a certified letter from Employee
Benefits in accordance with provisions of the Memorandums of
Understanding.
4. A retiree who fails to pay premiums due for coverage and is in arrears for
sixty (60) days shall be terminated from the Plan and shall not have
reinstatement rights.
ems/
2003 FMA MOU Final.doc za 04/02/02 7:54 AM
HUNTINGTON BEACH
MEMBERSHIP
HANDBOOK
FIRE MANAGEMENT
AND SUBSIDIZED
RETIREE
EMPLOYEE
HEAL
A -WT
i
This booklet provides a brief
description of the important features
of your health insurance coverage. It
is not a contract and only the
provisions of the Plan Document will
control.
Payments under this plan are based
on Usual, Customary and
Reasonable charges.
Revised April 2001
TABLE OF CONTENTS Highlights of the Employee Health Plan
Highlights of the Employee Health Plan 1 The Employee Health Plan was created for the purpose of providing medi-
CoPayment and Benefit Percentages
2 cal benefits for eligible employees and their eligible dependents.
3 This section is intended only as a brief summary of the Plan's benefits.
Definitions All maximums are per person unless specifically noted as per family.
6 Please refer to the subsequent sections for a more detailed description
Persons Covered and Effective Dates of covered expenses and benefits exclusions and limitations.
Preferred Provider and Exclusive Provider Organization 7
Eligible Employees
Deductibles and Out of Pocket Expenses g A permanent City employee
10 Eligibility Date
Covered Medical Expenses (See Persons Covered and Effective Dates section for enrollment details
Prescriptions 12 and effective dates)
12 Open Enrollment
Chiropractic and Physical Therapy The open enrollment period is the month of November. Coverage for a
Preventive Medical Care
12 participant enrolling during Open Enrollment will be effective Jan. 1.
12 Lifetime Maximum Benefit
Well Baby Care The lifetime maximum benefit is$1,000,000. This is the absolute limit on
General Exclusions and Limitations
13 what the Plan will pay for each participant's covered expenses.
When You Have a Claim 15 Calendar Year Maximum Benefit
The calendar year maximum benefits listed below are the limits on what
Claims Payment and Appeals 15 this Plan will pay for each participant's covered expenses in a calendar
year for the corresponding type of benefit:
Coordination with Other Plans 16
Mental/Emotional Disorder and or Substance Abuse:
Termination of Coverage 17 Administered by Managed Health Network. No benefits available through
the Employee Health Plan. Refer to MHN brochures for further informa-
tion.
Inpatient Hospitalization 100 days
(during each period of disability)
Chiropractic Care $2,000 or 24 visits
(whichever occurs first)
Wellness Benefit $200 per year
I
Deductible: Per Person $250 Definitions
Per Family $500
Calendar Year
Out of Pocket: Per Person $2,000 A period of twelve months commencing January 1 and ending December
Per Family $4,000 31 of the same year.
(Deductibles and Out of Pocket apply per calendar year)
Custodial Care
NOTE: The out ofpocket expenses do not include any charges that ex- Means services or supplies for persons who are physically or mentally dis-
ceed Usual, Customary and Reasonable rates, any expenses for treatment abled but who are not currently receiving medical,surgical or psychiatric
of a mental/emotional disorder and/or substance abuse, charges for pre- treatment to reduce their disability and to enable them to live without cus-
scription drugs or the EPO copayments. todial care.
Copayment and Benefit Percentage
Emergency
Benefits EPO% PPO% Non PPO% A sudden,unexpected,acute illness or injury that,without immediate
Description medical treatment,could result in death or cause impairment to bodily
functions.
Annual Deductible None $250/$500 $250/$500 Extended Care or Skilled Nursing_Facility
A licensed facility operating pursuant to law which is primarily engaged in
providing skilled nursing care on an inpatient basis during the convales-
Office Visits $5 copay 90% 70% UCR cent state of illness or injury under 24 hours a day supervision of a physi-
cian or registered graduate nurse. Such a facility must maintain complete
medical records on each patient and have established methods and proce-
Wellness No charge $200 max $200 max dures for the dispensing and administering of drugs. In no event shall the
term include a facility that is primarily:
• A rest home,retirement home or home for the aged
Inpatient $150 copay 90% 70% • A school or similar institution
Hospitalization (day 1-4)then • Engaged in the care and treatment of substance abuse,or of
100% mentally ill or senile persons
in custodial care
Emergency Services $5 copay 90% 70% • Engaged
Hospital
An institution operated pursuant to law that is accredited by the appropri-
Outpatient Services $5 copay 90% 70% ate national regulatory body for hospital accreditation. It must be primar-
ily engaged in providing medical,diagnostic and surgical facilities for the
care and treatment of sick and injured individuals on an inpatient basis. It
Durable Medical $5 copay 90% 70% must also provide such facilities under the supervision of a staff of physi-
Equipment cians and with 24 hour a day nursing services by registered graduate
nurses. The definition of hospital shall not include any institution or part
Prescription-pharmacy $5 generic/$8 brand thereof which is used principally as a rest facility,extended care facility,
nursing facility or facility for the aged.
Inpatient
Prescription—mail order $4 generic/$6 brand A person who is confined in a hospital as a registered bed patient and who
is charged at least one day's room and board by the hospital.
2 3
Medical Necessary or Medical Necessitv Plan Administrator
Describes medical treatment that: The Risk Management Division is the Plan Administrator for purposes of
• Is appropriate and consistent with the diagnosis this Plan's claims administration.
• Is in accordance with accepted medical standards,it would not Retiree
have been omitted without adversely affecting the patient's Any retired employee of the City who(a)has retired on a service or dis-
condition a the quality of medical care rendered ability retirement and(2)is not eligible for Medicare,and(3)has not at-
tained age 65.
Mental Health Disorder Usual.Customary and Reasonable
Any disorder characterized by abnormal functioning of the mind or Charges made for medical services or supplies essential to the care of the
emotions and in which psychological,intellectual,emotional or behav-
ioral disturbances are the dominate features. Mental health disorders participant will be considered reasonable and customary if they are the
include mental disorders,mental illnesses,psychiatric illnesses,mental amount normally charged by the provider for similar services and supplies
conditions and psychiatric conditions,whether organic or non-organic, and do not exceed the amount ordinary charged by most providers of com-
whether biological,non-biological,genetic,chemical,or non-chemical parable services and supplies in the geographic area where the services or
supplies are received. Whether charges are reasonable and customary
origin,and irrespective of cause,basis or inducement. shall be determined by the Plan Administrator or its agent in its sole dis-
Nurse
cretion by use of any customary or accepted method. In determining A licensed Registered Nurse(R.N.)or licensed Practical Nurse(LPN)or whether charges are reasonable and customary,the Plan Administrator
licensedgive due consideration to the nature and severity of the condition be-
licensed Vocational Nurse(LVN)who does not live with the patient and ing treated and any medical complications or unusual circumstances that
is not a member of the family. require additional time,skill or expertise.
Outpatient
A person who is not admitted as an inpatient but who receives medical
care.
Outpatient Surgery
Surgery performed on an outpatient basis at a hospital,ambulatory sur-
gical facility,or physician's office. An ambulatory surgical facility is
defined as a licensed,specialized facility,within or outside the hospital
facility that meets the following criteria:
• Is established,equipped and operated in accordance with the
applicable state laws and is primarily for the purpose of per-
forming surgical procedures
• Is operated under the supervision of a Medical Doctor(M.D.)
who is devoted full time to such supervision
• Requires,in all cases other than those requiring only local
infiltration anesthetics,that a licensed anesthesiologist admin-
ister the anesthetics and remain present through the surgery.
Physician
A duly licensed Doctor of Medicine(M.D.),Osteopath,Podiatrist,Chi-
ropractor or any other practitioner providing a covered service and act- 5
ing within the scope of his/her license.
4
Persons Covered and Effective Date
Preferred Provider Organization(PPO)
Those eligible are:
Exclusive Provider Organization(EPO)
The Preferred Provider Organization(PPO)and Exclusive Provider Or-
Their permanent employees and their spouses ganization(EPO)is a statewide network of physicians,hospitals and other
to
• Their unmarried children to age health care providers established specifically to provide comprehensive
full time student,
to,or
• Unmarried children from age L 25 if:ives at home and is dependent upon his/her medical service to Plan participants at reduced rates. As a participant in
(b) L
(a) the Plan,you will receive a directory of providers that belong to the PPO
. and EPO networks.
parent for at least 50%of his/her support
If you choose the PPO/EPO option,please follow the procedures for its
New permanent employees are eligible to participate in the Employee Health Plan on the first of the month following 30 days from the date of use carefully. If your doctor refers you to another provider,make sure that
the new provider is also an EPO or PPO before services are rendered.
hire.
H The copayments and applicable benefit percentages are shown in the
Effective Date Dependent Coverag e Highlights section. If you go to a PPO provider,do not pay for services at
Check with the Human Resources Division when you want to enroll a new spouse or new child. Appropriate forms must be completed within 60 the time of your visit. PPO providers are required to submit their medical
days of marriage,birth of a child or when the employee becomes legally bills to the Employee Health Plan first. The Employee Health Plan will
responsible for an adopted child. Dependent coverage will be effective on then calculate the Usual,Customary and Reasonable(UCR)rate and then
the date of marriage,date of birth or the newborn child or the date of issue an Explanation of Benefits(EOB)to the PPO and the participant.
adoption or the date of placement of an adopted child in your home. The PPO provider will then issue a statement to the participant for the co-
payment and deductible if applicable.
Change in Family Status If you go to an EPO,the provider may request payment of the$5 copay at
Once you are enrolled in the Employee Health Plan,you must notify the the time of your visit. You are not responsible for any other charges other
Plan Administrator or Human Resources Division within 60 days of any than the$5 copay. If you are admitted to a hospital,your copay will be
family status change,such as a newborn baby,or when you no longer need
a certain family member covered,or when a family member is no longer $150 per day to a maximum of$600 per period of hospitalization.
eligible as defined by this Plan.
Notice to Employees WaivingCoverage
If you decide to decline coverage under this Plan for yourself or your Eli-
gible Dependents for whatever reason,you must execute a waiver of cov-
erage on a form provided by the Human Resources Division at the time
coverage is declined,and return such form to Human Resources.
If you are declining enrollment for yourself or your Eligible Dependents
because of other health insurance coverage,you may, in the future,be able
to enroll yourself or your Eligible Dependents in the Plan,provided that
you request enrollment within thirty(30)days after your other coverage
ends.,
6 7
Deductibles and Out of Pocket Expenses
Family Out of Pocket Expense
Deductibles and out of pocket expenses represent the portion that the par- If the dollar amount of the family out of pocket expense amount,shown in
ticipant pays for covered expenses. This section generally describes these the Highlights section,is satisfied by the combined covered expenses ap-
cost sharing provisions of the Plan. plied to the individual out of pocket expense amount of several covered
family members,no additional out of pocket expense amount is required
Calendar Year Deductible I to be satisfied by the covered persons of that family for the remainder of
The calendar year deductible is the amount of covered expenses incurred the calendar year.Once a covered family member has satisfied the individ-
by a participant during a calendar year for which no benefits will be paid. ual out of pocket expense amount no additional covered expenses for that
After you,or a covered dependent,has satisfied the calendar year deducti- person will be counted towards the family out of pocket expense amount.
ble, the Plan pays a certain percentage of the covered expenses for that
individual during the rest of the calendar year. Deductible accumulation
period is January 1 through December 31.
Family Calendar Year Deductible
If the dollar amount of the family calendar year deductible,shown in the
Highlights section,is satisfied by the combined covered expenses applied
to the individual deductibles of several covered family members,no addi-
tional calendar year deductible amount is required to be satisfied by the
covered persons of that family for the remainder of the calendar year.
Once a covered family member has satisfied the individual deductible,no
additional covered expenses for that person will be counted toward the
family deductible.
Three Month Carryover
Any covered expenses incurred in the last three months of the calendar
year that are used to satisfy the calendar year deductible for that year will
be applied towards to deductible for the following year.
Out of Pocket ExWnses
Out of pocket expense is the amount of covered expenses you must pay
after the satisfaction of the calendar year deductible before certain benefits
begin to be paid at 100%. If,during the calendar year,your out of pocket
expenses satisfy the out of pocket expense amount,the rate of payment for i
certain covered charges will be increased to a full one hundred percent I
(100%). The one hundred percent(1001/6)will continue until the end of f
that calendar year. You must satisfy your deductible plus your out of
pocket amount before these benefits will be paid at 100%.
In no event will this provision apply to the deductible,any expenses for
treatment of a mental/emotional disorder and/or substance abuse,charges
for prescription drugs,charges that exceed Usual,Customary and Reason-
able charges,or the EPO copayments.
8
9
Covered Medical Expenses 11. Speech therapy by a qualified speech therapist. The therapy
must be to restore or rehabilitate speech loss due an illness or in-
List of Covered Medical Expenses jury,or due to surgery for an illness or injury. If speech loss is
The following expenses are covered by the Plan. Reimbursement is based due to a congenital anomaly,surgery to correct the anomaly must
upon the lifetime maximum and calendar year limits,benefit percentages have been performed prior to therapy.
and other limitations previously described in the Highlights section. 12. Elective surgery for sterilization,including tubal ligation and va-
sectomy.
1. Charges for services and supplies used in the administration of 13. Medical supplies necessary for treatment including but not lim-
anesthesia,when not duplicated in the hospital charges. ited to,an electronic heart pacemaker,surgical dressings, casts,
2. Transportation by a professional ambulance service to a local splints,and crutches.
hospital or convalescent facility for inpatient care,if medically 14. Surgeon's fees for the performance of surgical procedures, in-
necessary,or to the nearest hospital for emergency care. Ex- cluding necessary related postoperative care by a physician,sub-
penses for transportation by air will be covered only if an air am- ject to the reasonable and customary fees in the area.
bulance is medically necessary. The first$50 of charges will be 15. Wellness care(see Highlights section for details)
paid at 100%. 16. Chiropractic and Physical Therapy subject to Plan limitations
3. Rental or durable medical equipment when such equipment is 17. Occupational Therapy performed by a licensed occupational
deemed medically necessary, including,but not limited to,a therapist and ordered by a physician. It must be considered pro-
wheelchair,hospital bed,respirator,and equipment for the ad- gressive therapy,not maintenance therapy,and must not be per-
ministration of oxygen. Such equipment may be purchased,if, in formed for the purpose of vocational rehabilitation. Covered ex-
the judgment of the Plan Administrator,purchase of the equip- penses do not include either recreational programs or supplies
ment would be less expensive than rental or the equipment is not used in occupational therapy.
available for rental. 18. Emergency services. In the event of emergency services,the
4. Hospital room and board,at the semi-private hospital room and Plan will pay at the PPO rate for Non PPO providers. Emergency
board rate. If medical necessity requires an intensive care or in- service is defined as follows: services which are immediately
termediate care unit,the Plan will cover the room and board rate required to treat a sudden serious and unexpected illness or in-
charged by the hospital. jury,including services to alleviate pain associated with sudden,
5. Other hospital services and supplies furnished by the hospital for serious and unexpected illness and/or injury.
medical care during confinement,exclusive of physician's and
other professional services.
6. Radiology(x-rays)and laboratory charges in connection with
treatment of an illness or injury.
7. Outpatient surgery charges for necessary services and supplies
for surgical procedures performed on an outpatient basis at a hos-
pital,ambulatory surgical facility, or physician's office,provided
that benefits for such charges would be payable if the procedure
were performed during a hospital confinement.
8. Physician's fees for medical care and treatment of an illness or
injury covered under the terms of this Plan
9. Prescription drugs necessary for the treatment of an illness or in-
jury, if obtainable only on a physician's written prescription and
dispensed by a licensed pharmacist.
10. X-ray and radium treatments,and treatments with other mdioac-
tive substances.
10 11
Prescriptions
General Exclusions and Limitations
All prescription drug payments shall be made through the Advance Prescrip- Benefits for the following shall not be covered:
tion Card Service(PCS)and shall be on the basis of a copayment by the par-
ticipant of$5 for each generic drug prescription or$8 for each brand name Occupational Injuries or Illnesses. Any illness or injury arising out
drug prescription. No payments for any prescription drug shall be made
through the Employee Health Plan. Prescription drugs are available by mail of,or in the course of,employment is excluded.
order at a cost of$4 for generic and$6 for brand name prescriptions. Claims
forms are available in the Risk Management Office. Unnecessary Services or Supplies. Any services or supplies not rea-
sonably necessary for the medical care of the participant's illness or
injury are excluded.
Chiropractic and Physical Therapy Guidelines Weekend Admissions. If admitted to the hospital on a Friday, Satur-
Benefits are provided as follows: 3 times a week for the first month day or Sunday,charges for these days will be excluded unless admit-
2 times a week for the second month ted due to an emergency or if surgery is performed within 24 hours.
Once a week for the third month Excess of Usual,Customary and Reasonable. The portion of any
2 times a month for fourth month and charge for any services or supplies in excess of the reasonable and
thereafter customary charge is excluded.
These guidelines may be modified on an individual case-by-case basis pur- Mouth and Teeth Conditions. Treatment on or to the teeth,extraction
suant to the recommendation of our Medical Advisor. of teeth,treatment of dental abscesses or granuloma,dental examina-
tion or treatment of gingival tissues other than for tumors is excluded.
Chiropractic Limitations Hearin Aids. Examinations to determine the need for,or the proper
Benefits will be provided to a maximum of 24 treatments per year or$2,000, adjustment of hearing aids,are excluded.
whichever occurs first. Said limits are per person and commence January 1 Vision Care. Physicians services in connection with eye refractions
of each year. or any other examinations to determine the need for,or the proper ad-
Preventive Medical Care justment of,eyeglasses or contact lenses are excluded. Radial keratot-
omy,Lasik and similar procedures are also excluded.
Benefits will be provided up to$200 per person for preventive medical care Cosmetic Surgery. Charges in connection with cosmetic surgery are
per year. This care shall include preventive medical options such as an an- excluded unless performed for the correction of functional disorders
nuaI physical exam,PAP tests,flu shots,chest x-rays,EKG,PSA and other as a result of accidental injury occurring while the individuals are
diagnostic tests if certified by the physician that such procedures are in- covered.
cluded under a routine physical examination and are not in connection
with the diagnosis or treatment of any illness or disease. Other General Exclusions:
Well Baby Exams 1. Hospital admissions primarily for diagnostic study when in-
Three well baby examinations for an infant for the first year of life will be patient care would not otherwise have been required.
allowed subject to the$200 maximum benefit. All innoculations for infants/ 2• Custodial care
children will be provided and coverage is not limited to the$200 maximum 3. Personal or convenience items
4. Services or supplies not connected with the care and treat-
benefit. merit of an actual illness,disease or injury
12 13
5. Any illness or injury due to war,declared or undeclared,or any
act of war is excluded When you have a Claim
6. Any means of artificial fertilization,including but not limited to
artificial insemination,in-vitro fertilization or gamete intra-
fallopian transfer Before submitting a claim for medical expenses,review this brochure and
7. Reversing prior surgical sterilization procedures the bills you have accumulated. Be sure you are submitted itemized bills
8. Any charges for weight control or weight reduction program for which benefits are payable.
9. No benefits will be provided for any condition of pregnancy for
dependent daughters. Save all of your bills,including those being accumulated to satisfy a de-
10. Sales tax on prescription drugs or on any other covered item ductible. In most instances they will serve as evidence of your claim.
11. No benefits will be provided for any mental health care. Mental Submit the original bill,not a copy. Each bill must be complete and item-
health services are provided by Managed Health Network ized and should show the patient's full name,date or dates of service,na-
12. Treatment,services,equipment,new technology,drugs,proce- ture of the illness or injury,and type of service provided. Claim forms are
dures or supplies considered experimental or investigational at available in the Risk Management office. A separate claim form is re-
the time the procedure is performed or service or supply is pro- quired for each family member. Please mail all completed forms to:
vided
13. Air conditioners,dehumidifiers,air purifiers,arch supports,cor- City of Huntington Beach
rective or orthopedic shoes, heating pads,hot water bottles,home Employee Health Plan
enema equipment, etc.are not covered. Risk Management Division
14. Any items for which the participant is not legally required to pay, 2000 Main Street
or for which a charge would not have been made if the participant Huntington Beach,CA 92648
did not have this coverage.
15. Benefits available under the Plan may be reduced or eliminated All claims must be received no later than 12 months from the date of ser-
based upon the coordination of benefits or subrogation rules. vice. Claims submitted after this time period will be rejected.
16. Charges for failure to keep a scheduled visit,completion of claim
forms or providing supplemental information. Claims Payment and Appeals
17. Charges for vitamins(except pre-natal vitamins),minerals,nutri-
tional or food supplements or any other over the counter item. Notice of Decision
18. Any charges not listed in'Covered Expenses" A notice of decision will be sent to you within 30 days after receipt of a
19. Nursing Facility. Any services furnished by an institution which properly completed claim. If there is some reason your claim cannot be
is primarily a place of rest,a place for the aged,a nursing or con- processed within that time,you will be given notice of the reason for the
valescent home or any institution of like character,unless other- delay.
wise specifically provided for herein.
20. Smoking cessation program. Claim Appeal Procedure
If your claim is denied in whole or in part,you and your physician will be
provided with written notification explaining the reason. If you have rea-
son to believe that the denial of your claim was not correct under the terms
of the Plan Document,a request for review must be made within 60 days
from the notice of the claim denial. The claim,as well as all supporting
documentation,will be submitted to Medical Review for review by physi-
14 cians at the Foundation for Medical Care. You and your provider will be
notified in writing of the claim decision as soon as possible but not later
than 120 days after receipt of the request.
15
Coordination with Other Plans Termination of Coverage
Coverage will terminate for an employee on the last day of the month in
The Employee Health Plan contains a provision to prevent double pay- which employment terminates. Coverage for a dependent will cease on
ment for covered expenses. This provision works by coordinating the the earliest of the following:
benefits under this Plan with other similar plans under wluch a person is
covered, so the total benefits available will not exceed one hundred per- • Last day of the month in which the employee's coverage termi-
cent of allowable expenses. This provision is commonly called nates
"Coordination of Benefits".
• Date the dependent enters active service with the armed forces
When a claim is made,the primary plan(as described below)pays its • Date the dependent ceases to be an eligible dependent
benefits without regard to any other plans. The secondary plans adjust • For a dependent spouse,on the date of divorce
their benefits so that the total benefits available will not exceed the allow- • For dependent child/children,the date of the child's marriage or
able expenses. No plan pays more than it would otherwise pay without attainment of the maximum age limit of 25.
this coordination provision.
A plan without a coordination of benefits provision is always the primary Continuation of Benefits
plan. If all plans have such a provision: (1)the plan covering the patient
directly(e.g., employee or retiree),rather than as a dependent, is primary If a covered employee ceases active employment due to an authorized
and the others secondary: (2)if a child is covered under both parents' leave of absence,participation may be continued under COBRA or Family
plans,the parent whose birthday falls earlier in the year is primary, or, if and Medical Leave Act(FMLA). Please refer any questions regarding the
both parents have the same birthday,the plan covering the parent longer is continuation of health insurance coverage to the Employee Benefits Divi-
primary,but when the parents are separated or divorced,their plans pay in sion of the City of Huntington Beach.
this order: (a)the plan of the parent with custody of the child; (b)the plan
of the parent not having custody of the child(c)the plan of the spouse of
the parent with custody of the child;,and(d)the plan of the spouse of the
parent not having custody of the child.
When the order of benefits is not determined by the preceding paragraphs,
the benefits of the plan covering the person as an employee who is actively
employed(neither laid off nor retired),are determined before those of a
plan covering a person who is inactive. If the other plan does not have this
provision and,as a result,the plans do not agree on the order of benefits,
this provision is ignored.
If none of the preceding provisions determine the order of benefits,the
benefits of the plan that covered a person longer are determined first.
If none of the preceding provisions of this section make it able to deter-
mine which plan is primary,the allowable expenses shall be shared
equally between the plans.
17
16
Res. No. 2002-122
EXHIBIT C — EMPLOYEE HEALTH PLAN BROCHURE
A copy of the Employee Health Plan Brochure
may be obtained from the
Administrative Services Department
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TAB
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TABLE OF CONTENTS
PARTI - DEFINITIONS........................................................................................................... 1
A. "CALENDAR YEAR"...................................................................................6........................... 1
B. "SKILLED NURSING FACILITY" ................................................ 1
C. "EFFECTIVE DATE" ............................................................................................................... 1
D. "FAMILY MEMBER"............................................... ........................... .................................... 1
E. "LEGALLY OPERATED HOSPITAL" .......................................................................................... 1
F. "MASCULINE GENDER" ........................................................................................... 1
G. "PARTICIPANT"..................................................................................................................... 2
H. "PHYSICIAN" OR"SURGEON"................................................................................................ 2
1. "EMPLOYEE".......................................................................................................................... 2
J. "PLAN"................................................................................................................................. 2
K "CITY".................................................................................................................................. 2
L. "RETIREE"............................................................................................................................ 2
M. "ACCIDENT"......................................................................................................................... 2
N. "RELATIVE VALUE STUDIES(RVS)"....................................................................................... 2
O. "MEDICALLY NECESSARY" .................................................................................................... 2
P. "USUAL, CUSTOMARY AND REASONABLE(UCR) CHARGE"..................................................... 2
Q. "SECOND SURGICAL OPINION".............................................................................................. 3
R. "PPO OR PPO PROVIDER"................................................................................................... 3
S. "NON-PPO PROVIDER...................... ........................... ....................................................... 3
T. "SUBSIDIZED RETIREE.. ..................... ........................... ....................................................... 3
U. "CLAIMS ADMINISTRATOR" .................................................................................................... 3
V. "CUSTODIAL CARE" .............................................................................................................. 3
W. "MENTAL OR NERVOUS DISORDERS"..................................................................................... 3
x "TOTALLY DISABLED"............................................................................................................ 4
Y. "UTILIZATION REVIEW"..........................................................................................................4
Z. "UTILIZATION REVIEW ORGANIZATION" ...................................................................................4
AA. "HOSPITAL PRE-ADMISSION NOTIFICATION"......................................................................... 4
BB. "MEDICAL REVIEW ADVISERS"............................................................................................4
CC. "SUBSTANCE ABUSE" ........................................................................................................ 4
PART 11 - ELIGIBILITY AND RECORDS.................................................................................4
A. ELIGIBLE PARTICIPANTS.......................................................... ..............................................4
B. ADDING FAMILY MEMBERS.....................................................................................................4
C. PRE-EXISTING CONDITIONS.................................................................................................... 5
D. RETIREES............................................................................................................................. 5
E. FAMILY MEMBERS BECOMING INELIGIBLE................................................................................ 6
F. BENEFIT BOOKLET.................................................................................................................6
PART III - CONDITIONS UNDER WHICH BENEFITS WILL BE PAYABLE IN A HOSPITAL
OR SKILLED NURSING FACILITY.........................................................................................6
A. CARE FOR ILLNESS OR ACCIDENT........................................................................................... 7
B. BED CARE............................................................................................................................7
C. EFFECTIVE DATE...................................................................................................................7
TABLE OF CONTENTS
D. IDENTIFICATION CARD............................................................................................................7
E. DAYS OF CARE......................................................................................................................7
F. MEDICALLY NECESSARY SERVICES.........................................................................................7
PARTIV — EXCLUSIONS.........................................................................................................7
A. DIAGNOSTIC STUDY.................................................. ......................................a.....................7
B. RECOVERABLE BENEFITS.............. ........................... ..........................................................7
C. SERVICES/SUPPLIES..............................................................................................................8
D. NO CHARGE SERVICES/SUPPLIES...........................................................................................8
E. UNITED STATES FEDERAL OR FOREIGN GOVERNMENT AGENCY................................................8
F. SERVICES SUPPLIES NOT SPECIFIED HEREIN...........................................................................8
G. CARE AND TREATMENT OF ACTUAL ILLNESS/INJURY................................................................8
H. TREATMENT TO THE TEETH/EYES/EARS..................................................................................8
1. COSMETIC ..............................................................................................................................8
J. ACTS OF WAR........................................................................................................................8
K. NURSING FACILITIES ..............................................................................................................8
L. CUSTODIAL CARE ..................................................................................................................8
M. MEDICARE ............................................................................................................................8
N. SEX TRANSFORMATIONS........................................................................................................9
O. RECONSTRUCTION OF STERILIZATION PROCEDURE..................................................................9
P. CHARGES IN EXCESS OF UCR................................................................................................9
Q. EXPERIMENTAL.......................................................... .................................. .......................9 .
R. PREGNANCY FOR DEPENDENT DAUGHTERS................ ............................................................9
S. OUTPATIENT PSYCHIATRIC CARE ............................................................................................9
T. SUPPLIES..............................................................................................................................9
U.WEIGHT CONTROL.................................................................................................................9
V. SERVICES PROVIDED BY MEMBERS OF HOUSEHOLD ................................................................9
W. UNKEPT APPOINTMENTS .......................................................................................................9
X. FALSE STATEMENTS ............................................................................................................10
Y. SERVICES OR SUPPLIES.......................................................................................................10
Z. TREATMENT BY OTHER THAN A LICENSED PHYSICIAN.............................................................10
AA. DISCOUNTS THROUGH ANOTHER PLAN...............................................................................10
BB. RESIDENTS/INTERNS.........................................................................................................10
CC. INJURY INCURRED DURING COMMISSION OF A CRIME...........................................................10
DD. IRS REGULATIONS............................:...............................................................................10
EE. HYPNOSIS.........................................................................................................................10
FF. DIGESTIVE AIDS, VITAMINS, SUPPLEMENTS.........................................................................10
GG. SMOKING CESSATION........................................................................................................10
HH. SPAS OR SWIMMING POOLS ..............................................................................................10
11. MANAGED HEALTH NETWORK...............................................................................................10
PART V—COORDINATION OF BENEFITS..........................................................................11
A. BENEFITS............................................................................................................................11
B. DEFINITIONS........................................................................................................ ............11
1. "CLAIMS DETERMINATION PERIOD"....................................................................................11
2. "COVERED INDIVIDUAL"....................................................................................................11
TABLE OF CONTENTS
3. "COVERED SERVICES"..................................................................................................... 11
4. "THIS DOCUMENT"........................................................................................................... 11
5. "PLAN" ........................................................................................................................... 11
C. EFFECT ON BENEFITS.......................................................................................................... 11
D. FACILITY OF PAYMENT......................................................................................................... 13
E. RIGHT OF RECOVERY...................................................:....................................................... 13
F. RIGHT TO RECEIVE AND RELEASE NECESSARY INFORMATION................................................. 13
PART VI - CONTINUATION BENEFIT.................................................................................. 14
PART VII - GENERAL PROVISIONS.................................................................................... 15
A. PLAN DOCUMENT................................................................................................................ 15
B. WORKER'S COMPENSATION INSURANCE............................................................................... 15
C. CHIROPRACTOR OR PSYCHOLOGIST...................................................................................... 15
D. CHARTER............................................................................................................................ 15
E. EMPLOYER RESPONSIBILITY FOR FURNISHING HOSPITAL CARE 16
..............................................
F. DUPLICATE COVERAGE........................................................................................................ 16
1. NOTICE OF CLAIM.................................................................................................................. 16
J. PRESCRIPTIONS................................................................................................................... 16
G. NON TRANSFERABLE BENEFITS........................................................................................... 16
H. LIMITATION OF LIABILITY....................................................................................................... 16
PART Vlll SECOND OPINION SURGICAL PROGRAM ................................ ....................17
A. DEFINTION, EFFECTIVE 1-1-84............................................................................................. 17
B. ELECTIVE SURGERY............................................................................................................ 17
C. BOARD CERTIFIED............................................................................................................... 17
D. SECOND OPINION FEES PAID BY PLAN.................................................................................. 18
E. COVERAGE BY EMPLOYEE ORGANIZATION............................................................................. 18
PART1X - BASIC BENEFITS................................................................................................ 18
A. DEFINITION.......................................................................................................................... 18
B. SUBSTANCE ABUSE TREATMENT............... 18
C. OUT-PATIENT PRE-HOSPITAL ADMISSION TESTING................................................................ 18
D. OUT-PATIENT SURGERY...................................................................................................... 18
E. BASIC PROFESSIONAL BENEFITS.............................................. ...........................................19
F. AMBULANCE BENEFIT.......................................................................................................... 20
G. PREVENTATIVE MEDICAL CARE............... 20
PARTX - MAJOR MEDICAL ................................................................................................ 21
A. DEFINITION...............
B. SPECIAL CONDITIONS IN REGARD TO HOSPITAL BENEFITS......................................................23
C. BENEFITS FOR SERVICES AND SUPPLIES IN ELIGIBLE SKILLED NURSING FACILITIES................. 24
D. CARE FOR CONDITIONS OF PREGNANCY................................................................................ 25
E. CHIROPRACTIC AND PHYSICAL THERAPY GUIDELINES............................................................ 25
F. TREATMENT BY CALIFORNIA LICENSED CERTIFIED ACUPUNCTURIST........................................ 25
G. SUBSIDIZED RETIREE BENEFITS........................................................................................... 25
H. MUNICIPAL EMPLOYEES ASSOCIATION(MEA)....................................................................... 25
TABLE OF CONTENTS
PART XI - RETIREE SUBSIDY MEDICAL PLAN..................................................................25
A. ELIGIBILITY..........................................................................................................................25
B. SCHEDULE OF BENEFITS......................................................................................................26
C. BENEFIT SUMMARY..............................................................................................................29
D. MISCELLANEOUS PROVISIONS/ELIGIBILITY........................................:. ................................29
BENEFITS.............................................................................................................................31
SUBSIDIES............................................................................................................................31
MEDICARE............................................................................................................................31
CANCELLATION.....................................................................................................................32
PART XII - TERMINAL BENEFITS........................................................................................32
A. BENEFIT CONTINUANCE AT TIME OF TERMINATION OF EMPLOYMENT .......................................33
B. TERMINAL BENEFITS FOR TOTAL DISABILITY..........................................................................33
C. DEFINITION OF TOTAL DISABILITY..........................................................................................33
D. EXCLUSION OF TERMINAL BENEFITS .....................................................................................33
PART XIII -ADMINISTRATION OF THE PLAN....................................................................33
A- APPOINTMENT OF THE CLAIMS ADMINISTRATOR.....................................................................33
B. POWERS OF THE CLAIMS ADMINISTRATOR.............................................................................33
C. CLAIMS PROCEDURE............................................................................................................34
D. APPEAL PROCEDURE............................................................................................................34
E. LIMITATION OF LIABILITY.......................................................................................................35
PART XIV- DURATION AND AMENDMENT OF THE PLAN...............................................35
A. PERMANENCE OF THE PLAN..................................................................................................35
B. RIGHT TO AMEND.................................................................................................................35
C. SEVERABILITY.....................................................................................................................35
PART XV -ADMINISTRATIVE PROVISIONS..............................................................
A. MANAGEMENT RIGHTS .........................................................................................................36
B. PARTICIPANT'S RESPONSIBILITIES.........................................................................................36
C. MISSING PERSON ................................................................................................................36
D. GOVERNING LAW.................................................................................................................36
AMENDMENT NO. 1 ............................................................................................... .............37
AMENDMENTNO. 2 .............................................................................................................38
AMENDMENTNO. 3 ................................................................. .....................................39
AMENDMENTNO. 4 .............................................................................................................40
AMENDMENTNO. 5 .............................................................................................................41
EMPLOYEE HEALTH PLAN DOCUMENT
Nothing contained in this document shall in any manner restrict or interfere with the right of
any individual entitled to service and care to select the hospital, skilled nursing facility or to
make a free choice of his attending physician or surgeon who shall be holder of a valid and
unrevoked physician's or surgeon's certificate and who is a member of, or acceptable to, the
attending staff and Board of Directors of the facility in which services are to be provided and
rendered.
PART 1 - DEFINITIONS
A. `Calendar Year' Is the twelve-month period commencing January 1st of year
at 12:01 A.M., Pacific Standard Time.
B. "Skilled Nursing Facility" - Means an institution which (1) provides skilled nursing
care under 24 hour supervision of a doctor or graduate registered nurse, (2) has
available at all times the services of a doctor who is a staff member of a hospital,
(3) provides 24 hours a day nursing service by a graduate registered nurse on duty
at least 8 hours per day, and (4) maintains a daily medical record for each patient. It
shall specifically exclude any institution which is primarily a place of rest, a place for
the aged or a facility operated by the Federal Government or any agency thereof.
C. "Effective Date" - Is the date on which this Document becomes effective.
D. "Family Member" - Shall be the spouse of the Employee and children from birth to
nineteen (19) years of age, provided such children are unmarried, and dependent
upon the Employee for support and maintenance. Refer to Part II, Eligibility and
Records, Section E for further clarification. The term "children" shall include natural
children, legally adopted children, and stepchildren.
E. "Legally Operated Hospital" - Is an institution operated in accordance with the
laws of the jurisdiction in which it is located pertaining to institutions identified as
hospitals and which, for compensation from its patients and on an inpatient basis, is y
primarily engaged in providing diagnostic and therapeutic facilities for surgical and
medical diagnosis, treatment and care of injured and sick persons by or under the
supervision of a staff of licensed physicians or surgeons, and which continuously
provides 24 hours a day nursing service by registered graduate nurses. It shall
specifically exclude care provided by any institution or any affiliate or unit of a
legally operated hospital which is primarily a place of rest, a place for the aged, a
nursing or convalescent home, or a facility operated by the Federal Government or
any agency thereof.
F. "Masculine Gender" - Includes the feminine in context.
G. `Participant" - Is the eligible employee or retired employee of the City whose
Enrollment Form has been accepted by the Claims Administrator in accordance with
the enrollment regulations of this Document and in whose name the City's
Identification Card is issued.
0011662.01 -11- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
H. "Physician" or "Surgeon" - Is one who is duly licensed (1) to prescribe and
administer drugs, and (2) to perform surgery within the scope of his license.
Physicians include Acupuncturists, Chiropractors, and Physical Therapists when
acting within the scope of their license.
1. "Employee" - Means all permanent employees of the City of Huntington Beach
working at least 20 hours per week.
J. "Plan" - Means Huntington Beach Employee Health Plan.
K. "City" - Means City of Huntington Beach.
L. `Retiree" - Means any retired Employee of the City who (1) has retired on a service
or disability retirement, and (2) is not eligible for Medicare, and (3) has not attained
age 65.
M. "Accident" - Means a sudden, unexpected and unplanned event occurring by
chance which is caused by an independent external force and which results in
definite physical trauma.
N. `Relative Value Studies (RVS)" Is a listing of medical and surgical procedures
published by the California Medical Association with "Units" assigned to each
procedure in accordance with various medical criteria. The City provides benefits
which are valued by assigning a monetary value to the RVS Unit for covered
procedures.
O. "Medically Necessary" - Services and/or supplies are services or supplies which
the Claims Administrator's medical advisors determine to be reasonably necessary
and which are provided in accordance with local community standards for care and
treatment of the illness or injury involved. The Plan will provide benefits only for
these services and supplies which are determined to have been medically
necessary at the time
P. "Usual, Customary and Reasonable (UCR) Charge" - Is the amount'charged or
the amount the Claims Administrator determines to be the prevailing charge within
the general area in which the service was provided, whichever is the lesser.
0011662.01 -2- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
Q. "Second Surgical Opinion" - Means certain surgical procedures done on an
elective basis shall be mandated to have a second surgical opinion in order to be
payable at normal plan benefits, as specified in this Plan Document. These surgical
procedures are as listed:
' Cataract Sure Varicose Vein Ligation
Surgery 9
Cholecystostomy Tonsillectomy &Adenoidectomy
Hernia Repair Knee Surgery (Menisectomy)
Hysterectomy Hemorrhoidectomy
Laminectomy Dilation and Curettage
Mastectomy Repair of Deviated Septum
i
Onychotomy Spinal Fusion
Prostatectomy '
R. "PPO or PPO Provider" -A doctor or other health care professional or hospital who
belong to the Orange County Foundation Preferred Provider Organization (OCPPO)
or similar organization if OCPPO is replaced.
S. "Non-PPO Provider" A doctor, hospital, or other health care professional not
belonging to the Orange County Preferred Provider Organization. I
T. "Subsidized Retiree" - A subsidized retiree is an employee, who, at the .time of
retirement has a minimum of ten years of continuous City service or is granted an
industrial disability retirement and elects to participate in the Retiree Subsidy
Medical Plan.
U. "Claims Administrator" - Means the person(s) with whom the City has contracted
to provide the services described in Section XIII.
V. "Custodial Care" - Means services or supplies provided for persons who are
physically or mentally disabled but who are not currently receiving medical, surgical
or psychiatric treatment to reduce their disability and to enable them to live without
Custodial Care
W. "Mental or Nervous Disorders" - Are those conditions listed in the International
Classification of Diseases in the section on Mental Disorders (Diagnostic Codes
290-319), including drug or alcohol intoxification or dependence and learning
problems. These disorders may be of physical or functional etiology.
X. `Totally Disabled" - Is physically prevented from engaging in his or her regular or
customary occupation. A Dependent is Totally Disabled if prevented solely because
of Sickness or Injury, from engaging in substantially all of the normal activities of an
individual of similar age. Certification of Total Disability must be made by a
Physician.
0011662.01 -3- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
Y. "Utilization Review" - Means systematically evaluating the appropriateness and
necessity of medical care. Utilization Review consists of, but is not limited to:
1. Pre-certifying the appropriateness and necessity of non-emergency
confinements;
2. Reviewing, on a concurrent basis, the continued appropriateness and
necessity of confinement or home health care;
3. Determining the necessity of second opinions for Elective Surgical
Operations; and
4. Providing case management services.
Z. "Utilization Review Organization" - Means the organization that conducts
Utilization Review for the Plan.
AA. "Hospital Pre-Admission Notification" - Means complying with all the rules set
forth by the Utilization Review Organization.
BB. "Medical Review Advisers" - Means the consultants of employees hired by the
Utilization Review Organization or Claim Administrator to provide advise as to
whether services are Medically Necessary.
CC. "Substance Abuse" - Means conditions listed in the International Classification of
Diseases as alcoholic psychoses, drug psychoses, alcohol dependence syndrome,
drug dependence or non-dependent abuse of drugs (Diagnostic Codes 291 through
292.9 and 303 through 305.9).
PART II - ELIGIBILITY AND RECORDS
A. Eligible Participants - Shall be all permanent Employees and Retirees.
B. Adding Family Members - The Participants may add, upon notice to the Claims
Administrator, other eligible Family Members, subject to enrollment regulations in
effect with the City. Immediate coverage will be provided from and after the moment
of birth for each newborn child of a Participant covered by a 'Participant and one or
more dependent" type coverage without requiring evidence of insurability.
Extension of coverage for any condition commencing beyond thirty-one days from
the date of birth of a newborn child of a Participant covered under a 'Participant and
one dependent" type coverage shall be contingent upon application to the Claims
Administrator by the Participant in respect to each newborn child provided such
application is made within sixty days from date of birth of a child in accordance with
the enrollment regulations. An' application for coverage for a new spouse or new
child must be completed within sixty days of marriage. An individual who fails to
enroll when first eligible must submit satisfactory evidence of good health when the
application for enrollment is made except during open enrollment.
0011662.01 -4- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
C. Pre-Existing Conditions - The Medical Plan shall exclude coverage of pre-existing
medical conditions of new employees and dependents, except under the following
conditions:
1. The employee or dependent is free from treatment for the pre-existing
condition for three months after the effective date of coverage under the
plan.
2. A pre-existing condition of the employee is covered after the employee
completes six month of continuous employment.
3. A pre-existing condition of any dependent who has been enrolled on the
plan is covered after the employee completes twelve months of continuous
service.
D. Retirees -All Retirees and their eligible Dependents shall be covered if-
1. They were approved for coverage and covered by the prior plan on
October 31, 1979.
2. They retired on or after 11/1/79, and:
a. Made application within 31 days of retiring, and
b. Paid a quarterly premium, as 'determined by the City in advance.
Retirees must continue to pay the quarterly premium monthly cost, as
determined by the City, in advance to maintain coverage.
3. On the first of the month in which the retiree reached age 65 or on the date
the retiree can first apply and become eligible for medical coverage under
Medicare (whether or not such application is made), benefits under this
Document will be terminated.
4. Effective 1-1-86 if the spouse of an industrial disability retiree becomes an
employee of the City of Huntington Beach and elects family coverage under
the Employee Health Plan, the retiree can elect to cancel his insurance
coverage and be insured as a dependent of his spouse. Upon the
spouse's termination of City insurance benefits, the retiree can, without
evidence of insurability, become reinstated to the Employee Health Plan at
his own cost.
E. Family Members Becoming Ineligible - Family members become ineligible under
the following circumstances:
1. When the Participant becomes ineligible.
2. When a child attains the age of nineteen years, or upon prior marriage,
except that:
a. In respect to an unmarried child attaining the age of nineteen years,
should he continue to be dependent upon his parent(s) to the extent of
not less than fifty percent of his subsistence and support, his eligibility
for benefits here under shall continue while he remains in such status
0011662.01 4- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
until he attains age twenty-three; Effective 1-1-86 the definition of
dependent child is changed to require that children between the ages
of nineteen to twenty-three be either: _
. i
1) A full time student or
2) Lives at home and are dependent on the parent/employee for
more than fifty percent (50%) of his/her support.
b. In respect to an unmarried child attaining the age of nineteen years, or
twenty-three years when qualifying as set forth in Paragraph a. above,
should he at such time be incapable of self-sustaining employment by
reason of mental retardation or physical handicap and continue to be
dependent upon his parent(s) to the extent of not less than fifty
percent of his subsistence and support, his eligibility for benefits
hereunder shall continue regardless of his age while he remains in
such status. Evidence of such incapacity and dependency shall be
required within thirty-one days of the dependent's attainment of age i
nineteen years or twenty-three years whichever is applicable, and
periodically thereafter as may be required by the Claims Administrator,
but not more frequently than annually after a two-year period following
such dependent's attainment of the aforementioned age limitation.
Determination of eligibility by the Claims Administrator shall be
conclusive.
3. A spouse upon entry of final decree of divorce or annulment.
F. Benefit Booklet - The Claims Administrator shall issue for delivery to each
Participant an individual benefit booklet, setting forth a statement of benefits to
which the Participant and his eligible Family Members are entitled, and an
Identification Card.
PART III - CONDITIONS UNDER WHICH BENEFITS WILL BE PAYABLE IN A HOSPITAL
OR SKILLED NURSING FACILITY
Benefits will be provided for expenses incurred in any Legally Operated Hospital or skilled
nursing facility under the following conditions:
A. Care for Illness or Accident'- Benefits shall be provided for expenses incurred in
connection with illness or accident, but limited to those expenses billed by the
Hospital or Skilled Nursing Facility which are necessary for treatment of the
condition requiring such care.
B. Bed Care - The attending Physician or Surgeon must certify that bed care is
Medically Necessary.
C. Effective Date - Admission must occur on or after the Participant's or Family
Member's Effective Date hereunder.
D. Identification Card - The Participant's Identification Card must be presented at time
of admission or during the confinement stay. If such is not done because of factors
0011662.01 -6 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
beyond the control of the patient, benefits will be allowed only if claim is made within
ninety days from date of admission or thirty days from date of discharge, whichever
is later, accompanied by a receipted bill and such supporting statements as are
necessary to establish the claim.
against
E. Days of Care - Days of care under the above provisions shall be counteda a n
D
Y Y
P9
total days of care available under this Document.
F. Medically Necessary Services - Services for inpatient bed care must be Medically {
Necessary and not capable of being performed on an outpatient basis.
PART IV - EXCLUSIONS
{
Benefits shall not be provided for:
A. Diagnostic Study - Admissions primarily for diagnostic study when inpatient bed
care would not otherwise have been required, unless otherwise specified herein.
I
B. Recoverable Benefits - Any condition for which benefits of any nature are i.
recovered or found to be recoverable, whether by adjudication or settlement, under
any Workers' Compensation or Occupational Disease Law, even though the
participant or family member fails to claim his rights to such benefits.
C. Services/Supplies - Services or supplies for which the participant or family member
is not legally required to pay.
D. No Charge Services/Supplies - Services or supplies for which no charge is made.
E. United States Federal or Foreign Government Agency - Care or treatment
obtained from, or for which payment is made by, any United States Federal or
foreign government agency.
F. Services Supplies not Specified Herein - Services or supplies not specifically
provided for herein.
G. Care and Treatment of Actual Illness/Injury - Services or supplies not connected
with care and treatment of an actual illness, disease or injury.
H. Treatment to the Teeth/Eyes/Ears - Treatment on or to the teeth, extraction of
• teeth, treatment of dental abscess or granuloma, dental examinations, or treatment
of gingival tisues (gums) other than for tumors; eye glasses, eye refractions, eye
examinations for the correction of vision or fitting of glasses; or the furnishing or
replacement of hearing aids; except as specifically provided for under Major Medical
if such benefits are included in this document. -
0011662.01 -7- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
1. Cosmetic - Services or supplies for cosmetic purposes, unless performed for
correction of functional disorders or as a result of accidental injury occurring while
the individual is covered hereunder.
J. Acts of War - Conditions caused by or arising out of an act of war, armed invasion
or aggression, or any illness or injury occurring after the effective date of this
document and caused by atomic explosion or other release of nuclear energy,
whether or not the result of war.
K. Nursing Facilities - Any services furnished by an institution which is primarily a
place of rest, a place for the aged, a nursing or convalescent home or any institution
of like character, unless otherwise specifically provided for herein.
L. Custodial Care.
M. Medicare - Any services or supplies payable by Medicare, whether or not claim for
such Medicare benefits is made. On the first of the month in which the Participant or
eligible dependent who becomes age 65 or on the date the Participant can first
apply and become eligible for any type of Medicare coverage (whether or not such
application is made), benefits under this Document will be modified and reduced so
as to supplement Medicare coverage:
N. Sex Transformations - Any procedure or treatment designed to alter physical
characteristics of the Participant to those of the opposite sex, and any other
treatment or studies related to sex transformations.
O. Reconstruction of Sterilization Procedure - Reconstruction of prior surgical
sterilization procedures.
P. Charges in Excess of UCR - That portion of charges in excess of Usual,
Customary and Reasonable Charges, as determined by the Claims Administrator.
Q. Experimental - Experimental or investigative therapy, including any type of therapy
not generally recognized as of value by the medical community and its societies, as
determined by the Claims Administrator in the reasonable exercise of its discretion,
is not covered; all other charges, as for office visits or laboratory procedures,
incurred in conjunction with non-covered therapy will be considered non-covered.
R. Pregnancy for Dependent Daughters - No benefits will be provided for any
condition of pregnancy for dependent daughters.
S. Outpatient Psychiatric Care - No benefits will be provided for any psychiatric
services performed on an outpatient basis.
T. Supplies - Orthopedic Shoes (except when joined to braces) or shoe inserts, air
purifiers, air conditioners, humidifiers, exercise equipment and supplies for comfort,
0011662.01 -8- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
hygiene or beautification, educational services, nutritional counseling or food
supplements.
U. Weight Control -Any charges for weight control or weight reduction procedures.
V. Services Provided by Members of Household Charges for services furnished by
Immediate Relatives or members of the patient's household.
W. Unkept Appointments - Charges for unkept appointments, completion of claim
forms or providing supplementary information or interviews in which the patient is
not seen.
X. False Statements - Services payable by reason of any false statement.
Y. Services or Supplies - Services or supplies that were incurred prior to the date the
Employee or Dependent became covered or after termination of coverage, except as
otherwise specified.
Z. Treatment by Other Than a Licensed Physician - Treatment by anyone except a
Physician acting within the scope of his or her license.
AA. Discounts Through Another Plan -PPO-discounts through another plan..
BB. Residents/Interns - Residents or interns of a Hospital.
1
CC. Injury Incurred During Commission of a Crime - Treatment for any injury incurred
in the commission of a crime.
DD. IRS Regulations - Services not deductible under Section 213 of the Internal
Revenue Code.
EE. Hypnosis.
FF. Digestive Aids, Vitamins, Supplements - Digestive aids, vitamins, laetrile, or
mineral supplements, whether taken orally or injected, regardless of whether they
are prescribed by a physician.
GG. Smoking Cessation - Smoking cessation programs.
_ • HH. Spas Or Swimming Pools.
11. Managed Health Network - Inpatient mental health care and substance
abuse/detoxification will be provided by Managed Health Network, effective March 1,
1994. This applies to POA/PMA/MEO/MEA/NA/MSOA employees.
0011662.01 -9- 04/24195 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
PART V - COORDINATION OF BENEFITS
A. Benefits - All of the benefits provided by the Plan are subject to the following
provisions and limitation.
B. Definitions:
1. "Claims Determination Period" - Is a period beginning with any January
1 st and ending at 12 o'clock midnight on the next succeeding December
31 st, or that portion of such period during which the covered individual was
covered under this Document. However, should this document specify a
benefit year which does not coincide with the standard calendar year, then
the "claim determination period" will coincide with, and run concurrently
with, the stated benefit year or portion of such benefit year during which
the covered individual was covered under this document.
2. "Covered Individual" - Means the.Participant or Family Member eligible
for covered services under this Document.
3. "Covered Services" - Means any necessary, reasonable and customary
item of hospital or medical expense incurred, where at least a portion of
said incurred expense is covered under one or more of the Plans covering
the person for whom claim is made or service rendered. To the extent
legally possible, "covered services" shall be synonymous with allowable
expense.
4. "This Document" - Shall have the same meaning as Plan.
5. "Plan" - Means any plan, contract or policy providing benefits or services
for or by reason of hospital, surgical, or medical care or treatment, which
benefits or services are provided by (a) group, (b) group hospital or medical
services organization, group practice, or other type of group service
prepayment coverage, (c) any group coverage under labor management
trusteed plans, union welfare plans, employer organization plans, or
employee benefit organization plans, (d) any coverage under any
governmental program, or any coverage required or provided by any statute
"other than individual policies or contracts", (e) any group student coverage
provided, or sponsored, by a school or other educational institution.
C. Effect on Benefits:
1. For any claims determination period to which this provision is applicable,
the services due and the benefits that would be payable under this
Document in the absence of this provision for the allowable expenses
incurred during such claim determination period shall be reduced to the
extent necessary so that the sum of (a) such reduced benefits and (b) all
the benefits payable for such allowable expenses under all other Plans
shall not exceed one hundred percent of Covered Services under all Plans.
2. The services due or the benefits payable under this Document shall be
reduced in accordance with the foregoing Subsection I. When the covered
individual's other Plan:
a. Does not contain a Coordination of Benefits provision.
0011662.01 -10- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
b. The other Plan has a Coordination of Benefits provision similar to this,
and
1) this Document covers the individual as a dependent while the
other Plan covers him as an Employee; or
2) this Document covers the Participant as the child of a female
Participant while the other Plan covers him as the child of a
male Employee; or
3) this Document covers the Participant as the child of a male
Participant who has been legally separated or divorced from the
mother while the other Plan covers him as the child of the
employed mother, except that if valid evidence is submitted
establishing that the natural father has legal custody of the
dependent child, then in such case the order of benefits
determination shall be reversed; or
I
4) this Document covers the individual as a dependent child of a
male Participant who has been divorced from the subsequently
remarried mother while the other Plan covers him as the
dependent step-child of the Employee step-father except that if
valid evidence is submitted establishing that the natural father
has legal custody of the dependent child, then in such case the
order of benefits determination shall be reversed; or
5) this Document covers the individual as a Participant while the
other Plan covers him as an Employee, and the other Plan has
covered him for a longer period of time; or
9 P ,
6) this Document covers the individual as a dependent of a
Participant while the other Plan covers him as a dependent of
the same Employee, and the other Plan has covered him for a
longer period of time.
9
3. Effective January 1, 1987 the Department of Insurance has implemented
new Order of Benefit Determination rules called the Birthday Rule.
a. Except for cases of dependent children of divorced or separated
parents, the health plan of the person whose birthday (month and day,
not year) falls earlier in the calendar year will pay first and the plan of
the other person covering the dependent will be the secondary payer.
b. If persons with the two plans covering the same dependents have the
same birthday, the plan of the person which has had coverage longer
is the primary payer.
c. If one of the two plans has not adopted the Birthday Rule (such as if
one plan is in another state) the rules of the plan without the Birthday
Rule will determine which plan is primary and which is secondary.
d. The divorced/separated parent rule specifies that the health plan of
the parent with court ordered financial responsibility is not established
the plan of the parent with custody is the primary payer.
0011662.01 -11- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
e. The retiree rule specifies that when a retired employee has two health
plans because of coverage under a retirement health plan and as an
active worker covered by another health plan, the plan covering the
individual as an active employee will pay first and the plan of. the
company from which the worker is retired will pay second.
4. The Claims Administrator shall not be required to determine the existence
of any Plan or the benefits payable under any Plan, when computing the
services or benefits due any covered individual under this Document. The
services due or the benefits payable under this Document shall be affected
only to the extend that other Plan information is supplied by the covered
individual, any supplier of covered services hereunder, or any other
organization or person.
5. When a Plan provides benefits in the form of services rather than cash
payments, the reasonable cash value of each service rendered shall be
deemed to be both a covered service and a benefit paid. The reasonable
cash value of any services provided to the covered individual by any
service organization shall be deemed an expense incurred by said
individual, and the liability of the Claims Administrator under this Document
will be reduced accordingly.
D. Facility of Payment - Whenever payments which should have been made under
this Document in accordance herewith have been made under any other Plans, the
Claims Administrator shall have the right, exercisable alone and in its sole
r discretion to a over to an organizations making such other payments, an
pay Y 9 9 P Y Y
amounts it shall determine to be warranted in order to satisfy the intent of this
provision. Any amounts so paid shall be deemed to be benefits paid under this
Document and to the extent of such payments, the Claims Administrator shall be
fully discharged from liability under this Document.
E. Right of Recovery - Whenever payments for covered services have been made by
the Claims Administrator and said payments exceed the maximum amount of
payment necessary to satisfy the intent of this provision, irrespective of to whom
paid, the Claim Administrator shall have the right to recover such excessive amounts
from any persons to, or for, or with respect to whom such payments were made, or
from any Insurance Company, or any other organizations or persons.
F. Right to Receive and Release Necessary Information - For the purpose of
implementing this provision and in the interest thereof, the Claims Administrator may
release or obtain any information deemed to be necessary with respect to any
person claiming benefits under this Document. Such information may be released
or obtained without the consent of, or notice to, the covered individual or any other
person or organization.
PART VI - CONTINUATION BENEFIT
In accordance with the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA),
continuation benefits will be offered to Participants who experience a qualifying event.
0011662.01 -12- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
The following will be considered qualifying events for the purposes of determining eligibility
for continuation benefits due to loss of health care coverage:
A. Termination of employment (except for gross misconduct);
B. Reduction of work hours;
C. Death of Employee or Retiree;
D. Divorce or legal separation of Employee or Retiree;
E. Dependent child ceasing to be eligible; or
roceedin s but only with respect to Retirees.
F. Bankruptcy proceedings, Y P
A qualified beneficiary is a Participant who was covered for medical benefits on the date of
the qualifying event who, because of the qualifying event, would no longer be covered for
benefits as specified by the Plan.
If a qualifying event occurs, this Plan will be offered to the qualified beneficiary(ies) until the
earliest of the following dates:
A. Eighteen(18) months from the date of qualifying events (a) or(b), except this period
may be extended for an additional eleven (11) months if the qualified beneficiary
notifies the Personnel Division that the Social Security Administration has
determined that the qualified beneficiary was disabled as of the date• of the
qualifying event. Such notice must be received within sixty (60) days of the date of
determination and before the expiration of the initial eighteen (18) month period.
The qualified beneficiary is responsible for notifying the Personnel Division within
thirty (30 of the date of final determination that they are no longer
) days Y any
disabled;
z
B. Thirty-six (36) months from the date of qualifying event (c), (d), or (e);
C. The end of the period for which contributions were made;
D. The date the qualified beneficiary(ies) first becomes covered under another group
health plan or entitled to Medicare, except that if the other group health plan
excludes or limits a pre-existing condition of the qualified beneficiary, coverage may
be continued during the first eighteen(18) months of entitlement to Medicare due to
end-stage renal disease;
E. The date the City no longer provides group health coverage to any of its Employees;
or
F. In the case of a bankruptcy proceeding, the date of death of the qualified
beneficiary, or in the care of the surviving spouse or dependent children, thirty-six
(36) months after the date of death.
0011662.01 -13- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
The qualified beneficiary(ies) electing coverage are responsible for the payment of
contributions, plus any additional amounts permitted by law. The qualified
beneficiary(ies) must. enroll for continuation benefits within sixty (60) days of
notification. The qualified beneficiary(ies) will be allowed forty-five (45) days from
the date of enrollment to submit payment for all contributions due. Thereafter, the
qualified beneficiary(ies) will be allowed a thirty (30) day grace period in which to
submit contributions.
PART VII - GENERAL PROVISIONS
A. Plan Document - This Document, and the individual applications of Employees
shall constitute the entire Agreement between the parties and all statements made
by the City or by any individual Participant shall, in the absence of fraud, be deemed
representations and not warranties, and no such statement shall be used in defense
to a claim under this Agreement unless it is contained in a written application.
B. Worker's Compensation Insurance -This Medical Benefit Plan is not in lieu of and
does not affect any requirement for, or coverage by Workers' Compensation
Insurance.
C. Chiropractor or Psychologist - Subject to the conditions and limitations set forth
herein, if the Participant or Family Member uses the services of a licensed
chiropractor or psychologist performed within the scope of his license, and paymer)t
for such services would have been provided by this Document if performed by a
Physician or Surgeon, then such services shall be treated as though they had been
performed by a Physician or Surgeon for the purposes of determining benefits
hereunder.
D. Charter - None of the terms or provisions of the charter, constitution of by-laws of
the Claims Administrator shall form a part of this Document or be used in the
defense of any suit hereunder unless the same is set forth in full herein.
E. Employer Responsibility for Furnishing Hospital Care - The Employer and
Claims Administrator shall not be responsible for the furnishing of hospital care nor
for the quality thereof.
F. Duplicate Coverage - If the Participant or Family Member has duplicate coverage
with the Claims Administrator, benefits shall be limited to an aggregate amount paid
not to exceed 100% of the usual, reasonable, and customary medical expenses
incurred.
1. Notice of Claim - Properly completed claim forms itemizing the service received
and the charges must be sent to the Claims Administrator by the Participant or the
provider of service. These claim forms must be received by the Claims
Administrator within 12 months of the date services are rendered. The Claims
0011662.01 44- 04124/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
Administrator is not liable for payment of the benefits if claims are not filed within
this time period.
J. Prescriptions - All prescription drug payments shall be made through the
Prescription Card: Service and shall be on the basis of a co-payment by the
employee of $5 for each generic drug prescription or $8 for each non-generic drug
prescription. No payments for any prescription drug shall be made through the
Employee Medical Plan. Effective January 1, 1992 the dispensing limit has been
changed from 100 days to 34 days for prescriptions. A 90 day supply will be
allowed for mail order prescriptions only:
POA/M EO/M EA/P MA/NA/M SOA:
Effective January 1, 1994 the mail order drug co-payment shall be $4 for generic
and $6 for non-generic prescriptions per 30 day supply.
G. Non Transferable Benefits - No person other than the Participant or Family
Member is entitled to receive benefits to be furnished by the Claims Administrator
under this Document. Such right to hospital care or other benefits is not
transferable.
H. Limitation of Liability - The hospitals (or Skilled Nursing Facilities) furnishing care
or other benefits, to the Participant and Family Member and the Claims
Administrator shall not be liable for any claim or demand on account of damages
arising out of or in any manner connected with any injuries suffered by the ,
Participant or Family Member while receiving care in any hospital or Skilled Nursing i
Facility.
PART Vlll - SECOND OPINION SURGICAL PROGRAM
A. Defintion, Effective 1-1-84 - Certain surgical procedures done on an elective basis
shall be mandated to have a second surgical opinion in order to qualify as a covered
benefit. The surgical procedures which would require a second opinion if done on
an elective basis are as listed below:
1. Cataract Surgery -excision of a diseased lens of the eye.
2. Cholecystostomy - cutting into and draining of the gallbladder through
abdominal wall. j
i
3. Dilation and Curettage - expansion of cervix and scraping of uterine cavity.
4. Hemorrhoidectomy - surgical excision of hemorrhoids (piles).
5. Hernia repair- repair of an inguinal, femoral or umbical hernia.
6. Hysterectomy - removal of the uterus.
7. Knee Surgery (Menisectomy) - removal of meniscus cartilage of the knee.
0011662.01 -15- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
8. Laminectomy - surgery on the spinal canal through the vertebral arch.
9. Varicose Vein Ligation - repair of varicose vein.
10. Mastectomy - surgical removal of the breast.
11. Onychotomy - surgical removal of the nail of a toe or finger.
12. Prostatectomy - excision of part or all of the prostate gland.
13. Repair of deviated septum (SMR) - sub-mucous resection - plastic surgical
procedure to straighten nose.
14. Spinal fusion - surgical fusion of two or more vertebrae.
15. Tonsillectomy and/or Adenoidectomy - surgical removal of tonsils and/or
adenoids.
B. Elective Surgery - The listed surgical procedures shall be considered elective
unless the attending physician certifies that the procedure was performed on an
emergency basis without reasonable time for a second opinion.
C. Board Certified - The second opinion will be rendered ,by a physician who is a
qualified Board Certified surgeon in the same specialty as the original surgeon.
D. Second Opinion Fees Paid by Plan -The second surgical opinion fees will be paid
in full by the Employee Health Plan subject to UCR.
E. Coverage by Employee Organization:
1. MEO/Non Represented:
Should an employee or covered dependent elect a listed surgical procedure
without a second opinion or contrary to the recommendation of a second or
third opinion, the benefit charge will be reimbursed at 50% of the normal
benefits payable.
2. POA/MEA/PMA/FA/MSOA:
Should an employee or covered dependent elect a listed surgical procedure
without obtaining a second opinion no benefit will be payable.
3. MSOA:
Once a second opinion is obtained and the individual elects to have the
surgery, the normal benefit will be paid irrespective of the content of the
second opinion.
0011662.01 46- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
PART IX - BASIC BENEFITS
A. Definition -The term "Basic Benefit" as used herein means only those services and
supplies listed below. These services are not subject to a deductible and payment
shall be based upon charges not exceeding the Usual, customary and Reasonable
charges for such services.
B. Substance Abuse Treatment:
1. Benefits will be provided for 5 days of in patient detoxification with a life
time maximum benefit of$10,000.
2. POA/PMA/MEO/MEA/NA/MSOA: Effective March 1, 1994 this benefit will
be provided by Managed Health Network.
a
C. Out-Patient Pre-Hospital Admission Testing - For required medical testing done
on an out-patient basis prior to admission to a hospital, benefits will be provided at
100% of Usual, Customary and Reasonable charges. No basic benefits for
subsidized retirees.
D. Out-Patient Surgery - For surgery requiring the use of hospital surgical facilities,
surgical centers or other surgical facilities affiliated with an accredited hospital which
satisfies the definition hospital under this Plan Document, AND THE PHYSICIAN'S
CHARGES FOR THE SURGICAL PROCEDURE, benefits will be provided at 100%
of Usual, Customary, and Reasonable charges. No basic benefits for subsidized
retirees.
P OA/P MA/M EA/M E O/NA/M S OA:
Effective January 1, 1994, benefits will be paid at 100% of usual, customary and
reasonable charges for PPO providers. Covered expenses include anesthesia,
outpatient surgery, facility use, surgeon and pre-admission.
Plan will pay 70% of usual, reasonable and customary charges after the deductible
is met for non-PPO providers:
E Basic Professional Benefits - Basic Professional Benefits are provided when they
are Medically Necessary. These benefits are based on the California Relative
Value Studies - Fifth Edition. The Unit Value used in calculating Basic Professional
Benefits for Surgical Services and Doctor Visits in the Hospital is:
$65.00 Per Unit:
1. Benefits for Surgical Services
a. Surgical Services are defined as Medically Necessary operative and
cutting procedures for treatment of diseases and injuries, and for
reduction of fractures and dislocations.
0011662.01 -17- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
b. Primary Surgeon: Benefits are determined by multiplying the number
of Units specified for each procedure in the California Relative Value
Studies - Fifth Edition by the designated Unit Value.
c. Assistant Surgeon: If a benefit is paid to the Primary Surgeon and
scope of surgery customarily requires an Assistant Surgeon, benefits
will be provided for one Assistant Surgeon who is not a hospital intern,
resident or house officer. The benefit is 20% of the amount paid to the
Primary Surgeon, or one Unit -whichever is greater.
d. Benefits for Surgical Services are subject to these conditions and
limitations:
1) The service must be performed by a licensed Physician.
2) The service must be performed on or after the Participant's or
Family Member's Effective Date of coverage under this
Document. However, if the Member is already hospitalized
prior to the Effective Date, benefits for surgical services will not
be provided until after the Member is discharged from that
hospital.
3) If more than one surgical service is performed during one
operative session in the same operative area, payment will be
made only for the major procedure.
4) If more than one surgical service*is performed during the same
operative session in different operative areas, maximum
payment is made for the major procedure, plus one-half the
allowance for the minor procedure which provides the next
greatest allowance. However, the total benefit for the Primary
Surgeon under these circumstances shall not exceed 24.62
Units.
2. Professional Anesthetist Benefit
a. When the Participant or Family Member is entitled to hospital care and
surgical benefits hereunder, the plan shall pay for services of
professional anesthetist, in accordance with the Anesthesia Units
listed in the California Relative Value Studies - Fifth Edition and at the
Unit Value designated in Document.
b. The Units appearing in the Anesthesia column represent basic values.
To these will be added Time Units, representing the actual time spent
administering the anesthetic. Time Units are based on one Unit for
each quarter-hour or major part thereof.
3. Physician Visits in the Hospital
a. When a Participant or Family Member receives covered care in a
Legally Operated Hospital or Skilled Nursing Facility as a result of
illness or injury and no surgery is performed, payment toward the cost
of visits by the attending Physician shall be:
0011662.01 -18- 04/24/95 L.49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
Up to .37 Units for the first visit during eligible confinement, and .123
Units for one visit a day thereafter during the Period of Disability.
b. Benefits will be provided for consultation services by a Physician
(EXCEPT STAFF CONSULTATIONS REQUIRED BY HOSPITAL
REGULATIONS), if the Member is hospitalized and the condition
requires special skill or knowledge for diagnosis and treatment:
Up to .37 Units will be allowed per bedside consultation for a
maximum of one such consultation per admission.
F. Ambulance Benefit - Benefits will be provided for expense incurred by the
Participant or Family Member for necessary use of local surface ambulance service
for transportation to or from the Legally Operated Hospital (or Skilled Nursing j
Facility if that benefit in included in this Document) up to $50 for each covered 4
inpatient admission or conditions for which outpatient services are payable.
t
G. Preventative Medical Care:
1. Benefits will be provided up to $200 per person per year for preventative
medical care. Such care shall include such usual preventative medical
options as an every other year physical exam for adults, yearly PAP tests
for females, flu shots, chest x-rays,. EKG and other diagnostic lab tests if
certified by the physician that such procedures are included under a routine
physical examination and is not. in connection with the diagnosis or
treatment of any illness, disease or accidental bodily injury.
Three well baby exams for an infant for the first year of life will be allowed
subject to the $200 maximum benefit. All inoculations for infants/children i
will be provided and coverage is not limited to the $200 maximum benefit.
PART X - MAJOR MEDICAL
A. Definition - The term "Major Medical" as used herein means only those services
and supplies listed below, and only to the extent that they are not provided
elsewhere herein. To be eligible for Major Medical, it will be necessary that such be
furnished while the patient is covered hereunder in connection with diagnosis or
treatment of any illness, disease or accidental bodily injury, and be authorized by a
licensed Physician or Surgeon and for only as long as such authorization is given.
Upon receipt of due notice and proof that the Participant or Family Member shall
have incurred expense for Major Medical, benefits will be provided as follows:
1. Such expense must be incurred on or after the Participant's or Family
Member's Effective Date of coverage hereunder, or, in the event such
person is already hospitalized prior to such Effective Date, such expense
must be incurred subsequent to the date of discharge from the hospital. An
expense will be considered to have been incurred on the date that the
individual receives the services for which the charge is made.
2. Payment for such services shall be based upon charges not exceeding the
Usual, Customary and Reasonable Charges for such services in the
community.
0011662.01 -19- 04/24/95 8:49 AM
{
EMPLOYEE HEALTH PLAN DOCUMENT
3. After the deductible has been met, benefits shall be paid at 90% of usual,
customary and reasonable charges for PPO's and 80% for non-PPO's.
POA/PMA/MEA/MEO/NA/MSOA: -
Effective January 1, 1994, benefits shall be paid at the rate of 90% for
PPO's and 70% for non-PPG's of usual, customary and reasonable charges
after the deductible has been met. However, in the event of emergency
services, the plan will pay 90% of usual, customary and reasonable
charges for non PPO's. Emergency services is defined as follows:
services which are immediately required to treat a sudden serious and
unexpected illness or injury, including services to alleviate pain associated
with sudden, serious and unexpected illness and/or injury.
4. The Participant or Family Member will be responsible for the first $100.00
of expense incurred in each calendar year for Major Medical after becoming
eligible for benefits hereunder. However, no family shall be required to
satisfy more than an aggregate maximum deductible of $300 during any
one Calendar Year. Any expense for Major Medical incurred in connection
with an illness, disease or injury during the last calendar quarter of any year
and applied against such deductible amount for that year shall be carried
forward to apply against the deductible amount for the ensuing year. Also,
if the Participant and/or one or more Family Members shall suffer a bodily
injury as a result of the same Accident, the aggregate deductible amount
applicable to all said persons, in connection with total expense for Major
Medical incurred for such Accident, shall-be $100.00 for that year in which
the accident occurs. Separate deductibles will be required for other than
the first year unless such accident occurs during the last calendar quarter
of the year. In this event, the above stated provision relating to the
carrying forward of expense incurred to the ensuing year will apply, and
moreover, the provision relating to the aggregate deductible amount
applicable to all said persons will also apply for the ensuing year.
Effective 1-1-85, the individual deductible had been increased to $125 and
to $375 per family. Deductibles are calculated on a calendar year basis.
Effective 1-1-88, the individual deductible had been increased to $150 and
to $400 per family. Deductibles are calculated on a calendar year basis.
Effective 1-1-90, the individual deductibles is $150 a person and $450 per
family.
Effective 1-1-90, the deductible for subsidized retirees is $200 a person or
$500 per family.
5. Stop-Loss:
a. When expenses incurred by the participant or family member for
covered services and supplies exceeds the deductible amount,
benefits will be provided at 70% of usual, customary, and reasonable
charges (90% if PPO provider is used). Once the out-of-pocket
expense of $1,000 per individual or $2,000 per family is exceeded
during the calendar year, 100% of covered services and supplies will
be covered during the remainder of the calendar year. Only the cost
0011662 01 -20- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
of eligible services and supplies can be used to satisfy the out-of-
pocket limit. The maximum out-of-pocket expense for subsidized
retirees is $1,500 a person or$3,000 per family.
b. Mental Disorders: For in-patient psychiatric care benefits will be
provided at 50% of Usual, Customary and Reasonable Charges. No
stop-loss or 100% benefit will apply.
c. POAJPMA/MEA/MEO/NA/MSOA
Effective March 1, 1994, all in-patient psychiatric care benefits will be
provided by Managed Health Network at 50% of usual, customary and
reasonable charges. No stop loss or 100% benefit will apply.
6. The Participant or Family Member who has received at least $1,000.00 of
benefits hereunder may apply for reinstatement of maximum benefits by
furnishingevidence of good health satisfactory to Claims Administrator.
9 rY
However, notwithstanding the above, the Participant or Family Member who
has incurred expense hereunder which has been charged against the
aggregate maximum of $1,000,000.00 shall automatically have reinstated
toward such maximum as of the last day of each Calendar Year an amount
of up to $1,000.00.
7. Eligible services and supplies are:
a. Professional services rendered by a licensed Physician or Surgeon.
b. Professional services rendered by a licensed Physician or Surgeon or
doctor of dental surgery for treatment of a fractured jaw or other
accidental injury to natural teeth, providing that injury occurs while the
patient is covered hereunder. Such services will be covered only
during the six month period immediately following the date of injury.
c. Professional nursing services of a registered graduate nurse, other
than one who ordinarily resides in the Participant's home or who is
related to the Participant by blood or marriage.
d. Administration of anesthesia by an anesthetist.
e. X-ray, radium and radioactive isotope therapy.
f. Services of a licensed physician or surgeon, or a registered physical
therapist, in connection with physical therapy treatments, other than
one who ordinarily resides in the Participant's home or who is related
to the Participant by blood or marriage.
g. Diagnostic X-ray and laboratory tests for treatment of illness or
accident.
h. Services of a licensed ambulance company for local ambulance
services to or from a hospital or Skilled Nursing Facility.
i. Artificial limbs or eyes, casts, splints, trusses, braces, crutches,
including rental of wheelchair, hospital-type bed or iron lung required
for treatment up to a maximum charge of not to exceed the purchase
0011662.01 -21- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
price of the equipment used. These supplies will be limited to those
reasonable required by standard treatment practices for illness,
disease or injury occurring while the patient is covered hereunder.
Convenience or comfort items are not covered.
J. Blood transfusions, including cost of blood and blood plasma.
k. Services and supplies furnished and billed by a Legally Operated
Hospital, excepts personal services such as charges for radio,
telephone, television and the like, and private room charges
exceeding the most prevalent rate of the hospital for semi-private (two-
bed) accommodations.
B. Special Conditions in Regard to Hospital Benefits:
1. Hospital Pre-admission Notification
a. A hospital pre-admission notification to the Orange County Medical
Review (OCMR) shall be required prior to hospital admittance for non-
emergencies.
b. If the required notification is not given to OCMR, the benefit
entitlement will be subject to a $100 deductible against the charges for
hospital costs.
2. Room Accommodations - Benefits will be provided as follows:
a. 90% of charges for a room of two or more beds for a PPO, 80% for a
non-PPO provider.
b. 90% for PPO, 80% for non-PPO charges for care in special treatment
units licensed by the State, such as intensive care and coronary care
units.
c. If a private room is used, benefits will be equivalent to 100% of the
Contracting Hospital's or Skilled Nursing Facility's most prevalent
charge for a two-bed room.
d. POA/MEO/MEA/PMA/NA/MSOA:
Effective January 1, 1994 benefits will be paid at the rate of 90% for
PPO and 70%for non-PPO
3. Other Inpatient Services:
a. When furnished and billed by the Hospital, or Skilled Nursing Facility,
all services and supplies Medically Necessary for treatment of the
illness or injury requiring the covered confinement will be provided at
90% for PPO or 80% for non PPO charges during eligible days of -
care, except the acquisition costs of blood and blood plasma and the
charges for experimental or investigative procedures and services.
0011662-01 -22- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
b. POA/MEO/MEA/PMA/NA/MSOA:
Effective January 1, 1994 benefits will be paid at the rate of 90% for
PPO and 70% for non-PPO providers.
C. Benefits for Services and Supplies in Eligible Skilled Nursing Facilities:
1. Days of Inpatient Care
a. Covered inpatient services of a Skilled Nursing Facility will be paid up
to an aggregate of 100 days during each Period of Disability.
b. A Period of Disability is a continuous inpatient stay or a series of stays
where dates of discharge and re-admission are separated by less than
28 days. However, if inpatient y care is required because of an accident
within the 28 day period, a new Period of Disability begins.
c. Prior care in a hospital is not required before being eligible for care in
a Skilled Nursing Facility.
d. Admissions or continued stays for custodial or domiciliary care are not
covered.
D. Care for Conditions of Pregnancy:
1. Benefits will be provided for Normal Delivery, Cesarean Section and other
Complications of Pregnancy for active Employees and their spouse.
2. No benefits will be provided dependent daughters.
E. Chiropractic and Physical Therapy Guidelines:
1. Benefits will be provided as follows:
3 times a week for the first month of treatment
2 times a week for the second month of treatment
1 time a week for the third month of treatment
2 times a month for the fourth month and thereafter
2. Chiropractic Limits - Benefits are provided under Major Medical to a
maximum of 24 treatments per year or $2,000.00 whichever occurs first.
Said limits are per person and commence January 1 of each year.
3. These guidelines may be modified on an individual case-by-case basis
pursuant to the recommendation of the Medical Review Advisor.
F. Treatment by California Licensed Certified Acupuncturist - Will be covered to
the extent that treatment is for pain associated with injury or illness.
G. Subsidized Retiree Benefits - All eligible major medical expenses and hospital
benefits for subsidized retirees will be paid at 80% of UCR.
0011662.01 -23- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
H. Municipal Employees Association (MEA) - Effective January 1, 1995, all eligible
major medical expenses and hospital benefits for subsidized retirees will be paid at
70% of usual, customary and reasonable.
PART XI -RETIREE SUBSIDY MEDICAL PLAN
A. Eligibility - An employee who has retired from the City shall be entitled to
participate in the City sponsored medical insurance plans and the City shall
contribute toward monthly premiums for coverage in an amount as specified in
accordance with this Plan, provided:
1. At the time of retirement the employee has a minimum of ten (10) years of
continuous City service or is granted as industrial disability retirement; and
2. At the time of retirement, the employee is employed by the City; and
3. Following official separation from the City the employee is granted a
retirement allowance by the California Public Employees Retirement
System.
The City's obligation to pay the monthly premium as indicated shall be
modified downward or cease during the lifetime of the retiree upon the
occurrence of any one of the following:
a. During any period the retired employee is eligible to receive or
receives health insurance coverage at the expense of another
employer, the payment will be suspended. "Another employer" as
used herein means private employer or public employer or the
employer of a spouse. As a condition of being eligible to receive the
premium contribution as set forth in this plan, the City shall have the
right to require any retiree to annually certify that the retiree is not
receiving or eligible to receive any such health insurance benefits from
another employer. If it is later discovered that a misrepresentation has
occurred, the retiree will be responsible for reimbursement of those
amounts inappropriately expended and the retirees' eligibility to
receive further benefits will cease.
b. On the first of the month in which a retiree or dependent reaches age
65 or on the date the retiree or dependent can first apply and become
eligible, automatically or voluntarily, for medical coverage under
Medicare (whether or not such application is made) the City's
obligation to pay monthly premiums may be adjusted downward or
eliminated. Benefit coverage at age 65 under the City's medical plans
shall be governed by applicable plan document.
c. In the event the Federal Government or State Government mandates
an employer-funded health plan or program for retirees, or mandates
that the City make contributions toward a health plan (either private or
public) for retirees, the City's contribution rate as set forth in this plan
shall first be applied to the mandatory plan. If there is any excess, that
excess may be applied toward the City medical plan as supplemental
coverage provided the retired employee pays the balance necessary
for such coverage, if any.
:49 AM
0011662.01 -24- 04/24/95 8
EMPLOYEE HEALTH PLAN DOCUMENT
d. In the event of the death of any employee, whether retired or not, the
amount of the retiree medical insurance subsidy benefit which the
deceased employee was receiving at the time of his/her death would
be'eligible to receive if he/she were retired at the time of death, shah
be paid on behalf of the spouse or family for a period not to
exceed twelve (12) months.
B. Schedule of Benefits:
1. Minimum Eligibility for Benefits -With the exception of an industrial
disability retirement, eligibility for benefits begins after an employee has
completed ten (10) years of continuous service with the City of Huntington
Beach. Said service must be continuous unless prior service is reinstated
at the time of his/her rehire in accordance with the City's Personnel Rules.
2. Disability Retirees - Industrial disability retirees with less than ten (10)
years of service shall receive a maximum monthly payment toward the
premium for health insurance of $40 for retirements after 10/1/87, $80
after 10/1/88, and $121 after 10/1189. Payments shall be in accordance
with the stipulations and conditions which exist for all retirees. Payment
shall not exceed dollar amount which is equal to the full cost of premium for
employee only.
0011662.01 -25- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
3. All retirees, including those retired as a result of disability whose number of
years of service prior to retirement exceeds ten (10), shall be entitled to
maximum monthly payment of premiums by the City for each year of
completed City service as follows:
Maximum Monthly Payment
for
Retirements After:
Years of Service 1011l87 10l1/$8 '[0!1/89 10/1192< :
10 $40 $ 80 $ 121 $ 121
11 44 88 132 136
12 48 97 145 151
13 53 195 157 166
14 57 113 170 181
15 61 122 182 196
16 65 130 195 211
17. 69 138 207 226
18 73 146 220 241
99 77 155 232 256
20 . 81 163 244 271
21 86 171 257 286
22 90 179 269 300
23 94 188 282 315
24 98 196 294 330
25 102 204 306 344
26 106 213 319
27 110 221 331
28 115 1 229 344
Note: The above payment amounts may be reduced each month as
dependent eligibility ceases due to death, divorce or loss of dependent
child status. However, the amount shall not be reduced if such reduction
would cause insufficient funds needed to pay the full premium for the
employee and the remaining dependents. In the event no reduction occurs
and the remaining benefit premium is not sufficient to pay the premium
amount for the employee and the eligible dependents, said needed excess
premium amount shall be paid by the employee.
0011662.01 -26- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
Note: Retirees who elect to participate in Health Net or Family Health Plan
(FHP) shall be entitled to benefits of the program chosen.
C. Benefit Summary, effective January 1, 1995:
City Ptan='
Employees City Plan
NonSubsid-zed Retirees, Subsidized
Benefits COBRA Eligibles Retiree Plan
90% - (PPO) of UCR 80% of UCR after
after deductible deductible
Inpatient Hospital
70% (Non-PPO) of UCR MEA: 70% of UCR after
after deductible deductible
FA: 80% for Non-PPO
Deductible Per $150/$450 $200 / $500
Person
Maximum Out of
Pocket Expenses $1,000/$2,000 $1,500/ $3,000
(Excludes Deductible)
None None
Accident Benefit (Covered Same as Other (Covered Same as Other
Expenses) Expenses)
Prescription Drugs PCs PCs
Deductible Generic $5/$8 $5 / $8
/Non Generic
90% (PPO) of UCR 80% of UCR
after deductible after deductible
Major Medical
70% (Non-PPO) of UCR MEA: 70% of UCR after
after deductible deductible
FA: 80%for Non-PPO
D. Miscellaneous Provisions / Eligibility:
1. The effective start-up date of the Retiree Subsidy Medical Plan (80% Plan)
for the various employee groups shall be the first of the month following
retirement date.
2. A retiree may change plans, add dependents, etc., during annual open
enrollment. Personnel shall notify covered retirees of this opportunity each
year.
0011662.01 -27- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
3. Years of service computed for the Retiree Subsidy Medical Plan are actual
years of completed service with the City of Huntington Beach.
4. When a retiree is eligible for medical plan coverage at the expense of
another employer due to post-retirement employment of the retiree or
spouse of the retiree, the retiree and his/her spouse must take- that
coverage regardless of benefit level and shall be deleted from any City
Plan coverage. Exceptions to this requirement are limited to the following:
a. A retiree is not required to enroll in such "other" medical plan
coverage if there is significant disparity between the benefits provided
by the "other" medical plan and the Retiree Subsidy Medical Plan as
defined below. "Significant disparity" means coverage available under
the "other" medical plan is restrictive or limited in one or more of the
following ways:
1) No inpatient hospitalization coverage.
2) No major medical benefits.
3) Annual deductible is $1,000 or greater per person.
4) Major medical benefits are paid at 60% or less of covered
expenses.
b. The Risk Manager will have the authority to provide additional
exceptions following review of the- "other" medical plan benefit
provisions are comparable to the guidelines under"B" above.
c. Miscellaneous Provisions:
1) Benefits provided under the Retiree Subsidy Medical Plan will
be coordinated with the "other' medical plan as the primary
carrier
2) The City shall have the right to require any retiree to provide a
copy of the "other" medical plan policy for review by the Risk
Manager.
5. When a retiree becomes eligible for other group coverage and then
becomes no longer eligible, he/she may have the subsidy reinstated and
regain Retiree Subsidy Medical Plan coverage.
6. Dependents of a retiree may follow him/her into the Retiree Subsidy
Medical Plan or they may choose to exercise COBRA rights along with the
retiree.
7. When a retiree becomes 65 and has eligible dependents under 65, said
dependents are eligible to exercise COBRA rights. .
8. When a retiree is under 65 and his/her spouse is over 65, the spouse is not
covered.
0011662.01 -28- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
Benefits:
1. Retiree Subsidy Medical Plan includes Managed Health Network (MHN),
Prescription Card System (PCS), Orange County. Preferred Provider
Organization (OCPPO) and Medical Stop Loss insurance.
2. City Plans are the primary payer for active employees age 65 and over,
with Medicare the secondary payer. Retirees age 65 and over have no City
Plan options and are eligible only for Medicare.
3. Premium payments are to be received at least one month in advance of the
coverage period.
Subsidies:
1. The subsidy payments will pay for:
a. Retiree Subsidy Medical Plan
b. Health Net
c. Family Health Plan (FHP)
d. Part A of Medicare for those retirees not eligible for paid Part A
2. Subsidy payments will not pay for:
a. Part B Medicare
b. Regular City Employee Indemnity Plan f
c. Any other employee benefit plan
d. Any other commercially available benefit plan.
e. Medicare supplements
3. Employees who retire on or after the following dates shall be eligible for the
subsidy based on years of completed service with the City:
October 1, 1987 - MEO, MEA, POA, MSOA, FA, PMA
July 1, 1988 - Non-Represented
Retirees who retire prior to the above dates are not eligible for any subsidy
benefit.
Medicare:
1. All persons are eligible for Medicare coverage at age 65. Those with
sufficient credited quarters of Social Security will receive Part A of-
Medicare at no cost. Those without sufficient credited quarters are still
eligible for Medicare at age 65, but will have to pay for Part A of Medicare if
0011662.01 -29- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
the individual elects to take Medicare. In all cases Part B of Medicare is
paid for by the participant.
2. When a retiree and his/her spouse are both age 65 or over, and neither is
eligible for paid Part A of Medicare, the subsidy shall pay for Part A for
each of them or the maximum subsidy, whichever is less.
3. When a retiree at age 65 is eligible for paid Part A of Medicare and his/her
spouse is not eligible for paid Part A, the spouse shall not receive subsidy.
When a retiree at age 65 is not eligible for paid Part A of Medicare and
his/her spouse who is also age 65 is eligible for paid Part A of Medicare,
the subsidy shall be for the retiree's Part A only.
Cancellation:
1. For retirees/dependents eligible for paid Part A of Medicare, the following
cancellation provisions apply:
a. Coverage for a retiree under the Retiree Subsidy Medical Plan will be
eliminated on the first day of the month in which the retiree reaches
age 65. If such retiree was covering dependents under the Plan,
dependents will be eligible for COBRA continuation benefits effective
as of the retiree's 65th birthday.
b. Dependent coverage will be eliminated upon the whichever of the
following occasions come first:
1) After 36 months of COBRA continuation coverage, or
2) When the covered dependent reaches age 65 in the event such
dependent reaches age 65 prior to the retiree reaching age 65.
c. At age 65 retirees are eligible to make application for Medicare. Upon
being considered "eligible to make application", whether or not
application has been made for Medicare, the Retiree Subsidy Medical
Plan will be eliminated.
2. See provisions under "Benefits", "Subsidies", and "Medicare" for those
retirees/dependents not eligible for paid Part A of Medicare.
3. Retiree Subsidy Medical Plan and COBRA participants shall be notified of
non-payment of premium by means of a certified letter from Personnel in
accordance with provisions of the Memorandums of Understanding.
4. A retiree who fails to pay premiums due for coverage and is in arrears for
sixty (60) days shall be terminated from the Plan and shall not have
reinstatement rights.
PART XII -TERMINAL BENEFITS
A. Benefit Continuance at Time of Termination of Employment - Should a
Participant or Family Member be totally disabled at the date of termination of
coverage and be under treatment of a Physician, the services and benefits set forth
0011662.01 -30- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
in this Document shall be furnished to the extent such services and benefits relate
directly to the condition causing such total disability and for no other condition,
illness, disease or injury. Terminal Benefits shall be provided only when written
certification of the total disability and the cause thereof has been furnished by the
.` attending Physician within 90 days from the date coverage is terminated under this
Document. Proof of continuation of total disability shall be furnished to the Claims
Administrator not less frequently than 90-day intervals during the period that
terminal benefits are available.
B. Terminal Benefits for Total Disability - Terminal benefits for total disability shall
be provided:
1. UP o t a maximumperiod of 12 consecutive months or
2. Until the maximum amount of benefits has been paid, or
3. Until the total disability ends, whichever occurs first.
r
C. Definition of Total Disability - For the purposes of this benefit, the Employee shall
be considered totally disabled when, as a result of bodily injury or disease, such
Employee is unable to engage in any employment or occupation for which he or she
is or becomes qualified by reason of education, training or experience and not, in
fact, engaged in any employment or occupation for wage or profit. A Family Member
shall be considered totally disabled when such Member is prevented from
performing all regular and customary activities usual for a person of that age and
family status.
- Terminal Benefits for total disability shall not be
i
D. Exclusion of Terminal Benefits T y �
hol an art of the subscription
provided if the Participant is required to pay thew a or y p ;
charges required under the terms of this Document and such Participant ceases to
9 q P
pay such premiums while this Document is in effect.
PART XIII -ADMINISTRATION OF THE PLAN
A. Appointment of the Claims Administrator - The City shall appoint a Claims
Administrator who shall handle claims under Plan in accordance with its terms. The
person, persons or entity serving as Administrator shall serve at the pleasure of the
City.
B. Powers of the Claims Administrator - The Claims Administrator shall have such
powers as necessary for the proper handling of claims for benefits under the Plan,
including, but not limited to, the following:
1. To prescribe procedures to be followed by participants in filing applications
for benefits and for furnishing evidence necessary to establish their rights
to benefits under the Plan;
0011662.01 -31- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
2. To find facts and make determinations as to the rights of any Participant
applying for or receiving benefits under the Plan and to afford any such
Participant dissatisfied with any such finding or determination the right to a
hearing thereon;
3. To make benefit payments directly to Participants and/or their assignees
entitled to benefits under the Plan;
4. To obtain from the City, Participants and others, such information as shall
be necessary for the proper administration of the Plan;
5. To keep records regarding the administration of the Plan;
6. To furnish to City upon request such data with respect to the administration
of the Plan as is reasonable and appropriate; and
7. To collect, evaluate, analyze and prepare statistical and other data with
respect to the administration of the Plan.
The Claims Administrator shall have no power to add to or subtract from or to modify
any of the provisions of the Plan, to change or add to any benefit provided by the
Plan, or to waive or fail to apply any requirements of eligibility for a benefit under the
Plan.
No determination of the Claims Administrator in one case shall create a basis for
retroactive adjustment in any other case.
C. Claims Procedure - The Claims Administrator shall be required to give written
notice to any Participant who makes a claim for the commencement or continuation
of benefits under the Plan which claim is denied. Such notice shall be sent to the
Participant's last known address. The notice shall be send forth the specific reason
or reasons for the denial of the claim and shall include a specific reference or
references to pertinent Plan provisions upon which the denial is based, a description
of any additional material or information necessary for the claimant to perfect his
claim, which description shall indicate why such material or information is needed,
and an explanation of the Plan's claims review procedure.
D. Appeal Procedure - In the event that the claim is denied and the claimant wishes to
appeal his claim's denial, he or his duly authorized representative shall file a written
request for a review, which request must be made within 60 days of the receipt by
the claimant of the notice of his claim's denial. The claimant or his representative
may review pertinent documents relating to the claim and its denial and may submit
issues and comments in writing to the Administrator who shall make a decision on
the merits of the claim as soon as practicable but no later than 120 days after
receipt of a request for review. The decision on review shall be in writing and shall
include specific reasons therefore and specific references to the pertinent Plan
provisions on which the decision is based.
0011662.01 -32- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
In the event the claimant is dissatisfied with the Administrator's final decision, the
claimant may request that the claim file be sent to the City's Medical Review
Advisors. The claimant shall indicate in writing the reason or reasons for
disagreement with the Administrator's decision and shall submit such written
materials to the Administrator. The entire file shall be transmitted to the Medical
Review Advisors by the Administrator along with any additional written materials
submitted by the claimant. The Medical Review Advisors shall review the file and
render a written decision on the claim to the claimant and the Administrator and
there shall be no further appeals.
E. Limitation of Liability - The Claims Administrator shall be entitled to rely upon
information from any source in good faith to be correct.
PART XIV- DURATION AND AMENDMENT OF THE PLAN
A. Permanence of the Plan - The Plan shall continue in full force and effect unless
terminated, modified, altered or amended by the City as provided in the article.
Although the City has established the Plan with the bona fide intention and
expectation that it will be able to make contributions indefinitely, nevertheless the
City is not and shall not be under any obligation or Liability whatsoever to maintain
the Plan for any given length of time. The City may, in its sole and absolute
discretion, discontinue or terminate the Plan in accordance with its provisions at any
time without liability whatsoever for such discontinuance or termination.
B. Right to Amend - The City reserves the right at any time and from time to time to
modify, alter, or amend, in whole or in part, any or all of the provisions of the Plan,
provided, however, that no such modifications, alteration or amendment which
substantially increases the duties, obligations or liabilities shall be made without the
consent of the appropriate party. Notwithstanding the foregoing, any modification,
alteration or amendment of the Plan may be made retroactive to the Effective Date if
necessary or appropriate for the Plan.
C. Severability - If any provision of the Plan is held invalid or unenforceable, its
invalidity or*unenforceability will not affect any other provisions of the Plan, and the
Plan will be construed and enforced if such provision had not been included.
PART XV -ADMINISTRATIVE PROVISIONS
A. Management Rights - No Limitation of Management Rights Participation in the Plan
shall not lessen or otherwise affect the responsibility of an Employee to perform fully
his duties in a satisfactory and workmanlike manner, nor shall it affect the City's
rights to discipline, discharge, or take any other action with respect to an Employee.
B. Participant's Responsibilities - Each Participant shall be responsible for providing
the Claims Administrator with his current address. Any notices required or permitted
0011662.01 -33- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
to be given hereunder shall be deemed given if directed to such address and mailed
by regular United States mail. Neither the Claims Administrator nor the City shall '
have any obligation or duty to locate a Participant. In the event a Participant
becomes entitled to a payment under the Plan and such payment cannot be made
because the current address referred to above is incorrect, (ii) because such
Participant fails to respond to the notice sent to the current address referred to
above, (iii) because of conflicting claims to such payment, or (iv) because of any
other reason, the amount of such payment, if and when made, shall be that
determined under the provisions of the Plan without interest thereon. 3
i
C. Missing Person - If, within five years after any amount becomes payable hereunder
to a Participant the same shall not have been claimed, provided due and proper
care shall have been exercised by the Claims Administrator in attempting to make
such payment, the amount thereof shall be forfeited and shall cease to be a liability l
to the City.
D. Governing Law - The Plan shall be governed by and construed in accordance with
the federal laws governing employee benefit plans, and in accordance with the laws
of the State of California where such laws are not in conflict with the aforementioned
federal laws.
0011662.01 -34- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
i
AMENDMENT NO. 1 i
THE CITY OF HUNTINGTON BEACH
EMPLOYEE HEALTH PLAN
PLAN DOCUMENT
i
This Amendment No. 1 to the City of Huntington Beach Health Plan is to be attached to, and
made part of, this Employee Health Plan - Plan Document effective as follows:
As requested, the City of Huntington Beach Employee Health Plan document is hereby
amended in its entirety, effective May 1, 1983.
CITY OF HUNTINGTON BEACH
i
Signature: l /
Typed Name: Karen S. Foster
Typed Title: Risk Manager
0011662.01 -35- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
AMENDMENT NO. 2
THE CITY OF HUNTINGTON BEACH
EMPLOYEE HEALTH PLAN
PLAN DOCUMENT
This Amendment No. 2 to the City of Huntington Beach Employee Health Plan is to be
attached to and made part of the Employee Health Plan Document effective January 1, 1985
as follows:
1984 MEDICARE - DEFRA ENDORSEMENT
The terms of the Medicare Provision shall not apply to certain actively employed Insured
Employees covered under this Plan nor to their insured Dependents as shown below:
A Insured Employees will be covered under this Plan for their primary insurance
coverage unless they elect, in writing, to have Medicare as their primary
coverage. Any Insured employee who elects Medicare as primary coverage will
not be covered for health benefits under this Plan, nor will their Dependents be
covered under this Plan.
B. Spouses of actively employed Insured employees under age 70 who are insured
as Dependents under this Policy; and will be covered under this Plan for their
primary insurance coverage unless they elect, in writing, to have Medicare as
their primary coverage. Any spouse who elects Medicare as primary coverage
will not be covered for health benefits under this Plan.
CITY OF HUNTINGTON BEACH
Signature: v
Typed Name: / Karen S. Foster
Typed Title: Risk Manager
0011652.01 -36- 04/24/95 8:49 AM
r
EMPLOYEE HEALTH PLAN DOCUMENT
AMENDMENT NO. 3
RETIREES MEDICAL INSURANCE
SUBSIDY BENEFIT(RMIS)
Eligible retirees may receive a subsidy for payment of medical insurance premiums. The
eligibility requirements and monthly subsidy amounts are available in the Personnel Division.
The modification in coverage for the Retiree Medical Insurance subsidy is as follows:
Annual deduction for retiree/family $200/$500
Major medical stop loss level $5,000.00
Basic in-patient benefits after deductible 80%
Outpatient surgery and pre-admission testing after deductible 80%
Accident benefit after deductible 80%
Surgery and anesthetics after deductible 80%
CITY OF HUNTINGTON BEACH
Signature: )! /f �►�
Typed Name: Karen S. Foster
Typed Title: Risk Manager
0011662.01 -37- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
AMENDMENT NO. 4
This amendment No. 4 effective July 1,1993 is hereby adopted.
A Part ll.0 page 5 is amended to comply with all the provisions of California AB 1672
as it applies to this self-funded plan. AB1672 states (among other items) the
following:
Pre-existing conditions are not to be denied, excluded or limited for more than 6
months after the effective date of that person's coverage under the plan.
This plan will credit the time the person was covered under qualifying prior coverage
but only if the previous coverage was continuous to a date not more than 30 days
before the effective date of the new coverage. However, if.
an individual's employment has ended; and
he lost his group health coverage as a result of termination of employment;
or
his employer's contribution towards health coverage terminated; then the
insurer offering the new group health plan must credit the time the
individual was covered under the previous group health plan, but only if the
previous coverage was continuous to a date not more than 90 days before
the effective date of the new coverage.
an eligible employee or a dependent who is a "Late Enrollee" may be excluded
from a policy/plan for a maximum of 12 months. The term "Late Enrollee" is
defined in AB1672 to exclude a person:
who gave a written statement stating that he was declining coverage
initially because he was covered under another employer's plan and
who later requests coverage within 30 days of termination of coverage
under the prior plan;
for whom a court has ordered that coverage be provided for a spouse
or minor child under a covered employee's health benefit plan and the
request for coverage is made within 30 days after the issuance of the
court order.
3. Part X Major Medical B. 1. This paragraph is eliminated. There is no 100
day limitation on inpatient hospital care.
CITY OF HUNTINGTON BEACH
Signature:
Typed Name: Karen S. Foster
Typed Title: Risk Manager
0011662.01 -38- 04/24/95 8:49 AM
EMPLOYEE HEALTH PLAN DOCUMENT
AMENDMENT NO. 5
CITY OF HUNTINGTON BEACH
EMPLOYEES AND RETIREES
INDEMNITY HEALTH PLAN
Effective January 1, 1995, coverage is amended as follows:
City P(an
Employees „ City Ptar.
Non Subsidized Retirees, Subsidized
Benefits COBRA Eligibles Retiree Ptan .
Inpatient Hospital 90% - (PPO) of UCR 80% of UCR
after deductible after deductible
70%-(Non-PPO) of UCR MEA: 70% of UCR
after deductible after deductible
FA: 80% for Non-PPO
after deductible
Deductible Per Person/Maximum $150 /$450 $200 / $500
Per Family
Maximum Out of Pocket
1 000�/ 2 000 1 50$ 0 / 3000
Expenses (Excludes Deductible)
$ $ $
Accident Benefit None None
(Medical) (Covered Same as Other (Covered Same as Other
Expenses) Expenses)
Prescription Drugs PCs PCs
Deductible Generic/Non $5/ $8 $5/$8
Generic
Major Medical 90% (PPO) of UCR 80% of UCR
after deductible after deductible
70% (Non PPO) of UCR MEA: 70% of UCR
after deductible after deductible
FA: 80% for Non-PPO
after deductible
CITY OF HUNTINGTON BEACH
Signature: ✓'
Typed Name: Karen S. Foster
Typed Title: Risk Manager
0011662.01 -39- 04/24/95 8:49 AM
, o go®z �-
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Administered by:
Private Medical-Care, Inc.
12898 Towne Center Drive
Cerritos,CA90703-8579
t_ L California
• Eligibility for you and your family
If you meet your group's eligibility requirements for dental coverage,
DeltaCare is a dental program that you can enroll in the DeltaCare program.You may also enroll eligible
dependents,including your lawful spouse and unmarried children
provides you and your family with (which includes stepchildren and legally adopted and foster children
quality dental benefits at an affordable to the age limit specified by your group).,Contact your benefits
cost. The DeltaCare program is administrator if you have any questions.
designed to encourage you and your
family to visit the dentist regularly to • Easy enrollment
maintain your dental health. To enroll in the DeltaCare program,simply complete an enrollment
form indicating your choice of dentist(from the list of network dental
To receive your DeltaCare benefits, you offices)and the name of your group.Return this form as directed by
select a primary care network dentist your benefits administrator.
when you enroll. The DeltaCare
• How your DeltaCare program works
network consists of private practice
dental offices that have been carefully Your selected primary care network dentist will take care of the
screened for quality. dental care needs for your family.If you require treatment from a
specialist,your primary care network dentist will handle the referral
for you.
After you have enrolled,you will receive a PM membership card and
an Evidence of Coverage that fully describes the covered benefits of
your dental program.The membership card will have the telephone
number and address of your network dentist.Simply call the dentist
to make an appointment.
✓ Extensive benefits for you and your family
✓ No restrictions on pre-existing conditions, except for Under the DeltaCare program,many services are covered at no
work in progress cost,while others have copayments(fees you pay your network
✓ Large,stable network of dentists,so you can enjoy a dentist)for certain procedures.See the"Description of Benefits and
long-term relationship with your dentist. Copayments"for a list of your benefits.
Please note:Dental services that are not performed by your network
CONVENIENCEdentist must be prior authorized by PM to be covered by your
✓ No claim forms to complete DeltaCare program.
✓ Easy access to specialty care
✓ Expanded business hours for toll-free customer • Provisions for emergency care
service,from 5 a.m.to 6 p.m., Pacific Time
Under your DeltaCare program,you are covered for out-of-area
dental emergencies(35 or more miles from your primary care
network dentist).Your program pays up to$100 for emergency
✓ No deductibles or annual dollar maximum dental expenses incurred in each 12-month period.
✓ Out-of-pocket costs are clearly defined
✓ Out-of-area dental emergency coverage up to $100
each 12-month period
These services are performed as needed and deemed necessary by your attending DeltaCare network dentist subject to the limitations,
exclusions and governing administrative policies of the program.
ADA En,pllm ADA Ettolm
Codes Pays Codes Pays
I. DIAGNOSTIC 7130 Root removal—exposed roots.............................No Cost
Office visit,per visit 7210 Surgical removal of erupted tooth ......................No Cost
(in addition to other services) .........................No Cost 7220 Removal of impacted tooth—soft tissue ..............No Cost
0120 Periodic oral evaluation ...............No Cost 7230 Removal of impacted toothpartially bony .........No Cost
0140 Limited oral evaluation—problem focused...........No Cost 7240,7241 Removal of impacted tooth
0150 Comprehensive oral evaluation No Cost completely bony.............................................No Cost
0160 Detailed and extensive oral evaluation 7250 Surgical removal of residual
problem focused ............................................No Cost tooth roots(cutting procedure).......................No Cost
0210 Intraoral radiographs- 7286 Biopsy of oral tissue—soft...................................No Cost
complete series(including bitewings) .............No Cost 7310 Alveoloplasty in conjunction
0220,0230 Intraoral periapical film.......................................No Cost with extractions,per quadrant........................No Cost
0240 Intraoral occlusal film..........................................No Cost 7320 Alveoloplasty not in conjunction
0270, with extractions,per quadrant........................No Cost
0272,0274 Bitewing radiograph(s).......................................No Cost 7470 Removal of exostosis-maxilla or mandible..........No Cost
0330 Panoramic film...................................................No Cost 7510 Incision and drainage of abscess—
intraoral soft tissue.........................................No Cost
IL PREVENTIVE 7960 Frenulectomy—(frenectomyorfrenotomy)
1110,1120 Prophylaxis(cleaning)—adult/child separate procedure .......................................No Cost
1 per 6 month period .....................................No Cost
1201 Topical application of fluoride, V. PERIODONTICS
including prophylaxis(to age 19) (Includes preoperative and postoperative evaluations and treatment
1 per 6 month period .....................................No Cost under local anesthetic)
1203 Topical application of fluoride, 4210 Gingivectomy or gingivoplasty,per quadrant.......No Cost
excluding prophylaxis(to age 19) 4211 Gingivectomyor gingivoplasty,
1 per 6 month period .....No Cost per tooth(fewer than six teeth)......................No Cost
1330 Oral hygiene instructions................. ,..........No Cost 4220 Gingival curettage surgical,per quadrant .........No Cost
1351 Sealant,per tooth ..............................................No Cost 4240 Gingival flap procedures including
1510 Space maintainer--fixed—unlateral ....................No Cost root planing(per quadrant)............................No Cost
1515 Space maintainer—fixed--bilateral ......................No Cost 4260 Osseous surgery,flap entry and closure,
1520 Space maintainer—removable--unilateral...........No Cost per quadrant..................................................No Cost
1525 Space maintainer—removable—bilateral.............No Cost 4341 Periodontal scaling and root planing,
1550 Recementationof space maintainers .................No Cost per quadrant..................................................No Cost
4355 Full mouth debridement to enable
III. RESTORATIVE(Fillings) comprehensive periodontal evaluation
(Includes indirect pulp capping,bases,rners and acid etch procedures) and diagnosis.................................................No Cost
2110 Amalgam--one surface,primary.........................No Cost 4910 Periodontal maintenance
2120 Amalgam—two surfaces,primary.......................No Cost (following active therapy)................................No Cost
2130 Amalgam--three surfaces,primary.....................No Cost
2131 Amalgam--four or more surfaces, VL PROSTHETICS
primary...........................................................No Cost (Crowns,bridges and dentures)
2140 Amalgam--one surface,permanent...................No Cost 2510 Inlay—one surface—base metal noble.................No Cost
2150 Amalgam--two surfaces,permanent..................No Cost 2520,6520 Inlay-two surfaces—base metal noble ...............No Cost
2160 Amalgam--three surfaces,permanent...............No Cost 2530,6530 Inlay--three or more surfaces-
2161 Amalgam-- base metal noble............................................No Cost
four or more surfaces,permanent.................No Cost 2543,6543 Onlay--three surfaces—base metal noble...........No Cost
2330 Resin--one surface anterior...............................No Cost 2544,6544 Onlay—four or more surfaces-
2331 Resin--two surface anterior................................No Cost base metal noble............................................No Cost
2332 Resin--three surface anterior.............................No Cost 2710 Crown—resin (laboratory) ..................................No Cost
2335 Resin—four or more surfaces 2740 Crown—porcelainlceramict................................No Cost
or involving incisal angle(anterior) .................No Cost 2750 Crown--porcelain fused to high noble metai*t....No Cost
2336 Composite resin crown,anterior—primary..........No Cost 2751 Crown—porcelain fused to
2940 Sedative filling ....................................................No Cost predominantly base metalt............................No Cost
2951 Pin retention--per tooth, 2752 Crown—porcelain fused to noble metalt.............No Cost
in addition to restoration.................................No Cost 2790 Crown--full cast high noble metal*......................No Cost
2791 Crown—full cast predominantly base metal.........No Cost
IV. ORAL SURGERY 2792 Crown--full cast noble metal...............................No Cost
(includes preoperative and postoperative evaluations and treatment 2810 Crown--3/4 cast metal noble..............................No Cost
under local anesthetic) 2910 Recement inlay..................................................No Cost
7110,7120 Single tooth extractionleach additional ...............No Cost 2920 Recement crown................................................No Cost
700M
1 � i
ADA
Codesftys
Codes Pays
2930,2931 Crown--prefabricated stainless steel-- 6752 Crown--porcelain fused to noble metalt.............No Cost
primary/permanent ........................................No Cost 6790 Crown--full cast high noble metal*......................No Cost
2950 Crown buildup 6791 Crown--full cast predominantly base metal.........No Cost
(restorative material and pins)........................No Cost 6792 Crown--full cast noble metal...............................No Cost
2952 Cast post and core* 6930 Recement bridge(fixed partial denture).. .........No Cost
(in addition to crown) .....................................No Cost 6940 Stress breaker,per unit (in addition to
2954 Prefabricated post and core mixed partial denture,retainer)......................No Cost
(in addition to crown) .....................................No Cost 6970 Cast post and core*
5110,5120 Denture--complete maxillary (includes canal preparation)...........................No Cost
or mandibular(upper or lower)......................No Cost 6972 Prefabricated post and core buildup
5130,5140 Immediate denture—maxillary (including canal preparation,
or mandibular(upper or lower).......................No Cost restorative material and any pins) No Cost
5213,5214 Denture—maxillary or mandibular
(upper or lower)partial with metal *Base ornoble metal is the benefit. High noble metal(precious),if used,
lingual or palatal bar,clasps and Mllbe charged to the enrollee at the additionallaboratorycost of the high
acrylic saddles,and acrylic base or noble metal. This applies to crowns,bridges,cast and post cores,inlays
cast metal framework and teeth.....................No Cost and onaays.
5410 Adjust complete denture—maxillary....................No Cost
5411 Adjust complete denture—mandibular ................No Cost t Porcelain on molars is considered optional treatment.
5421 Adjust partial denture--maxillary.........................No Cost
5422 Adjust partial denture—mandibular.....................No Cost VIL ENDODONTICS
5510 Repair broken complete denture base..No Cost 3110,3120 Pulp capping(direct/indirect)..............................No Cost
5520 Replace missing or broken teeth-- 3220 Therapeutic pulpotomy
complete denture(per tooth) .........................No Cost (excluding final restoration) ............................No Cost
5610 Repair resin denture base..................................No Cost 3310 Root canal therapy—anterior
5620 Repair cast framework.......................................No Cost (excluding final restoration) ............................No Cost
5630 Repair or replace broken clasp ..........................No Cost 3320 Root canal therapy--
bicuspid'
5640 Replace broken teeth(per tooth).......................No Cost (excluding final restoration) No Cost
............................
5650 Add tooth to existing partial denture...................No Cost 3330 Root canal therapy—molar
5660 Add clasp to existing partial denture...................No Cost (excluding final restoration No Cost
5730 Reline complete maxillary denture 3410 Apicoectomy/periradicular surgery—anterior.......No Cost
(chairside)......................................................No Cost 3421 Apicoectomy/pedradicularsurgery--
5731 Reline complete mandibular denture bicuspid(first root) .........................................No Cost
(chairside)......................................................No Cost 3425 Apicoectomylpedradicular surgery-
5740 Reline maxillary partial denture molar first root No Cost
(chairside)......................................................No Cost 3426 Apicoectomylpedradicular
5741 Reline mandibular partial denture sure each additional root No Cost
(chairside)......................................................No Cost 3430 Retrograde filling,per root.................................No Cost
5710 Rebase complete maxillary denture ...................No Cost 3450 Root amputation, r root..................................No Cost
5711 Rebase complete mandibular denture ...............No Cost
5720 Rebase maxillary partial denture........................No Cost VIIL ADJUNCTIVE GENERAL SERVICES
5721 Rebase mandibular partial denture....................No Cost 9110 Palliative(emergency)treatment of dental pain..No Cost
5750 Reline complete maxillary denture(lab) .............No Cost 9211 Regional block anesthesia..................................No Cost
5751 Reline complete mandibular denture(lab)...........No Cost 9212 Trigeminal division block anesthesia...................No Cost
5760 Reline maxillary partial denture(lab)..................No Cost 9215 Local anesthesia................................................No Cost
5761 Reline mandibular partial denture(lab)..............No Cost 9310 Consultation(diagnostic services provided by
5820 Interim partial denture(maxillary).......................No Cost dentist or physician other than practitioner
5821 Interim partial denture(mandibular)...................No Cost providing treatment ................No Cost
5850,5851 Tissue conditioning--per denture........................No Cost 3440 Office visit after regularly scheduled hours...........$20.00
6210 Pontic--cast high noble metal*............................No Cost 0125 Failed appointment without 24 hour notification,
6211 Pontic--cast predominantly base metal...............No Cost per 15 minutes of appointment time................$10.00
6212 Pontic--cast noble metal.....................................No Cost
6240 Pontic--porcelain fused to high noble metal*t.....No Cost D(- ORTHODONTICS
6241 Pontic—porcelain fused to Start-up fees(excluding records).............................................$250.00
predominantly base metalt ............................No Cost Dependent children to age 19..................................................$500.00
6242 Pontic—porcelain fused to noble metalt .............No Cost Adults and covered full-time students.......................................$500.00
6750 Crown—porcelain fused to high noble metal*t....No Cost
6751 Crown--porcelain fused to Any procedure not listed is available on a fee-for-service basis.
predominantly base metalt............................No Cost
�oolas
DELTACARE® PARTICIPATING DENTAL OFFICES °�`"`HEALTH
fDdl.DPLAN
® a,amr rcerixic�Denul flan
o(Califanua
Fourth Quarter 2002-Southern California
Open Offices Volume I
AGOURA HILLS #125501 ANAHEIM #188001 APPLE VALLEY #005101 BAKERSFIELD #131001
AGOURA DENTAL GROUP DANNY THOMAS,DOS ASPEN DENTAL GROUP STEPHEN KANN, DDS
29525 CANWOOD ST STE 250 601 S EUCLID ST 15995 TUSCOLA RD STE 201 1919 G STREET
(818)991-9852 (714)778-0700 (760)242-2620 (661)323-8585
FIT I (SR TA) 6% P/T I (VI,SR RU) FIT 1 (TA,RU) F/T I
ALHAMBRA #000647 ANAHEIM #IC0301 APPLE VALLEY #128401 BAKERSFIELD #164101
MOHAMMAD DABBOUSI,DDS UNIVERSAL CARE DENTAL SANG PAIK,DDS SIAN POH, DDS
401 N GARFIELD AVE 1808 W LINCOLN STE 201 20162 HWY IS STE L 2721 H ST
(626)570-0974 (714)780-5665 (760)946-1466 (661)324-9709
FIT I (SP,TA AR) & F/T I P/T I (SP,TA,VI) C1i HT 1 (KO,SP) F/T I
ALHAM113 #051601 ANAHEIM #I C7301 APPLE VALLEY #2C500I BALDWIN PARK #000313
DRS LEE AND YEE MANHAR MISTRY DDS INC APPLE VALLEY DENTAL PRAKASH PATEL,DDS
157 N GARFIELD AVE 303 N EAST ST 18245 HIGHWAY 18 STE 4 4138 N MAINE AVE STE N3
(626)284-5113 (714)772-0770 (760)242-2977 (626)960-6395
F/T 2 PIT I (CH,SP,VI) & F/T I (SP) F/T 1 (SP) F/T I (SP)
ALHAMBRA #00O201 ANAHEIM #235001 ARCADIA !#196501 BALDWIN PARK #057801
NADIR YAZDANI,DDS SMILES FOR ORANGE COUNTY ARCADIA DENTAL CENTER DAVID KUTNER,DMD
747 S GARFIELD AVE 9672 BALL ROAD 75 N SANTA ANITA BLVD 215 13734 RAMONA BLVD
f�6)289-6815 C F714)772 0102 (626)447-5126 (626)960-6616
FIr 4(CH) FIT I PIT I (SR KO) Ck
ALHAMBRA #118001 ANAHEIM #256401 ARCADIA ##386201 BANNING #169501
ALHAMBRA FAMILY DENTISTRY DRS ANTHONY AND NAOMI WONG WILLIAM HOUSTON,DDS ADRIAN ACOSTA,DDS
600 W MAIN STREET STE 102 3356 W BALL ROAD STE 215 25 N SANTA ANITA AVE SUITE E 4240 W RAMSEY AVE
(626)282-4119 (714)995-3051 (626)254-1948 (909)849-4484
FIT I (SR AR) & F/T 2(SR CH) FIT I P/T i FIT 2(SP.RU)
ALTA LOMA #002495 ANAHEIM ##256501 ARCADIA #3C8201 BARS TOW #000301
DR TOM DENTAL OFFICE ANAHEIM FIRST FAMILY DENTAL ANDREW LIM, DDS GENTLE'DENTAL CARE
6795 CARNELIAN ST 1 161 N EUCLID ST 1043 W HUNTINGTON DRIVE 113 E MOUNTAIN VIEW
(909)483-3431 (714)999-5050 (626)445-9660 (760)256-2896
F/T I (SR CH) & F/T 2 PIT 2(SR CH) FIr I (KO,SP) 6% F/T I (SP)
ALTA LOMA #198801 ANAHEIM ##258301 ARLETA #000223 BELL #002095
CARNELIAN FAMILY DENTISTRY DALWAN)AND DHOLAKIYA FAMILY DENTISTRY ST GEORGE DENTAL CLINIC
6626 CARNELIAN ST 815 N EUCLID STREET 9069 1/2 WOODMAN AVENUE 6905 112 S ATLANTIC BLVD
(909)987-4113 (714)758-0791 (818)893-8799 (323)773-5029
F/T I (SR CH) F/T 4(SR CH,JA) FIT 2(SP) PIT I (SR AR,RU) 6%
ALTA LOMA #359101 ANAHEIM #274701 ARLETA #002852 BELL GARDENS #328401
JEFFREY LLOYD.DDS ANAHEIM OPEN 7 DAYS DENTAL OSBORNE DENTAL OFFICE INC MARKETPLACE DENTAL OFFICE
9310 BASELINE ROAD 637 N EUCLID ST 13205 OSBORNE STREET SUITE F 6815 EASTERN AVE STE AI
(909)989-1868 (714)772-2893 (818)890-2426 (323)560-2595
F/T i (SP) F/T 6 P/T I (SP,CH,VI,AR,JA) & F/T t (SR) 61 F/T I (SP) &
ANAHEIM #001669 ANAHEIM #2C1801 ARLETA #198601 BELL GARDENS #372001
ANAHEIM FAMILY DENTAL OFFICE VILLAGE DENTAL GROUP WOODMAN FAMILY DENTISTRY JIN WEI CHU,DDS
2170 W LINCOLN AVE 1210 S BROOKHURST ST 8725 WOODMAN AVE 6526 EASTERN AVE
(714)535-3933 (714)535-7500 (818)891-6670 (323)771-3949
FIT 1 P/T I PIT 2 & F/T I (SP) FIT 2(SP)
ANAHEIM #002252 ANAHEIM #3C6001 ARTESIA #000733 BELLFLOWER #002497
SMILECARE DENTAL GROUP PREFERRED DENTAL CARE SARAH CUPINO,DMD THE DENTAL GRP OF BELLFLOWER
1 1 12 N MAGNOLIA AVE 2207 S HARBOR BOULEVARD 12146 SOUTH STREET SUITE E 10106 ALONDRA BLVD SUITE A
(714)828-1211 (714)971-7800 (562)924-1007 (562)867-5117
F/T I P/T 2(SP,VI) FIT I P/T 2(SR EI) FIT I (SR TA) & FIT 2(SR)
ANAHEIM #003047 ANAHEIM HILLS #000219 ARTESIA #1 12201 BELLFLOWER #002498
STATE COLLEGE DENTAL GROUP STAR DENTAL CARE SIOE HWA ONG DDS INC A ALONDRA DENTAL GROUP
330 N STATE COLLEGE BLVD 105 5031 E ORANGETHORPE AVE B2 17906 S PIONEER 10106 ALONDRA BLVD SUITE B
(714)772-5005 (714)693-1889 (562)860-9612 (562)920-8324
P/T 3(SR TA,PE,VI) 61 FIT I FIT t PIT 2(SR TA) Ck FIT I (SP,)
ANAHEIM #003048 ANAHEIM HILLS #352101 AZUSA #002012 BELLFLOWER #002531
SOUTH ANAHEIM DENTAL GROUP SUNSHINE DENTAL OFFICE APPLE DENTAL GENE MEYER,DDS
2300 S HARBOR BLVD 8285 E SANTA ANA CYN RD 115 891 EARROW HWY STE B 9725 FLOWER STREET
(714)750-3030 (714)974-5599 (626)332-4788 (562)867-6196
PIT I (SP) C-V% F/T I P/T i (SR EI) FIT i F/T I (SP,TA)
ANAHEIM #183601 ANAHEIM HILLS #3C2201 BAKERSFIELD #002973 BELLFLOWER #003208
NANDINI MURTHY,DDS ANAHEIM HILLS DENTAL GROUP SMILECARE DENTAL GROUP MICHAEL BADEA, DDS
1655 W BROADWAY STE 9 5731 A SANTA ANA CNYN RD 2750 MING AVE 9222 E ROSECRANS AVE
(714)774-2638 (714)998-2956 (661)396-1701 (562)272-0222
FIT I (SP) F/T I (SP) FIT 2 P/T I FIT I PIT 3 &
E
- The wheelchair symbol indicates functional accessibility for individuals with limited mobility. Information regarding dental office
accessibility for patients with mobility impairments is available by calling PMI's Customer Relations department at(800)422-4234.
BELLFLOWER #I85501 BREA #3C1501 CANOGA PARK #000281 CATHEDRAL CITY #I C3501
GERALD SANDARG,DDS IMPERIAL DENTAL CARE AAA DENTAL GROUP GENTRY PLAZA DENTAL CARE
17024 S CLARK AVE STE C 200 E IMPERIAL HWY 21 123 VICTORY BOULEVARD 68555 RAMON ROAD STE D 102
(562)925-7436 (714)671-9999 (818)888-2700 (760)202-1171 I FIT (SP) F/r i (IN,SP,FR) F/T 2(SP.RU,HE AM,TA) F/T I PIT I
BELLFLOWER #I C0901 BUENA PARK #001687 CANOGA PARK #001745 CATHEDRAL CITY #309001
UNIVERSAL CARE DENTAL BUENA PARK DENTAL CENTER CARL JOHNSON, DDS ARTHUR WILLARDSEN,DDS
17660 LAKEWOOD BLVD 8402 COMMONWEALTH AVE 7241 OWENSMOUTH AVE 68487 E PALM CANYON DR I
(562)461-1180 (714)739-2051 (818)346-3040 (760)328-6208
F,? I PIT 2(SP,VI) & FIT I (AR,FR.SP) P/T I F/T I (SP)
BELLFLOWER #329301 BUENA PARK #002515 CANOGA PARK #002858 CENTURY CITY. #12S601
JOHN LIM, DMD BEACH DENTISTRY SINAI DENTAL CLINIC BARRY KASHFIAN,DMD
9202 ALONDRA BLVD 7841 COMMONWEALTH AVE 7257 VASSAR AVE SUITE#203 2080 CENTURY PARK EAST 1406
(562)920-6644 (714)739-7173 (818)251-9794 (310)553-1578
F/T I (SP) ( FIT I (SPAR.) F/T 1 (SP,) FIT 2(SP TA)
BELLFLOWER #359701 BUENA PA #1 17901 CANOGA PARK #003624 CERRITO #002718
BELLFLOWER FAMILY DTL SERVICE MICHAEL CHANG, DDS SHAWN RABIZADER DDS EASTERN DENTAL
16925 BELLFLOWER BOULEVARD 7700 ORANGETHORPE AVE STE 6 22030 SHERMAN WAY#202 11466 SOUTH STREET
(562)866-9739 (714)994-4482 (818)887-0260 (562)402-8166
FIT I (SP) F/r 2(CH,SP) P/T 2(SP) FIT I (SR KO) 6%
BELLFLOWER #363401 BUENA PARK #157001 CANOGA PARK #2C4801 CERRITOS #184301
MAURICE VARGAS.DDS ST THERESE FAMILY DENTISTRY WEST VALLEY DENTAL BLOOMFIELD DENTAL CENTER
16537 BELLFLOWER BLVD STE B 6891 LA PALMA AVE 6543 TOPANGA CANYON BLVD. 12657 166TH ST
(562)866-7073 (714)994-6911 (818)883-7979 (562)926-6502
F!r I (SP) LFi FIT I (TA) FIT 2 P/T I F/T 2(SR CH,VI,AR) CK.
BEVERLY HILLS #003120 BURBANK #000082 CANOGA PARK #362701 CERRITOS #21 S401 �.
SMILE MAKERS SAN GABRIEL DENTAL PARY AFRASHTEH,DDS CERRITOS DENTAL CENTER
998 S ROBERTSON BLVD 103-A 255 E ORANGE GROVE STE B 7259 OWENSMOUTH AVE 11135 183RD STREET
(310)358-1200 (818)557-0996 (818)999-9900 (562)860-9639
P/T I (SP) & FIT I (TA,SP) F/T I (SP,FR) F/T 7 P/T I (SP,VI,FR) &
BEVERLY HILLS 0 #003545 BURBANK #000301 CANOGA PARK #375401 CHATSWORTH #142801
DENTAL GROUP OF BEVERLY HILLS JAMES MATHESON,DDS KISHORE SHAH, DDS DOUGLAS DILL, DDS
99 N LA CIENEGA BLVD#300 2720 W MAGNOLIA 21001 13 SHERMAN WAY 10242 CANOGA AVE
(310)289-1818 (818)8424879 (818)346-7032 (818)882-5252
(SR TA) 61 FIT I F/T I PIT 2(SP,TA) & F/T I PIT I (SP,TA)
BEVERLY HILLS #146801 BURBANK #002855 CANYON COUNTRY#146601 CHATSWORTH #284101
DENTAL GROUP OF BEVERLY HILLS ABC DENTAL GROUP ANNA LIBERMAN, DDS DEVONSHIRE PLAZA DENTAL GROUP
250 N ROBERTSON BLVD STE 412 1319 N SAN FERNANDO BLVD 18507 SOLEDAD CANYON RD 10230 CANOGA AVE
(310)271-3003 (818)557--2299 (661)252-0020 (818)341-8400
FIT I (SP,JA) FIT I (AM,AR,) F/T 3(SR RU,TA.AM) F/T I (SP)
BEVERLY HILLS #201601 BURBANK . #003538 CARLSBAD #OC8801 CHINO #002337
JOEL OVADIA,DDS DR MA LOURDES ANDRES-JAVIER CARLSBAD OPEN 7 DAYS DENTAL GALVAN FAMILY DENTISTRY INC
8500 WILSHIRE BLVD#.602 216 E ALAMEDA AVE 5814 VAN ALLEN WAY STE 220 4514 PHILADELPHIA ST STE A
(310)289-1101 (818)848-3026 (760)918-9000 (909)465-1016
FJT 1 (RU,AR) FIT I (SP) F/T 3 F/T I P)T I (SP,TA) L�
BEVERLY HILLS #305001 BURBANK #OC4301 CARLSBAD #2C2001 CHINO #031701
KAMBIZ KASHFIAN, DDS RENE GHOTANIAN,DDS PLAZA FAMILY DENTAL GROUP ANTHONY KAVORINOS,DDS
50 N LA CIENEGA BLVD STE 206 500 E OLIVE AVE STE 460 2630 EL CAMINO REAL 12604 CENTRAL AVE
(310)659-7949 (818)846-2600 (760)434-1761 (909)591-1745
Fi-r I FIT I P/T I (SP) L FIT I (SP) FIT I PIT I (SR KO)
BEVERLY HILLS #363001 CALABASAS #0031 19 CARSON #002545 CHINO #327401
PACIFIC DENTAL CARE SCHECHTER DENTAL CORP RANDOLPH LUM, DDS WIWAM VALDEZ,DDS
9025 WILSHIRE BLVD STE 315 26560 AGOURA ROAD#102 21847 S AVALON BLVD 4129 RIVERSIDE DR
(310)274-7485 (818)880-4023 (310)549-9710 (909)591-9211
PIT 2(SP) 6% PIT I (SR GE) F/T 2(SR CH) & FIT I (SP) &
BLOOMINGTON #370001 CALABASAS #356501 CARSON #2411Of CHINO #367601
JACK ACKERMAN,DDS CALABASAS DENTAL GROUP MICHAEL ALKOV,DDS FAMILY DENTAL CENTER
19059 VALLEY BLVD STE 103 26500 AGOURA ROAD STE 115 550 E CARSON STE C 5436 RIVERSIDE DRIVE
(909)877-3660 C� F�8)71-0680 (310)835-7884 (909)465-5551
I FIT I (SP) Ck F/T I (SR TA) FIT I (SP)
I BONITA #271301 CALIFORNIA CITY #195301 CARSON #362401 CHINO #3C2701
1 BONITA FAMILY DENTAL ASPEN DENTAL GROUP CARE DENTAL CENTER JENNIFER HUNG, DDS
F 4424 BONITA ROAD 21007 NEMOPHILA AVE STE B 23517 MAIN ST STE 106 14335 PIPELINE AVE STE A
(619)479-8703 (760)373-1950 (310)513-0222 (909)628-8911
I FT I (SP) FIT I (SR TA) FIT I P/T I (SR CH) & FIT 1 (SP,CH,PE,GR) &
E BREA #001673 CAMARILLO #003118 CARSON #363701 CHINO HILLS #003117
WALTER DAO,DDS LAS POSAS DENTAL CARE FAMILY DENTAL CENTER CHINO HILLS DENTAL GROUP
F 782 N BREA BLVD 3901 LAS POSAS RD STE 209 22813 S FIGUEROA ST 3410 GRAND AVE STE C
(714)674-0114 (805)383-6745 (310)549-3717 (909)364-0001
1 F,7 I (SR FR) & F/T I (CH,SP) F/T I (SP,AR) FIT I P/T I (SP) 6%
( BREA #152701 CAMARILLO #198701 CARSON #368301 CHINO HILLS #176301
( WILLIAM LOU, DDS CAMARILLO DENTAL GROUP GEORGE STRONG,DDS ST JUDE DENTAL CARE
552 E LAMBERT ROAD 2380 E LAS POSAS ROAD A 301 W CARSON ST 14676 PIPELINE AVE UNIT Q
t (714)990-3344 (805)388-9110 (310)787-7053 (909)393-3180
F N7 I FIT 2(SP) F/T I (SR TA) F/T 5(SP) 6%
1; BREA #IC4801 CAMARILLO #285401 CASTAIC #385401 CHULAVISTA #000225
y BERRY IMPERIAL DENTAL GROUP FARID SEHATI, DDS CASTAIC DENTAL CENTER PREFERRED DENTAL CARE
n 649 W IMPERIAL HWY STE H 484 MOBIL AVENUE STE 33 31886 N CASTAIC ROAD 690 E STREET
(714)529-1232 (805)482-9568 (661)257-2300 (619)426-4264
FIT 2(SP) & FIT 2(SR PE) & 2 FIT 2 P/T I (SP,TA) & Frr I P/T I (SP)
05 cK- The wheelchair symbol indicates functional accessibility for individuals with limited mobility.Information regarding dental office
accessibility for patients with mobility impairments is available by calling PMI's Customer Relations department at(800)422-4234.
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L Z I£-VVV(619) 111 E-098(606) 9VL E-L EL(606) VVV 1-9LV(619)
d US 3AV NOSNHO(H1NON OOL 91Z OA19 NV9 ONOWVIO N OSL Z01#311n s 1S A3lNl)10W 191 3AV ONIHl IOE
1V1N3o o3NN3d3Nd SOO'NVVWVS W33SSVM dn10N9 1V1N30 VNON00 V1SIA Vin1HJ liO IVNOISS310Nd
IV0000# N V l3 10900Z# NV OONOWVIO ZOSZ00# V-N--0 S-0-5 LS1E00# VISIAVVIH'
EN I O #179901 FOUNTAINV"ALLEY #186301 GLENDALE #002305 HACIENDAHGTS #2C3501
RENE GHOTANIAN,DDS WADID FATTOUCH,DDS MALOU ANDRES JAVIER,DMD MATTHEW TSAY,DDS
5363 BALBOA BLVD STE 346 1 1 180 WARNER AVE STE 251 1 140 E CHEVY CHASE DR 17138 E COLIMA ROAD STE C
(818)990-3551 (714)775-0661 (818)247-3387 (626)854-1826
F/T I (SP,HE) F/T I (SR VI,PE,FR,AR) C� F/T 3(SR) GLI F/T I P/T I (SP,CH) 61
ENCINO #184401 FOUNTAINVALLEY #260701 GLENDALE #002331 HACIENDAHGTS #2C9401
ENCINO DENTAL CENTER PAUL JARUSZEWSKI,DDS ADVANCED DENTAL CARE COMFORT SMILE FMLY DENTISTRY
17815 VENTURA BLVD STE 101 18430 BROOKHURST STE 104 610 N CENTRAL AVE STE 207 15724 E GALE AVENUE
(818)708-1200 (714)963-3005 (818)545-8971 (626)333-5244
F/T I (SP,HE) FIT I (SP) CT% FIT i FIT I (SR CH)
EN I O #237501 FOUNTAINVALLEY #384201 GLENDALE #002375 HARBOR CITY #2C9101
HERBERT SCHNEIDER.DDS QUALITY DENTAL CARE SMILE DENTAL PRACTICE CLAUDIA ROMANO.DDS
15720 VENTURA BLVD STE 322 17150 EUCLID STE 311 1114 E BROADWAY ST 1537 W LOMITA BLVD
(818)788-7060 (714)444-4224 (818)500-7740 (310)530-5252
F/T 2(SR FR,HE) & F/T I (AR,FR) (LI (AM,PE,RU) FIT 2 P/T I (SP) (�
ESCOND'DO #003S41 FULLERTON #000288 GLENDALE #002856 HAWAIIAN GDNS #003202
ACACIA DENTAL CARE FARID HANNA, DDS SMILECARE DENTAL GROUP ANTHONY CAO,DDS
639 S ESCONDIDO BLVD 100 N STATE COLLEGE BLVD#E 1809 VERDUGO BLVD#340 12531 E CARSON STREET
(760)489-6197 (714)738-6001 (818)790-0581 (562)924-2448
F/T I (SP) F/T I (AR.FR,SP) F/T 2 P/T I (SR RU) 61 F/T I (SR VI) &
ESCONDIDO #154801 FULLERTON #001690 GLENDALE #003132 HAWTHORNE #001294
EL NORTE FAMILY DENTAL SUNSHINE DENTAL ARTEMIS SARADJIAN.DDS CASTLE DENTAL
306 W EL NORTE PKWY STE D&E 506 W COMMONWEALTH 205 S VERDUGO ROAD SUITE A 13220 S HAWTHORNE BLVD
(760)480-5600 (714)738-7777 (818)244-4949 (310)679-9019
FIT I (SP) F/T I (SR KO) F/T 2(AM,RU,SP,PE) F/T 2 P/T 2(SP) &
i.
ESCONDIDO #191801 FULLERTON #228001 GLENDALE #171801 HAWTHORNE #001811
FAMILY CARE DENTAL FULLERTON DENTAL CENTER JOHN GAZARIAN, DDS KIMS HAWTHORNE DENTAL GROUP
1114 W VALLEY PKY 446 E COMMONWEALTH AVE 230 N MARYLAND AVE STE 205 3300 W.ROSECRANS AVE#105
(760)738-1070 (714)680-6767 (818)502-9990 (310)679-3300
F/T I P/T 1 (SR TA) FIT 2(SP) & F/T I (AM.TA,SP,PE) & P/T I (KO,SP) &
ESCONDIDO #196901 FULLERTON #276001 GLENDALE #IC9401 HAWTHORNE #001815
VILLAGE DENTAL CENTER ERIC MEYER,DDS HI CARE DENTAL CENTER INC HAWTHORNE FMLY&COSMETIC DTL
8895 LAWRENCE WELK DRIVE 2720 N HARBOR BLVD STE 110 819 N PACIFIC AVE 13402 S HAWTHORNE BLVD
(760)749-7500 (714)879-7943 (818)240-1760 (310)675-5050
F/T I P/T I FIT I (SP) FIT 3 P/T 3(AM,SP) FIT 1 P/T I (SP)
ESCONDIDO #I C9901 FULLERTON #364101 GLENDALE #365701 HAWTHORNE #OC4501
DEL LAGO DENTAL GROUP ALICE SKUBEN, DDS JERRY KOLESAR,DMD JOHN LEGASPI, DMD
3440 DEL LAGO BLVD STE C 170 N RAYMOND AVE 1122 N BRAND BLVD STE 102 13352 HAWTHORNE BLVD
(760)746-8777 (714)870-2000 (818)242-2667 (310)973-1525
F/T i PIT I (SR TA) FIT I (SR TA) & F/T I P/T I (SP) FIT 2(SP)
ESCONDIDO #360501 GARDEN GROVE #000297 GLENDALE #3C4601 HAWTHORNE ##165901
JAMSHID KHAZIAN. DMD PRIMARY DENTAL CARE MONTROSE DENTAL GROUP COMFORT DENTAL CENTER
727 E GRAND AVE 12570 BROOKHURST ST SUITE 2 3600 OCEAN VIEW BLVD#6 4277 W EL SEGUNDO BLVD
(760)738-7000 (714)537-5700 (818)541-9010 (310)970-0900
F/T i (SR TA,PE) F/T I (SR RU) F/T 2(AM,PE) F/T I P/T I (SP) &
FONTANA #1 17301 GARDEN GROVE #127401 GLENDORA #000307 HAWTHORNE #358501
VILLANUEVA DENTAL OFFICE UNIVERSAL CARE DENTAL WOODGLEN DENTAL CENTER GEORGE SALAMA,DDS
17500 FOOTHILL BLVD STE C2 12852 PALM DRIVE STE 208 220 S GLENDORA AVE STE B 13109 HAWTHORNE BOULEVARD
(909)357-7000 (714)530-9801 (626)914-4054 (310)973-2600
FIT I P/T I (SP) 61 P/T 9(SP,VI) & FIT I (SR AR) F/T 3 P/T I (SP) CILI
FONTANA #151301 GARDEN GROVE #254301 GLENDORA #191001 HAWTHORNE ##3C4901
FONTANA DENTAL GROUP GARDEN GROVE DENTAL CARE HARRY PAGES,DDS CHOICE DENTAL GROUP
9193 SIERRA AVE STE D 12630 BROOKHURST ST STE B 1010 E ALOSTA AVE 12730-D HAWTHORNE BLVD
(909)822-2226 (714)530-4920 (626)914-3068 (310)644-4000
F/T 2(SR AP,VI) F/T 2 P/T I (SP,VI,TA,PE,HE) & F/T I (SP) & F/T I (SP) &
FONTANA #195201 GARDEN GROVE #353101 GLENDORA #288401 HEMET ##OC6501
SIERRA FAMILY DENTISTRY BRISTOL DENTAL GROUP GLENDORA DENTAL CENTER ARIEL FERNANDEZ, DDS
9870 B SIERRA AVE 13212 S HARBOR BOULEVARD 130 W ALOSTA AVE STE 316 810 ST JOHN PLACE
(909)823-2020 (714)638-9999 (626)335-7727 (909)652-4040
F/T I P/T I (SP) F/T I P/T 2(SP) 61 FIT I (SR AR) F/T I (SP)
FONTANA #325201 GARDENA #001813 GRANADAHILLS #000632 HEMET #125301
GUPTA DENTAL GROUP CITY DENTAL CENTER OF GARDENA FAMILY DENTISTRY SHAILESH PATEL,DDS
11623 CHERRY AVE STE B2 1300 W 155 STREET STE 208 17050 CHATSWORTH AVE#109 475 W STETSON STE L
(909)355-1485 (310)715-2723 (818)832-2087 (909)925-4002
F/T 2(SP) F/T 2 P/T I (SP,TA) & F/T I (SP,TA) FIT I
FONTANA #368601 GARDENA #173301 GRANADA HILLS #171701 HESPERIA #000001
SIERRA DENTAL OFFICE PLAZA DENTAL KAMRAN RARE, DDS DENTAL GROUP OF HESPERIA
9647 SIERRA AVE 14240 S VERMONT AVE 10144 BALBOA BLVD 15776 MAIN ST STE 18
F/T91 P/T I (SP) 6%823-5959 FITOI SSP-5511 & F/T 23SP-0200 & F/T I 8484 &
FONTANA #3C2901 GLENDALE #001666 GRANADA HILLS #320001 HESPERIA #360701
HERTIAGE DENTAL CARE ALENOUSH BAGDASARYAN,DDS JOHN BOSAK, DMD DESERT DENTIST INC
7360 CHERRY AVE STE 340 457 PALM DR# 100 10727 WHITE OAK AVE STE 213 15555 MAIN ST STE C3
(909)355-9350 (818)956-3733 (818)368-5676 (760)244-5047
F/T I PR 2(SP) & F/T I (AM,SP) FIT 2 F/T 2(SP) &
FOUNTAINVALLEY #002516 GLENDALE #001817 GRAND TERRACE #002341 HESPERIA #391001
DAVID COHEN,DDS CENTRAL DENTAL CARE AZURE HILLS DENTAL GROUP DESERT VALLEY DENTAL GRP
11180 WARNER AVE SUITE#451 607 N CENTRAL SUITE 301 22575 BARTON ROAD 17247 MAIN ST
(714)444 4428 (818)242-4781 (909)825-6003 (760)244-2625
F/T 1 61 P/T I (AR,SP) 4 F/T I (SP) F/T I (SR RU,VI,TA) &
c� The wheelchair symbol indicates functional accessibility for individuals with limited mobility. Information regarding dental office
accessibility for patients with mobility impairments is available by calling PMI's Customer Relations department at(800)422-4234.
HOLLYWOOD #015901 INDIANWELLS #175501 LA CRESCENTA #316801 LA MIRADA #359401
SAID ALY,DDS ARTHUR WILLARDSEN,DDS CRESCENTA FAMILY DENTAL MAGDY&ALINA GAD
1680 N VINE STREET STE 1020 74-900 HWY I I I SUITE#1 10 2644 FOOTHILL BLVD 12252 LA MIRADA BLVD
(323)464-2033 (760)345-8626 (818)248-9988 (562)943-0151
F/T I (AR,AM,CH) F/T 2(SP) F/T I Prr I (KO) P/T I (CH) C�
HOLLYWOOD #389001 INGLEWOOD #000078 LA HABRA #002721 LA PUENTE #00208S
ARNOLD RIFMAN, DDS TOOTH SPA CHESTER JENG DDS INC LA PUENTE VILLAGE DENTISTRY
6234 FOUNTAIN AVE 8615 CRENSHAW BLVD 744 W LA HABRA BLVD 401 S AZUSA AVE STE A
(323)466-2937 L� FIT 2($ 1152 (562)691-0738 (626)810-8222
FIT I (SP,RU) FIT 2(SP) Prr 2
HUNTINGTON BCH#000185 INGLEWOOD #001510 LA HAS #002824 LA QUINTA #000631
UNA MUSLEH, DDS FRANCISCO GONZALEZ, DDS LA HABRA FAMILY DENTAL OFFICE LA QUINTA DENTAL GROUP
19754 BEACH BLVD 11254 S CRENSHAW 331 N HARBOR BLVD 78575 HWY 1 I I SUITE#300
(714)964-8830 (323)756-1463 (561)694-3511 (760)771-0300
FIT 1 (SPAR) FIT i (SP) HT I PIT I (SP) F/T I (SR CH)
HUNTINGTON BCH#003093 INGLEWOOD #001900 LA HABRA #I C2401 LA VERNE #172701
BEACH DENTAL GROUP FAMILY DENTAL CENTER HARBOR DENTAL DENTAL CARE OF LA VERNE
19720 BEACH BLVD 3108 W IMPERIAL HWY 971 N HARBOR BLVD 2323 FOOTHILL BLVD
F7141 93 1010 `� FR0)�S)2992 (562)690-3551 (909)596-1861
PIT I (SP,CH) & P!r I (SR CH) L�
HUNTINGTON BCH#003209 INGLEWOOD #002784 LA HABRA #I C2801 LAGUNA BEACH #001503
YORKTOWN DENTAL PRACTICE AAA DENTISTRY HARBOR DENTAL CARE LAGUNA BEACH DENTAL GROUP
9931 YORKTOWN AVENUE 2798 W IMPERIAL HWY 1150 E IMPERIAL HWY 31796 S.COAST HWY
F714)63 9809 (323)418-8888 `� F714)PR 992-2200
`� P�9)415-1020
FIT I (SP,TA) (SP) Ltti
HUNTINGTON BCH#176201 INGLEWOOD #099901 LA JOLLA ■■ #003519 LAGUNA BEACH #1 15601 t.
PACIFICA DENTAL KAUFMAN&WEINER DDS INC RAYMOND i'ASH DDS PC MARTIN KRUGER,DDS
18821 DELAWARE ST STE 101 3516 W IMPERIAL HWY 9850 GENESEE AVE STE 720 385 N COAST HWY
(714)848-8211 (310)677-9101 (858)453-5525 (949)494-7115
F/T 2(SR FR,TA) F/T 3 P/T I (SP) P/T I (SP) FIT I P!r I (SP)
j HUNTINGTON BCH#200701 INGLEWOOD #228401 LA JOLLA #OS5201 LAGUNA HILLS #001890
BEACHSIDE DENTAL GROUP FORUM DENTAL GROUP JOYCE PETERSON,DDS DUC VU,DDS
18800 MAIN ST STE 110 400 E REGENT STREET 8950 VILLA LA JOLLA DR 1105 23595 MOULTON PKWY STE I
(714)842-6151 (310)674-7590 858 455-9614 949 454 0499
PIT 4(SP) & FIT 2(SP) F/T 3 P/T I (SP,VI,GE) Prr 1 1,SP
i
(V ) (.
HUNTINGTON BCH#2C 1601 INGLEWOOD #263001 LA JOLLA #OC2101 LAGUNA HILLS #1.85901
h KOSMAS PAPPAS,DDS NARINDER UPPAL,DDS LA JOLLA DENTAL ARTS OAKBROOK DENTAL CENTER
5942 EDINGER 301 N PRAIRIE AVE#320 7540 FAY AVE 24351 AVE DE LA CARLOTTA N4
(714)377-4449 (310)671-6114 (858)729-9808 (949)951-7800
Prr 2(SP) F/T I (SP,PE) PJT I (SP) AT I (AR,SP)
HUNTINGTONPARK#002376 IRVINE #000596 LA MESA #000226 LAGUNA HILLS #358601
HUNTINGTON PARK FAMILY DENTAL MALEK MANSOUR,DDS PREFERRED DENTAL CARE SUSAN MILLAR. DDS
2711 E SLAUSON AVE 16100 SAND CANYON AVE#330 8881 FLETCHER PRKWY STE 325 24031 ELTORO RD STE 220
(323)582-4474 (949)585-1515 (619)697-2800 (949)837-6206
F/T 2(AR,SP) Chi FIT 2(FR.AR,SP) & F/T 2 P/T i (SP) F/T 2 &
HUNTINGTON PARK#002488 IRVIN #001816 LA MESA #003167 LAGUNA HILLS #394801
PACIFIC FAMILY DENTISTRY SEAN FAHIMI DMD SMILECARE DENTAL GROUP MARTIN KRUGER,DDS
5914 PACIFIC BLVD 62 CORPORATE PARK SUITE#225 5601 GROSSMONT CENTER DRIVE 24022 CALLE DE LA PLATA 450
(323)581-0100 (949)559-5595 (619)462-2272 (949)830-0074
F/T I (SP,KO) & P/T I (SP,VI,AR) & F/T I PIT 2(SP,) F/T 5(SP,VI,FR) L�
HUNTINGTON PARK#158201 IRVINE #002410 LA MESA #266701 LAGUNA HILLS #3CO101
YOUR CHOICE DENTAL CALIFORNIA SMILE DESIGN GROSSMONT DENTAL GROUP RUXANDA GHIBU,DDS
6601 RUGBY AVE STE 400 2646 DUPONT DR STE C200 5565 GROSSMONT CTR 459 24401 RIDGE RT DR 107A
(323)585-1515 (949)955-3366 (619)464-3383 (949)588-2112
P/T 2(RU,SP) 61 F/T I (IT,AR,RU) & F/T 7 PIT 3 F/T I (SP)
HUNTINGTON PARK#270201 IRVINE #002461 LA MESA #358801 LAGUNANIGUEL #001925
KIMS FAMILY DENTISTRY ROYA TOOMARIAN,DDS SMILEHAVEN DENTAL CENTER LAGUNA NIGUEL DENTAL GROUP
2750 FLORENCE AVE 4330 BARRANCA PKWY STE 230 4700 SPRING ST STE 210 27901 LA PAZ ROAD SUITE D
(323)587-6600 `� F�9)786-0640 ` (619)(S j2801 (949)389-9195
FfT I (SP,KO) Prr I (SP,) 6%
HUNTINGTONPARK#355801 IRVINE #160901 LA MESA #3C1401 LAGUNANIGUEL #170,6011
SEVILLE DENTAL CENTER DDS DENTAL 2000 LA MESA FAMILY DENTAL RANCHO NIGUEL DENTAL GROUP
7705 SEVILLE AVE STE A 33 CREEK ROAD STE 210 5652 LAKE MURRAY BLVD. 30140 TOWN CENTER DRIVE
(323)582-6938 (949)857-6757 (619)465-3393 (949)2494180
FIT I (SP) Ck F/T I PIT I F/T I FIT 4 Prr 2(GE)
HUNTINGTON PARK#3 76 101 IRVINE #181901 LA MIRADA #002493 LAGUNANIGUEL #IC2701
JUSTIN FAMILY DENTIST GERALD SANDARG,DDS IMPERIAL DENTAL SEA COUNTRY DENTAL
7208 PACIFIC BLVD STE 200 17655 HARVARD PLACE STE F 15769 E IMPERIAL HWY 32341 GOLDEN LANTERN STE B
(323)582-2200 (949)833-8884 (562)902-9898
F/T I (SP,KO) & F/T 2 P/T I & Frr 2(CH,SP) & Frr94(VI,GE)
0
HUNTINGTONPARK#392401 IRVINE #339901 LA MIRADA #058501 LAGUNANIGUEL #304801
PAYAM MOJAB,DDS FARZAD SHAYGAN,DDS JOHN WESTERMEYER,DDS SOBHI BATNIJI,DDS
2542 E FLORENCE AVE STE A 4040 BARRANCA PARKWAY 140 11900 LA MIRADA BLVD STE 7 30231 GOLDEN LANTERN ST D
(32,3)582-0755 (949)559-7300 (562)947-376 f
)363-1200
FIT I (SP,PE) & F/T 2(PE) C FIT 2(SP) P/T 91 (SR AR,FR)
IMPERIAL #185301 IRWINDALE #369901 LA MIRADA #175301 LAGUNA W ODS #I C8101
PEOPLES DENTAL OFFICE 369 DENTAL CENTER LA MIRADA FAMILY DENTAL CHRISTINE CHUNG, DDS
2387 HWY 86 13105 RAMONA BLVD STE A 13922 IMPERIAL HWY 24310 MOULTON PKWY STE C1
(760)353-5100 (626)962-2778 (562)926-7025 (949)859-3988
FIT 9(SP) FIT 2(SP) 5 FIT i P/T I (SP) FIT 2 Prr i (VI,SP)
c� The wheelchair symbol indicates functional accessibility for individuals with limited mobility. Information regarding dental office
accessibility for patients with mobility impairments is available by calling PMI's Customer Relations department at(800)422-4234.
LAKE ELSINORE #002547 LAWNDALE #002490 LONG BEACH #127801 LOSANGELES #601747
ELSINORE HILLS FMLY DENTISTRY RANDOLPH LUM, DDS UNIVERSAL CARE DENTAL WHITTIER DENTAL GROUP
31500 GRAPE SUITE#8 15655 HAWTHORNE BLVD 2360 PACIFIC AVE 2901 WHITTIER BLVD B
(909)471-1628 (310)675-7111 (562)595-0731 (323)526-1992
P!T 2(AM,SP,VT) P/T 3 (SP,TA,RU.) Ck Prr 5(SP,VI) 61 Prr 2(SR TA) &
LAKE ELSINORE #161201 LAWNDALE #148601 LONG BEACH #188101 LOSANGELES #001749
TUSCANY DENTAL ALL SMILES DENTAL CARE LONG BEACH DENTAL GROUP DR NAMIAN FAMILY DENTISTRY
361 RAILROAD CANYON RD STE A 15228 S HAWTHORNE BLVD 659 REDONDO AVE 609 S ATLANTIC BLVD
(909)471-1400 (310)679-8000 (562)439-0494 (323)980-9768
FIT I P/T 3(SPAR) Frr I (SR TA) F/T I PIT I (SP) FIT I PIT 1 6%
LAKE ELSINORE #187401 LEMON GROVE #2C7801 LONG BEACH #208701 LOSANGELES #001814
LAKE ELSINORE DENTAL GROUP GROVE DENTAL JAMES SERLES, DDS BRIGHTER DENTAL
32235 MISSION TRAIL STE 8 6963 BROADWAY 4301 ATLANTIC AVE STE 4 6221 WHILSHIRE BLVD STE 507
(909)674-6808 (619)464-7099 (562)426-9308 (323)939-7899
F/T 5(SP) F/T 2(SP) F/T I (RU,SP) P/T I (SP,HE)
LAKE FOREST #000595 LOMA LINDA #148301 LONG BEACH #2C6101 LOSANGELES #001915
DIMENSION DENTISTRY MOUNTAIN VIEW FMLY DENTISTRY ROSS DAY,DDS HOLLYWOOD VINE DENTAL OFFICE
20671 LAKE FOREST DRIVE B 103 1 1 175 MOUNTAIN VIEW AVE#N 6226 E SPRING STREET 200 5280 HOLLYWOOD BLVD
(949)458-2582 (909)796-2299 (562)421-3336 (323)469-9169
F/T I (SP,VT,GE) C-V% F/T I Ck F/T I PIT I (SR RU,AM)
LAKE FOREST #OC4801 LOMITA #001898 LONG BEACH #388301 LOSANGELES #001919
LAKE FOREST DENTAL GROUP A DENTISTRY KNOLLS DENTAL GROUP NORMA MIRANDA,DDS
23082 RIDGE ROUTE DR STE A 1816 LOMITA BLVD 3703 LONG BEACH BLVD E4 1363 SOUTH OLIVE STREET
(949)770-9355 (310)326-4117 (562)427-3890 (213)748-7218
F/T I P/T 1 (FR,TA,SP) P/T i (SR KO,TA) Ck F/T 2(SP,TA) (Ei Prr I (SP) &
LAKE FOREST #387801 LOMITA #OC610I LOS ALAMITOS #187701 LOSANGELES #002326 't
ELTORO DENTAL CENTER PCH DENTAL LOS ALAMITOS DENTAL ARTS CENTURY CITY DENTAL GROUP
23684 ELTORO RD STE F 2207 PACIFIC COAST HIGHWAY 3855 KATELLA AVE STE 102 10350 SANTA MONICA BLVD 190
F/r 2(SP,PE8 I) & FfT I(SP)2633 ck F/T22 P/T I FfT I(P,1704 61
LAKEWOOD #001050 LOMITA #131501 LOS ALAMITOS #263501 LOSANGELES #002332
LAKEWOOD CERRITOS DENTAL CTR NARINDER UPPAL,DDS GOPALYETURU,DDS KEROMINA DENTAL OFFICE
5819 ADENMORE 25107 NARBONNE AVE 3662 KATELLA AVE STE 206 4738 WHITTIER BLVD
(562)804-2296 (310)539-8392 (562)598-7914 (323)268-3395
F/T 7(SP,TA,VI) F/T I (EI) F/T I (SP) & F/T I (SR AR)
LAKEWOOD #052901 LONG BEACH #000633 LOS ALAMITOS #283401 LOSANGELES #002377
LAKEWOOD DENTAL ARTS UNITED FAMILY DENTAL ASHOKKUMAR MEHTA,DDS LILIA MARTINEZ,DDS
5555 DEL AMO BOULEVARD 141-P EAST WILLOW STREET 10900 LOS ALAMITOS BLVD 133 194 S ALVARADO ST
(562)866-1735 (562)988-2888 (562)596-8888 (213)484-1500
F/T 2(SP) FIT I (SR PE,VT) & FIT 3 PIT I (k, F/T I (SP) &
LAKEWOOD #210601 LONG BEACH #000901 LOSANGELES #000034 LOSANGELES #002487
DAVID GOREN&ASSOC JASBIR BATRA DDS INC DENTAL CTR OF HIGHLAND PARK LIBERTY DENTAL GROUP
5203 LAKEWOOD BLVD 925 E SAN ANTONIO DR STE 10 5807 NORTH FIGUEROA AVE 5877 S VERMONT AVE
(562)531-7373 (562)428.4678 (323)982-0999 (323)759-1523
FIT 2(SP) P/T I F/T I P/T I (SR) Ck F/T I (SP) C
LAKEWOOD #329201 LONG BEACH #001922 LOSANGELES #000635 LOSANGELES #002507
JITEN VASA,DDS SHAMANNA MOHAN, DDS CENTRO MEDICO/DENTAL FAMILIAR BRENTWOOD DENTAL GROUP
11455 E CARSON STE E 5399 ORANGE AVE 514 E WASHINGTON BLVD 11980 SAN VICENTE BLVD#660
(562)860-7116 (562)422-9698 (213)749-3934 (310)979-8345
FIT I (SP) F/T I (SR) F/T 2 Prr I (SR RU) L F/T i (PE) L�
LANCASTER #001214 LONG BEACH #002517 LOSANGELES #000637 LOSANGELES #002540
ELITE DENTAL DONNA MARIE CALIMA, DMD DAN BENYAMINI,DDS WOODSIDE DENTAL
44439 N 17TH ST W#201 389 REDONDO AVE 1826 WEST 7TH STREET 10921 WILSHIRE BLVD#505
(661)723-1461 (562)621-9796 (213)484-6660 (310)824-0055
P/T I (SP,TA KO) F/T I (TA,SP) L1k F/T 2(SR) & FIT 2(SR)
LANCASTER #001505 LONG BEACH #002792 LOSANGELES #000948 LOSANGELES #002541
SMILECARE DENTAL GROUP UNIVERSAL CARE DENTAL DENTAL PROS DIVYA PATHAK,DDS
1228 WEST AVE K 2925 N PALO VERDE 906 N VERMONT AVE 3756 SANTA ROSALIA DR#227
(661)949-1970 (562)429-1642 (323)953-7700 (323)292-7124
F/T 2 P/T I (SP,VI) & PIT 3(SP,TA VT) & F/T I (SR AM,) FIT I (SR) Ck
LANCASTER #001819 LONG BEACH - #002864 LOSANGELES #001156 LOSANGELES #002777
HI DESERT DENTAL CENTER MAGED ZAKY NESSIM DDS INC PERSONAL DENTAL BELINDA BALAIS,DMD
1745 WEST AVE"K"SUITE C 3821 ATLANTIC AVE#F 6222 WILSHIRE BLVD#103 2010 WILSHIRE BLVD STE 602
(661)723-5400 (562)424-0724 (323)9334444 (213)483-5160
FIT 2 P/T 2(SP,TA,RU) C1 Prr 1 (SP) FIT 2 P/T 2(SR TA.JA,) C% FIT 1
LANCASTER #002336 LONG BEACH #080501 LOSANGELES #001401 LOSANGELES #002779
AMERICAN BRIGHT DENTAL ALAN GRANT,DDS W A STOMEL DDS DENTOLOGY DENTAL GROUP
44810 N ELM AVE 3620 LONG BEACH BLVD B6 6317 WILSHIRE BLVD#303 11444 WASHINGTON BLVD#B
(661)945-2645 (562)426-6458 (323)651-3833 (310)572-6167
F/T i (SP) F/T 5 P/T I (SR TA,RU) & Frr 2 & FIT I P/T 2(SP)
LANCASTER #180101 LONG BEACH #OC6201 LOSANGELES #001509 LOSANGELES #002788
FML DTL PRACTICE OF LANCASTER FIROZ HAKAKHA,DDS DR TSOLARYAN'S DENTAL OFFICE SHAUNA LEE, DDS
44558 IOTH STREET WEST 1 183 E ANAHEIM ST 3161 LOS FELIZ BLVD 4146 E OLYMPIC BLVD STE F
F/T12 P/T 1111(SR FR) FfT 2(S 6600 & FIT32(AM,RU) Ck 663-2606 FIT3I (SP)
C
LANCASTER #378501 LONG BEACH #OC6301 LOSANGELES #001664 LOSANGELES #002863
KAMRAM SAIDARA, DDS FAMILY DENTAL CARE IGAL ELYASSI,DDS YORK DENTAL OFFICE
2030 WEST AVE STE J 1327 LONG BEACH BLVD 6200 WILSHIRE BLVD#1609 6306 YORK BLVD
(661)949-6757 (562)218-5555 (323)549-0900 (323)254-3451
F/T 5 P/T I (SP) F/T 2(SP) & 6 F/T 3(SP,PE,HE) 61 FIT I Prr I (SP.RU.HE.FR,AM,)
6,- The wheelchair symbol indicates functional accessibility for individuals with limited mobility. Information regarding dental office
accessibility for patients with mobility impairments is available by calling PMI's Customer Relations department at(800)422-4234.
LOSANGELES #002865 LOSANGELES #126501 LOSANGELES #320101 LOSANGELES #372901
CYPRESS DENTAL CLINIC FARZIN MOUSAVi,DDS NELSON WALKER DDS STEVEN STANLEY.DDS
2135 CYPRESS AVE 6075 S VERMONT.AVENUE 3756 SANTA ROSALIA DR 317 6221 WILSHIRE BLVD STE 307
(323)223-0731 (323)758-3131 (323)290-5340 323 931-1446
FIT I (SP) 61 FIT i (SP) 61 FIT I (SP) & F/T I(RU)
LOSANGELES #002866 LOSANGELES #127601 LOSANGELES #328301 LOSANGELES #373201
JOCELYN CAPISTRANO,DDS UNIVERSAL CARE DENTAL WEST COAST DENTAL ELEANOR ONGCAPIN, DDS
628 N VERMONT#5 I 1 I I W 6TH STE 120 2604 S VERMONT AVE STE 109 579 S FAIRFAX AVE
F�3)6444-3650 (21)(S-0009 ` (323)731 1333 (323)(53-48,4
(T ) (SP) & F/T I SP,TA
LOSANGELES #002868 LOSANGELES #152101 LOSANGELES #328501 LOSANGELES #375201
ALINA OGANYAN,DDS CALIFORNIA DENTAL CARE WATTS WATTS HEALTH
®FOUNDATION INC HOLLYWOOD SMILE DENTAL CENTER
1727 N VERMONT AVE STE 109 11628 SANTA MONICA BLVD 101 8182 SUNSET BLVD STE 202
(323)644-3366 (310)207-1060 (323)564-4331 (323)654-1100
F/T I (AM,RU) F/T I P/T I (SP) & F/T 3 P/T I (SP) C FIT 2(SP,RU,GE) C
LOSANGELES #003153 LOSANGELES #173201 LOSANGELES #345501 LOSANGELES #375701
ADELAIDA QUINGCO,DDS CONTINENTAL DENTAL GROUP MANOJ AMIN,DDS DAVID DAMES,DDS
1127 WILSHIRE BLVD STE#1103 600 W MANCHESTER AVE STE 2 2613 SUNSET BOULEVARD 1964 WESTWOOD BLVD STE 145
(213)250-3998 (323)750-1582 (213)484-1845 (310)474-5575
FIT I (SP,) & PR I (SP) & F/T I & F/T 1 PIT I (SR RU) (ILL
LOSANGELES #003540 LOSANGELES #175401 LOSANGELES #349001 LOSANGELES #375801
ARMEN MANSSOUSIAN, DMD SAMI NOUHAD,DDS CHERYL GINGHAM,DDS VICTOR SAAD,DDS
2621 E IST ST 7080 HOLLYWOOD BLVD STE 817 11905 S CENTRAL STE 203 12427 W WASHINGTON BLVD
(323)268-9386 (323)466-3541 (323)564-7504 (310)390-9581
F/T I P/T I (SP,JA) FIT I (SP,AR,FR) & F/T I (SP) FIT 2(SPAR) &
LOSANGELES �� #003544 LOSANGELES #183501 LOSANGELES #353301 LOSANGELES #382501
ALVARADO FAMILI DENTAL CENTER WILLIAM FAULKNER, DDS DEVANG GANDHI DENTAL CORP ELYSON AND ASSILI
811 S ALVARADO ST 5870 CRENSHAW BLVD 513 2500 W FLORENCE AVE 745 S KERN AVE
F/T31 PIT I (SP) &383-3314 F/I(S-0231 `� F/T31(SP) P/T
p/T 2(S;2125
L�
LOSANGELES #005901 LOSANGELES #184701 LOSANGELES #355601 LOSANGELES #389101
JAMES BLACK, DDS FLORENCE COMPTON DENTAL GROUP MICHAEL SCHNEIDER&ASSOC LADERA DENTAL GROUP
3015 CRENSHAW BOULEVARD 7110 S COMPTON AVE 10921 WILSHIRE BLVD STE 809 5814 RODEO ROAD
F/T35 P/T (SR KO) &801 F/T33(RU,SP)8 (� FIT 2 P/T I (TA,FR,GE)208-6813 FIT I(S j7200 &
LOSANGELES #041801 LOSANGELES #198001 LOSANGELES #356101 LOSANGELES #393301
RK CHETTY DDS INC UNITED FAMILY DENTAL GROUP PARASTOO FARHOODI,DDS LUZ CUBILLOS, DDS
252S COLORADO BLVD STE A 5109 E WHITTIER BLVD 3169 BARBARA COURT 12456 VENICE BOULEVARD
F2885 F2222 FIT3I /T 6440 F 2 SP3 2423
IT I (SP) & /T I (SP)
Ck &
LOSANGELES #042201 LOSANGELES #IC6401 LOSANGELES #356201 LOSANGELES #3C4701
PATRICK CLERK,DDS NADER RAMZi, DDS LESLIE LADDARAN,DDS SPARKLE DENTALSERVICE
1 127 WILSHIRE BLVD STE 907 1 125 S BEVERLY DRIVE STE 400 2105 BEVERLY BLVD STE 101 2703 1/2 S VERMONT AVE
(213)481-1252 (310) 8 7447 (213)484-1288 (323)735-7223
`�
FIT I (SP) ( ) P!T I (SR CH,TA) 6% F/T I &
LOSANGELES #044501 LOSANGELES #211901 LOSANGELES #362101 LOSANGELES #3C7801
WILSHIRE CENTER DENTAL GROUP CULVER DEL REY DENTAL OFFICE VERONICA DE GUTA,DMD CASTLE DENTAL
3932 WILSHIRE BLVD STE 100 12202 W WASHINGTON BLVD 907 N VIRGIL AVE 4251 CRENSHAW BLVD
F/T36 P/T 6336 SUNAR Ck F/TT4 915-9797 FR,SP,TA,VI,G & FIT I (T-8384 F/T 1295-5577
( ) ( P ( ) F/T I P/T I (�
LOSANGELES #091901 LOSANGELES #219901 LOSANGELES #362901 LYNWOOD #002089
SHAW ADAMS DENTAL GROUP KENNETH CHANG, DDS CLARITA OBEJERA,DDS B.A. DIERMENJIAN, DDS
12714 S AVALON 4026 W OLYMPIC BLVD 3827 SUNSET BLVD STE A 11337 LONG BEACH BLVD
(323)754-2949 (323)930-1744 (323)953-4980 (310)608-7777
F/T 3(SP) F/T I (SP) F/T I (SP,TA) & F/T 2 P/T I (SP) &
LOSANGELES #092401 LOSANGELES #226701 LOSANGELES #365501 LYNWOOD #3C4301
SHAW ADAMS DENTAL GROUP PINAKIN PARIKH,DDS BENJI BEHROOZAN,DDS UNIVERSAL CARE DENTAL
5220 W WASHINGTON BLVD 103 5016 YORK BOULEVARD 5255 W SUNSET BOULEVARD 3680 E IMPERIAL HWY#100
(323)933-5641 (323)254-1831 (323)463-7262 (310)761-8100
FIT 2(SP) F/T I (SP) F/T I (SRAM) F/T I P/T 2(SP,VT,TA,EI) (k
LOSANGELES #OC7201 LOSANGELES #270101 LOSANGELES #365601 MANHATTAN!MOO 1748
WILLIAM GINZBURG, DDS BRUCE WALKER,DDS LA BREA FAMILY DTL PRACTICE BEACH CITIES DY
3130 S SEPULVEDA BLVD STE D 8540 SEPULVEDA BLVD 1212 3400 S LA BREA 400 S SEPULVEDA BLVD 280
F/T I(SR FR,RU &268-0646 FIT01 P/T 1886 SR TA & F/TA2(SR KO,TA &734-2284 (3 10)(06-0745
) ( ) ( ) FIT I SP) 61
LOSANGELES #110101 LOSANGELES #270601 LOSANGELES #366001 MANHATTAN BEe H#2C1401
THELMA AGONIAS-YOUNG,DDS BYUNG CHUL KIM,DDS EMILY LEE,DDS MANHATTAN VILLAGE DENTAL GRP
3875 WILSHIRE BLVD STE 901 765 N VIRGIL AVE 3756 SANTA ROSALIA DR 200 1200 ROSECRANS AVE STE 210
(213)383-2700 (323)665-5887 (323)299-1994 (310)414-0620
FIT I (SR TA) F/T I (SR KO) F/T I (SP) FIT I (SP) 61
LOSANGELES #112101 LOSANGELES #272501 LOSANGELES #367901 MANHATTAN BEACH#2C2701
MARK LASKA, DDS IMPERIAL FAMILY DENTISTRY AIRPORT CTR FAMILY DENTAL MANHATTAN BEACH DENTISTRY
3460 WILSHIRE BLVD STE 210 1839 W IMPERIAL HWY 5304 W CENTURY BOULEVARD 500 S SEPULVEDA STE 210
(213)386-3348 (323)757-1761 (310)215-1455 (310)(72-8188
PIT 3(SP) & F/T 2(SP) & P/T I (SP) & F/T 2 SP
LOSANGELES #121001 LOSANGELES #2C4701 LOSANGELES #372501 MARINA DEL REY #111501
HIGHLAND PARK DENTAL GROUP WILSHIRE DENTAL CARE MEHRDAD MAKHANI,DDS MARINA DENTAL CENTER
5740 1/2 YORK BLVD 6200 WILSHIRE BLVD STE 1508 6200 WILSHIRE BLVD STE 1606 13155 MINDANAO WAY
(323)257-0915 (323)938-6137 (323)933-7744 (310)821-1(1
F/T 2(SP,RU) FIT 3 PIT 2(SR RU,TA) C� 7 FIT I (SR RU) & FIT I PIT I (SP)
&
&- The wheelchair symbol indicates functional accessibility for individuals with limited mobility. Information regarding dental office
accessibility for patients with mobility impairments is available by calling PMI's Customer Relations department at(800)422-4234.
MARINA DEL REY #173401 MONTCLAIR #199101 MORENO VALLEY #396301 NATIONAL CITY #181201
MARINA DENTISTRY JOHNSON FAMILY DENTISTRY DTL ASSOC/MORENO VALLEY MALL THOMAS TOMA. DMD
4292 LINCOLN BLVD 9645 MONTE VISTA STE 305 22500 TOWN CRCL STE 2074 3460 HIGHLAND AVE STE D
(310)578-5000 (909)621-6002 (909)697-6800 (619)420-1100
F/T I (SP) 61 F/T 2(SP) FIT 4 PIT I (SP) F/T 2(SP,AR,TA)
MAYWOOD #159601 MONTCLAIR #3C2S01 MURRIETA #003165 NATIONAL CITY #321901
SOUTHEAST DENTAL GROUP AMIEL PATEL,DDS MURRIETA DENTAL GROUP ERNEST TAUB, DDS
4332 E SLAUSON AVE 4921 MORENO STREET 25395 MADISON AVE STE#103 936 HIGHLAND AVE
(323)588-2141 (909)625-3865 (909)696-5660 (619)474-6200
FIT I P/T 2(SP,GE) ck F/T I (SP) F/T I P/T 1 (SR) F/T 2 P/T I (TA,SP)
MAYWOOD #168701 MONTEBELLO #156901 MURRIETA #OC2201 NATIONAL CITY #355101
DANIEL GAROIAN,DDS GREENWOOD DENTAL MURRIETA DENTAL GROUP RICHARD CERVANTES,DDS
4201 E SLAUSON AVE 1214 IR S GREENWOOD AVE 40770 CALIFORNIA OAKS RD 1919 HIGHLAND AVE
(323)560-4658 (323)728-3272 (909)677-3078 (619)477-3770
F/T I (S) FIT I (SP,FR). Lk P/T I (SP) F/T I (SP,TA)
MENIFEE #183201 MONTEBELLO #210901 MURRIETA #2C5901 NEWBURY PARK #171201
MENIFEE VALLEY DENTAL GROUP DANIEL FARKAS,DDS MADISON SPRINGS DENTAL STEVEN DESTLER, DDS
26910 NEWPORT ROAD STE B 3301 W BEVERLY BLVD 25285 MADISON AVE 107 587 N VENTU PARK RD#C
(909)672-9457 (323)722-6766 (909)698-3585 (805)499-1253
F/T I (SP) F/T 3(SP) FIT 6(SR GE,GR,VI,TA) FIT I P/T I (SP) &
MECALI #351701 MONTEBELLO #239301 MURRIETA #3C8601 NEWHALL #001217
DENTICENTER DR DAVIDS FAMILY DENTISTRY MURRIETA FAMILY DENTAL GROUP ELITE DENTAL
REFORMA AVE 999 STE 14 210O W BEVERLY BLVD 40643 CALIFORNIA OAKS ROAD 23206 LYONS AVE#203
(619)247-6884 (323)724-9536 (909)677-7779 (661)255-7338
F/T I (SP) FIT I (SP) & FIT I P/T 2 FIT 1 P/T 1 (SP,)
MIRA LOMA #002546 MONTEBELLO #363901 N HOLLYWOOD #000012 NEWPOKT BEACH #125801
MIRA LOMA DENTAL CENTERS SHAHEN GHAZARIAN, DDS MICHAEL KOSDON,DDS NEWPORT BEACH DENTAL
11058 LIMONITE AVE 1437 W BEVERLY BLVD 10545 VICTORY BLVD 1501 SUPERIOR AVE STE 100
(909)737-6005 (323)722-2922 `� F818)PIT 9353 Lk F�9)650-6772
F/T I (SP) F/T I (AW) (SP) &
MISSION HILLS #355501 MONTEBELLO #391101 N HOLLYWOOD #001667 NEWPORT BEACH #146701
PARVIZ KOHANOFF,DDS RONALD ARAKAWA,DMD FAMILY DENTISTRY JEFFREY LYSDALE,DDS
11550 INDIAN HILLS RD 281 2059 W WHITTIER BLVD 11436 VANOWEN STREET 355 PLACENTA AVE STE 205
(818)361-8777 (323)727-9898 (818)503-9697 (949)646-0818
F/T I (SR PE) & FIT I (SP) Lk FIT I (SR RU) F/T I
MISSION HILLS #366901 MONTEREY PARK #196401 N HOLLYWOOD #001914 NORCO #142201
ELOISA MARQUEZ, DMD PACIFIC DENTAL GROUP IOSEF MAMALIGER, DDS NORCO FAMILY DENTAL
15531 DEVONSHIRE 2016 S ATLANTIC BLVD 12450 BURBANK BLVD#L 2031 RIVER ROAD
(818)894-7979 (323)725-6797 (818)763-0777 (909)372-9094
F/T I (SR TA) 61 P/T 2(SRAM,IT) ck P/T I(RU,HE) P/T 2(PE.SP)
MISSIONVIEJIO #001693 MONTEREY PARK #239601 N HOLLYWOOD #002797 NORCO #190201
LOS AUSOS DENTISTRY ISAAC CHEN, DDS DANIEL BOUDAIE FAMILY DENTIST CHARLES RODGERS,DDS
22951 LOS ALISOS BLVD#2 2071 S ATLANTIC BLVD STE F/G 10941 VICTORY BLVD 1260 HAMNER STE C&D
FIT91(RU,)
`� F/T 2(SR,CA,CH) CK 7878 F/T84(SP,TA,) C F/T91�Sp)5200
MISSIONVIEJO #001866 MONTEREY PARK #359501 N HOLLYWOOD #002840 NORTH HILLS #000195
MISSION VIEJO DENTAL ASSOC LEELING AND GRANT PACIFIC DENTAL GROUP DENTAL SOLUTION GROUP
25522 MARGUERITE PKWAY##100 616 N GARFIELD AVE STE 404 6801 LANKERSHIM BLVD#101 9146-A SEPULVEDA BLVD
F/T 2(SP,CH,) Lk 586-6200 F/T61(SP) 122 P/T82(SP,RU,7) 61 764-0718 F/T 2(SP) 61
MISSIONVIEIO #003205 MONTROSE #128201 N HOLLYWOOD #003100 NORTH HILLS #002753
PACIFIC DENTAL OFFICE ARROYO VERDUGO FAMILY DENTAL BRIGHT SMILE DENTAL HOMA SHAHRIARI DDS INC
25523 MARGUERITE PKWY STE C 3465 NVERDUGO ROAD 5054 LANKERSHIM BLVD 15206 PARTHIENIA ST
(949)768-1800 (818)249-1819 (818)623-1940 (818)892-0714
FIT I P/T 3(SR RU) F/T I P/T I (SP) F/T I PIT I (SP,TA) F/T I (S)
MI$SSIONVIEIQ #152801 MORENO VALLEY #000617 N HOLLYWOOD ■#003546 NORTHRIDGE #002307
AVALON DENTISTRY CALIFORNIA DENTAL OFFICE HAMLIN DENTAL GROUP AT-EASE DENTISTRY
27725 SANTA MARGARITA PKY 12800 HEACOCK STREET A 1 12509 OXNARD ST STE 201 11155 TAMPA AVE
(949)951-0951 (909)247-2688 (818)285-5757 (818)363-3382
FIT 5(S) (k FIT 3(SR CH) FIT I (SP,AM) FiT. I (VI) Lk
MI1SIONVIE10 #271001 MORENO VALLEY #003105 N HOLLYWOOD #20,9401 NORTHRIDGE #026401,
FAMILY COSMETIC DENTAL SMILECARE DENTAL GROUP ALAN BRODY,DDS LAWRANCE LEVINE,DDS
26302 E LA PAZ STE 211 12125 DAY ST BLDG N STE 211 12S20 MAGNOLIA BLVD STE 202 8363 RESEDA BLVD STE 202
FIT 2(SR CCH.PE,RU) 61 110 F/92 22 2-2 000 FIT I(5;2682 & FITB1 885-0536 61
MISSIONVIE(Q #3CO601 MORENOVALLEY E#003531 N HOLLYWOOD #305301 NORTHRIDGE #106101
MONTGOMERY& KIRIAK DDS COMMUNITY DENTAL OF DR CHI LAUREL CHANDLER DENTAL RICHARD ROTHSTEIN,DDS
27871 MED CTR RD STE 165 11875 PIGEON PASS ROAD B-9 5451 LAUREL CNYN BLVD STE100 9145 RESEDA BOULEVARD
(949)347-0807 (909)488-8688 (818)508-1250 (818)886-9920
FIT I PIT I (SP,GE) P/T I (SR CH,KO) FIT 2 PIT I (SP) F/T I Prr I
MONROVIA ##155501 MORENOVALLEY #273301 N HOLLYWOOD #349801 NORTHRIDGE #176401
FOOTHILL DENTAL CENTER ROBERT SILVOLA,DDS JULIAN GERSHFELD,DDS HAMLIN DENTAL GROUP
121 S MYRTLE AVE 12810 HEACOCK ST STE B 103 5160 VINELAND AVE STE 105 8349 RESEDA BLVD STE F
P/rbl (VI,SP)2 & F/T42(SP) PIT
PIT8I 761 8899 ck F/T81 P/T i667
(SP)
MONTCLAIR #179501 MORENO VALLEY #346201 NATIONAL CITY #OC2301 NOR'THRIDGE #365901
CENTRAL FAMILY DENTISTRY JAMES DICKEY,DDS TOWN AND COUNTRY DENTAL BHARATI DESAI,DDS
9197 CENTRAL AVE STE C 24266 POSTAL AVE STE 100 1536 SWEETWATER RD STE E 8954 RESEDA BLVD STE 100
(909)398-1107 (909)242-2600 (619)477-4945 (818)701-3010
F/T I (CH,SP) FIT 1 8F/T I (SP,TA) F/T I (S)
ck- The wheelchair symbol indicates functional accessibiFti for individuals with limited mobility. Information regarding dental office
accessibility for patients with mobility impairments is available by calling PMI's Customer Relations department at(800)4224234.
NORTHRIDGE #378801 ORANGE #001875 PACOIMA #148401 PASADENA #001746
BABAK KOHANOFF,DDS ST CATHERINE DENTAL CENTER KISHORE SHAH. DDS LAKE ORANGE DENTAL
18250 ROSCOE BLVD STE 225 235 EAST KATELLA AVENUE 13279 VAN NUYS BLVD 720 N LAKE AVE 7
(818)349-9151 (714)633-3336 (818)899-2505 (626)808-9797
F/T I (SP) P/T 2(SP,VI) & F/T I (SP,TA) PIT I (ARAU) &
NORTHRIDGE #3C7201 ORANGE #002242 PALM DESERT #2C3701 PASADENA #001902
ALL FAMILY DENTAL CARE SMILECARE DENTAL GROUP DESERT CROSSING DENTAL GROUP PASADENA FAMILY DENTAL CENTER
8864 CORBIN AVENUE 179 N TUSTIN AVE 72333 HWY I I I STE B 950 E COLORADO BLVD STE 201
(818)700-7980 (714)288-103S (760)674-9666 (626)431-1930
F/T i (SP) PIT I (SP,PE) & F/T I (SP) P/T I (SR FR) 61
NORWALK #002720 ORANGE #IC5301 PALM SPRINGS #199801 PASADENA #002781
NORWALK FAMILY DENTISTRY COMFORT SMILE DESERT DENTAL GROUP PASADENA DENTAL CENTER
15617 STUDEBAKER RD STE 5 1920 E KATELLA STREET STE J I I I I TAHQUITZ CYN WAY 210 766 N LAKE AVE
(562)484-3936 (714)997-4133 (760)327-1125 (626)808-1717
FIT I (TA,SP) C FIT I (SP) F/T I (SP) PIT I (SRAM) Chi
NORWALK #603204 ORANGE #280401 PALMDALE #000997 PASADENA #002786
NORWALK FAMILY DENTAL TUSTIN PLAZA DENTAL ANDRE KANARKI, DDS SUNNY KIM. DDS
12319 E IMPERIAL HWY 1872 N TUSTIN AVE 1543 E PALMDALE BLVD B 826 E UNION STREET
(562)868-7955 (714)637-8662 (661)274-1866 (626)793-4683
FIT 2(SP) & F/T 3 P/T 2(SP,JA) F/T I F/T I (KO)
NORWALK #121901 ORANGE #282401 PALMDALE #001507 PASADENA #038601
PADDISON DENTAL GROUP ORANGE HILL DENTAL SMILECARE DENTAL GROUP LEON ROISMAN,DMD
12501 S NORWALK BLVD 3138 E CHAPMAN AVE 38745 TIERRA SUBIDA AVE#150 310 S LAKE LOWER LEVEL
(5621 2 0880 (714)639-2703 (661)272-9091 (626)795-6855
FIT ( ) F/T I (SP) & FIT 3 P/T 2 & F/T 5 P/T I (SP) &
NORWALK #364001 ORANGE #367801 PALMDALE #001732 PASADENA #148701
CHAN LEE,DDS TOWN&COUNTRY DENTAL HI-DESERT DENTAL CENTER SHAUN MALEK, DDS
11780 FIRESTONE BLVD I I I I TOWN&COUNTRY RD 33 2205 E PALMDALE BLVD 465 NORTH LAKE AVE
(562) (SP,9897 (714)285-0505 (661)273-1333 (626)405-1445
CH) C� F/T 3 P/T I (SP,CH) FIT I PIT 2(RU,SRTA,KO,AR)6% F/T I (SP) &
OCEANSIDE #002321 ORANGE #388601 PALMDALE #IC0801 PASADENA #IC8201
DENTISTRY 2000 DENTAL GROUP OF ORANGE PREMIER DENTAL CARE WASHINGTON DENTAL GROUP
3529 CANNON ROAD SUITE 2G 1502 E COLLINS 3005 E PALMDALE BLVD STE 22 2554 E WASHINGTON BLVD
FR i 945-7000 (714)2BU464 (661)273-5221 (626)296-0056
F/T I (SP) & FIT I (SP,AM,AR) & FIT I P/T I (SP,AR,AM)
OCEANSIDE #002510 OXNARD #002325 PALMDALE #375601 PASADENA #272401
A+GENTAL DENTAL OF OCEANSIDE PACIFIC DENTAL GROUP Y SIANI, DMD PASADENA DENTAL ASSOCIATES
2216 EL CAMINO REAL STE 121 2150 N ROSE AVE 2270 E PALMDALE BLVD STE E 1302 N ALTADENA DRIVE
(760)439-7800 (805)604-0449 (661)947-6782 (626)797-6778
F/T I (RU,GE,SP) PIT 1 (SP) & F/T I (SP) 61 F/T 2(SP)
OCEANSIDE #OC6001 OXNARD #002328 PANORAMA CITY #002803 PASADENA #316601
NORTH COUNTY FAMILY DENTAL BEACH CITIES DENTAL GROUP VAN NUYS PANORAMA DENTAL CTR DAVID WYNDHAMSMITH,DDS
3837 PLAZA DR STE 805 1801 SOLAR DR STE 290 8227 VAN NUYS BL 1092 E GREEN STREET
FIT 2(3 6354 ��)278-8887 (818)989-3074 (626)795-9328
& FIT 2(SRAM,RU,AR,FR) Ck FIT I PIT 2(SP,IT,GE.CH,JA,VI)Gk
OCEANSIDE #125701 OXNARD #002749 PANORAMA CITY #003116 PA SA ENA #35 301
COLLEGE DENTAL GROUP FREMONT SQUARE FMLY DENTISTRY BRIGHTER SMILE DENTAL GREEN STREET DENTAL
467 COLLEGE BLVD 2 712 N VENTURA RD 9501 VAN NUYS BLVD STE#115 1 175 E GREEN STREET
(760)631-3060 (805)988-4540 (818)893-1782 (626)578-1687
F/r 2(SR IT,FR,VI,TA,GE) F/T t (SP) 61 P/T I (SP,) & F/T I &
ONTARIO #000194 OXNARD #002823 PANORAMA CITY #188301 PASADENA #387501
FAMILY DENTISTRY ISLAND PLAZA DENTAL GROUP HAMLET DAVARI,DDS DAVID LAWSON,DDS
628-C WEST HOLT BLVD 2500 SAVIERS ROAD 8121 VAN NUYS BLVD STE 310 700 E WALNUT STREET STE 1
(909)986-6424 (805)486-4896 (818)782-8120 (626)793-6175
F/T I (SP,FR) Chi F/T I P/T 2(SP) & P/T I (SP) F/T 3 PIT I (SP)
ONTARIO #001601 OXNARD #002857 PANORAMA CITY #341801 PASADENA #3C2601
WILLIAM STANLEY,DDS IRAJ MOVAHHEDI,DDS DAN ROSEN/SR NOURIAN DDS FAIR OAKS DENTAL
211 N EUCLID AVE 4225 SAVIERS ROAD#9 8424 VAN NUYS BLVD 301 S FAIR OAKS STE 208
(909)983-9639 (805)982-8283 (818)893-4222 (626)431-2654
FIT 4 P/T I (SP) FIT I (SP) FIT 1 P/T 2,(SP,KO) 61 F/T I (SP)
ONTA-RIO #OC2401 OXNARD #OC2901 PANORAMA CITY #357201 PERRIS #IC5501
ARCHIBALD RANCH DENTAL OXNARD DENTAL PRACTICE GARY KARSH,DDS INLAND DENTAL GROUP OF PERRIS
3065 B ARCHIBALD AVE 2411 SAVIERS ROAD 8614 VAN NUYS BOULEVARD 2560 N PERRIS BLVD STE FI
F/T 2(SP)3640 & FIT 3(SPA487 `� P/T81 (SP.RU) d% F/T I(S 7-6466
ONTARIO #357001 OXNARD #IC3601 PANORAMA CITY #3C4801 PICO RIVERA #000013
KYUNG CHUNG,DDS DENTAL CARE OF OXNARD GENTLE DENTAL CENTER FAMILY DENTISTRY
941 W MISSION BLVD STE H 1350 W GONZALES RD 2ND FLOOR 14526 ROSCOE BLVD 4400 ROSEMEAD BLVD#2
(909)984-7883 (805)988-5888 (818)893-7858 (562)695-5251
F/T I (SP.KO) PIT 2(SP,AM,TA) & FIT I PIT I (SP,RU) F/T I (SP,IN,FR,CH,VT) 61
ONTARIO #367201 OXNARD #395S01 PARAMOUNT #355901 PICO RIVERA #143901
JASWANT SUTHAR,DDS ABAJIAN &RHAYEM DDS WEST COAST DENTAL RIVERA FAMILY DENTAL
2242 S MOUNTAIN AVE 1901 N SOLAR DRIVE SUITE 205 14525 LAKEWOOD BLVD STE A 9050 WHITTIER BOULEVARD
(909)391-1549 (805)988-2250 (562)272-0000 (562)942-8900
FIT I (SP) Chi FIT 2(SP,FR AR) & FIT I P/T I (SP) F/T 2 P/T I (SP,AM,RU) Chi
ORANGE #001750 PACOIMA #002092 PARAMOUNT #370701 PICO RIVERA #320601
PETER SUMARSONO,DDS URIZAR DENTAL CLINIC PARAMOUNT FAMILY DENTAL CTR ASHOKKUMAR MEHTA,DDS
1042 N TUSTIN STREET 13215 VAN NUYS BLVD 8131 ROSECRANS AVE STE 101 9514 WHITTIER BOULEVARD
(714)771-0058 (818)890-6442 (562)634-2984 (562)942-2345
F/T I (SR) FIT I (SR) 9 F/T I (SP.EI) F/T I (SP) &
(-k- The wheelchair symbol indicates functional accessibility for individuals with limited mobility. Information regarding dental office
accessibility for patients with mobility impairments is available by calling PMI's Customer Relations department at(800)422-4234.
PICO RIVERA #367S01 REDLANDS #002339 RIALTO #193901 RIVERSIDE #2CO201
DANNY MUDITAJAYA, DDS JOHN CESARIO,DDS NEELA GHATNEKAR,DDS ARLINGTON DENTAL
8308 ROSEMEAD BOULEVARD 233 CAJON STREET SUITE#8 1786 N RIVERSIDE AVE STE 5 3297 ARUNGTON AVE STE 101
(562)949-0177 (909)798-7228 (909)874-0323 (909)683-6055
F/T 4(SP,TA) Ck FIT I FIT 2(SP) Ck F/T 2(SP)
PLACENTIA #001674 REDLANDS #155201 RIVERSIDE #000161 RIVERSIDE #2C9201
ROSE LINDA DENTAL BROOKSIDE DENTAL ASSOCIATES ALLAN ETEMADI, DDS CENTRAL RIVERSIDE DTL PRAC
1203 E YORBA LINDA BLVD 720 BROOKSIDE AVE STE 100 6071 MAGNOLIA AVENUE 3630 CENTRAL AVE STE 6
(714)528-2833 (909)798-7111 (909)680-1777 (909)682-1720
F/T I (SP,GE,) Ck F/T 2(SP) F/T 2(SR.FR) F/T 4
PLACENTIA #003050 REDLANDS #301601 RIVERSIDE #000612 RIVERSIDE #320501
THE DENTAL GROUP OF PLACENTIA DRS LOW&U JAMES LUCAS, DDS M K MANSOUR. DDS
1858 N PLACENTIA AVE 229 CAJON AVE 6339 BROCKTON AVE 7776 LIMONITE AVE
(714)577-9070 (909)792-9217 (909)369-3597 (909)360-0696
P/T I (AR,KO,SP,IT,GE,FR) F/T 2 F/T I (SR RU,AR) F/T 3(SR FR,AR)
PLACENTIA #394701 REDLANDS #356801 RIVERSIDE #000734 RIVERSIDE #388201
IMPERIAL ROSE FMLY DENTISTRY UNITED DENTAL GROUP NEWPORT DENTAL GROUP SNUAP DENTAL GROUP
1061 E IMPERIAL HIGHWAY 434 CAJON ST STE 101 3560 ARLINGTON AVE SS IS VAN BUREN BLVD
(714)577-7575 (909)793-8793 (909)680-1200 (909)352-5838
Ffr 2(SR KO) Ck Pfr I (AR.SP) F/T I (SP) F/T I (SP)
POMONA #000292 REDONDO BEACH #001672 RIVERSIDE #000767 RNCHO CUCAMONGA#053101
FAMILY DENTAL CLINIC RAMIN ABDO,DDS NEWPORT DENTAL GROUP ANTHONY KAVORINOS,DDS
2280 S GAREY AVE 220 VISTA DEL MAR ST D 3724 LA SIERRA,SUITE FI 10630TOWN CENTER DR STE 131
(909)364-0633 (310)316-2611 (909)688-2400 (909)987-6643
FIT I (SP) F/T I F/T I (SP) F/T I PIT I (SP) &
POMONA #001718 REDONDO BEACH #002783 RIVERSIDE #001823 RNCHO CUCAMONGA#1 1770(
BELLA MANCHANDIA, DDS DENTAL CTR OF REDONDO BEACH RIVERSIDE DENTAL OFFICE STAR DENTAL GROUP
551 HOLT BLVD 1959 KINGSDALE AVE 1485 UNIVERSITY AVE 12729 FOOTHILL BLVD STE A
(909)622-8600 (310)921-3938 (909)784-4441 (909)899-8757
F/T I (SP) PIT I (SP.) Ck Pfr 1 (SP) FIT 3(SP)
POMONA #002031 REDONDO BEACH #126601 RIVERSIDE E #003520 RNCHO CUCAMONGA#IC7401
TOOTH TOWNE DENTAL OFFICE GALLERIA DENTAL CARE COMMUNITY DENTAL OF DR CHI RANIA REFAAT,DDS
2127 N TOWNE AVENUE 1505 HAWTHORNE BLVD 4595 LA SIERRA AVE 7388 CARNELIAN ST STE C
(909)623-4442 (310)370-1586 (909)688-6000 (909)989-1758
FIT I (SR) Ck FIT 1 P/T I (IT,FR,SP) FIT I (SP,KO,CH) F/T 2(SR AR) Ck
POMONA #002509 REDONDO BEACH #270001 RIVERSIDE #008201 RNCHO CUCAMONGA#IC8301
SAHARA DENTAL BARRY KASHFIAN DENTAL GROUP DONALD PEARSON, DDS KRISHAN MITTAL,DDS
676 FAIRPLEX DR 1917 S CATALINA AVE B 6900 BROCKTON AVE STE 2 10064 ARROW ROUTE
(909)623-9590 (310)375-0787 (909)682-2245 (909)987-5522
Ffr I (SR AR.FR) Ck FIT 3(TA,SP) F/T 2(SR KO) F/T I (SP,IN) Lk
POMONA #198201 RESEDA #00I668 RIVERSIDE #080601 RNCHO CUCAMONGA#390301
POMONA FAMILY DENTAL OFFICE CANBY DENTAL LOW FAMILY DENTISTRY RANCHO CUCAMONGA DENTAL CARE
175 W LA VERNE STE A 18440 SHERMAN WAY 6862 PALM AVE` 10470 FOOTHILL BLVD STE 126
F�9I (SP) 15 Lk P[T 13SP,PE) & F/T 2(SP)5490 F/T91 9SP-7888 &
POMONA #210101 RESEDA #002754 RIVERSIDE #121101 RNCHO CUCAMONGA#3C7001
DENTAL ASSOCIATES OF POMONA JOHN FOROUTAN,DDS RIVERSIDE DENTISTRY GHAZAL DENTAL CORPORATION
180 EMISSION BOULEVARD 18308 SHERMAN WAY#1 1857 UNIVERSITY AVE 10797 FOOTHILL BLVD
(909)623-5278 (818)881-0404 (909)781-3021 (909)581-0888
FIT I (SR CH) F/T I (SP) & FIT 2(VI.SP) F/T I
POMONA #308201 RESEDA #092901 RIVERSIDE #152301 RNCHO SANTA MAR#3C6501
HARPREET GILL,DDS HARVEY DLUGATCH,DDS LA SIERRA FAMILY DENTISTRY RANCHO DENTAL GROUP
722 EARROW HIGHWAY 18909 SHERMAN WAY 3410 LA SIERRAAVE STE D 30592 SANTA MARGARITA PKWY
(909)621-9177 (818)345-1343 (909)354-9550 (949)766-5740
F/T I PIT 1 (SP,TA) Ck F/T I (SP) F/T I (SR JA,KO) Ck F/T I P/T I (SR)
POMONA #318801 RESEDA #325401 RIVERSIDE #172501 ROLLING HILLS #3C3801
KI SUN CHOI,DDS LINDA KAPGAN,DDS VIVIAN KWON, DDS PENINSULA DENTAL ARTS
956 N GAREY AVE 19301 D SATICOY ST 2955 VAN BURAN BLVD STE H4 927 DEEP VALLEY DR 125
(909)629-9741 (818)772-4222 (909)689-8544 (310)377-9575
F/T I (SP,KO) PIT I (RU,SP) & FIT I (SR KO) PIT 3(CA,SP)
POMONA #357101 RESEDA #382301 RIVERSIDE #174701 ROSEMEAD #001705
POMONA DENTAL GROUP ROBERT FREEMAN,DDS RIVERSIDE FAMILY DTL OFFICE MIN LWIN,DDS
850 N INDIAN HILL BOULEVARD 19231 VICTORY BLVD STE 216 10286 INDIANA AVE 8115 E GARREY AVE
(909)626-3541 - (818)344-0257 (909)352-9747 (626)571-7000
F/T I P/T I (SR KO,CH) FfT I P/T 1 Ck P/T I (SP.KO) P/T 3(SR CH,CA.) Lk
PORT HUENEME #222901 RIALTO #000131 RIVERSIDE #I C0701 ROSEMEAD #002496
ANA HERNANDEZ CARR, DDS DR AHUJAS DENTAL OFFICE UNIVERSAL CARE DENTAL STEVEN HOU,DDS
2480 VICTORIA AVE 204 1 130 N RIVERSIDE AVE 4381 BROCKTON AVE 3163 SAN GABRIEL BLVD#106
(805)985-1159 (909)873-0277 (909)784-0636 (626)288-8357
FIT I (SP) PIT I (EA,SP) UK FIT I P/T 2(SP) F/T 1 (CH,SP) Ck
POWAY #001867 RIALTO #117501 RIVERSIDE #207301 ROSEMEAD #003133
FARAJZADEH &BAKER PRO DENTAL FAMILY DENTISTRY M J SAVANT,DDS SETHI FAMILY DENTAL CENTER
13422 POMERADO RD#201 511 S RIVERSIDE AVE 4080 TYLER AVE STE D 2111 N SAN GABRIEL BLVD#1
(858)679-4949 (909)820-2274 (909)359-0149 (626)280-4976
P/T I (SP,RU,TA) Ck F/T I Pfr 2(SP) F/T I F/T 1 (SP,) Ck
POWAY #051001 RIALTO #166001 RIVERSIDE #267501 ROSEMEAD #003513
E DENNIS FINK, DDS DENTAL CARE OF RIALTO DENTAL ASSOC OF RIVERSIDE SMILECARE DENTAL GROUP
12620 MONTE VISTA RD STE D 1727 N RIVERSIDE AVE 3487 CENTRAL AVE 4100 ROSEMEAD BLVD
F�8)485-8800 (909)873-0355 (909)369-1001 (626)575-1161
F/T 4(SP.CH) 10FIT 3 Pfr 3(SP) F/T 2 PIT 2(CA.TA,VI,SP)
ck- The wheelchair symbol indicates functional accessibility for individualsvrith limited mobility. Information regarding dental office
accessibility for patients with mobility impairments is available by calling PIMI's Customer Relations department at(800)422-4234.
ROSEMEAD #306001 SAN CLEMENTE #OC2701 SAN DIEGO #252901 SAN GABRIEL #001457
BORIS ZAK, DDS OCEANVIEW PLAZA DENTISTRY STEPHEN BARAL, DDS DR.M LWIN
8951 GLENDON WAY 638 CAMINO DE LOS MARES C 140 3651 4TH AVE STE 300 1739 SAN GABRIEL BOULEVARD
(626)288-7667 (949)234-0500 (619)298-2942 (626)288-5777
FIT 2(SP,RU,AM) Ok F/T 4(AR) F/T 2(SP) P/T 3(SP,CH,CA)
ROWLAND HEIGHTS#002543 SAN DIEGO #000076 SAN DIEGO #2C6501 SAN GABRIEL #001807
STAR DENTAL PRACTICE PREFERRED DENTAL JEROME BANNISTER,DDS SAN GABRIEL FAMILY DENTISTRY
18750 COLIMA RD STE A-1. 3330 THIRD AVE STE 400 4370 PALM AVENUE SUITE C 531 W LAS TUNAS DR STE B
(626)965-2521 (619)291-8750 (619)428-8682 (626)281-1618
FIT I PIT 3(SP) & FIT I P/T I (CH,SP) FIT I (SP,TA) FIT I (SP) L�
ROWLAND HEIGHTS#268501 SAN DIEGO #000648 SAN DIEGO #2C9601 SAN GABRIEL #001909
PLAZA DENTAL GROUP TIERRASANTA FAMILY DENTAL GRP STADIUM DENTAL CARE BHANUMATI TOPRANI,DDS
18156 E COLIMA ROAD 10645 TIERRASANTA BLVD STE B 8590 RIO SAN DIEGO DR 110 5204 N ROSEMEAD BLVD
(626)965-0971 (858)277-6080 (619)299-1122 (626)286-2111
FIT 3(SP) CILI FIT 4(SP,TA,FR) F/T I PIT 2(SP,RU,TA) PIT I (SP)
ROWLAND HEIGHTS#372101 SAN DIEGO #001895 SAN DIEGO #377901 SAN GABRIEL #002378
MICHAEL CHAN,•DDS PACIFIC DENTAL MARK RIEDLER, DDS HONG SUN,DDS
1725 S NOGALES AVE STE 107 9330 B MIRA MESA BLVD 4167 OHIO ST 6951 N ROSEMEAD BLVD
(626)913-0222 (858)695-3177 (619)281-6635 (626)292-5865
FIT 2(SR CH) & FIT l P/T I (TA,V1) FIT I (SR GE) F/T I PIT I (CA,CH) &
SAN BERNARDINO #000129 SAN DIEGO #00241 1 SAN DIEGO #385601 SAN GABRIEL #OC3501
SAN BERNARDINO DENTAL GROUP SMILECARE DENTAL GROUP BERNARDO DENTAL OFFICE THOMAS WU,DDS
575 W 5TH ST 1333 CAMINO DEL RIO STE 20 16466 BERNARDO CTR DR STE185 1 103 S SAN GABRIEL BLVD A
(909)888-6581 (619)260-4990 (858)676-1845 (626)286-7000
F/T 2(SP,KO) FIT I P/T 3(SP) F/T I (SP) F/T I PIT I (CH,SP,CA) &
SAN BERNARDINO #000132 SAN DIEGO #002413 SAN DIEGO #393701 SAN GABRIEL #176601 I
DR AHUJAS DENTAL OFFICE SMILECARE DENTAL GROUP CARMEL PLAZA DENTAL CENTER SUN DENTAL
654 4TH ST#A 10788 BLACK MOUNTAIN ROAD 11738 CARMEL MOUNTAIN ROAD 1720 S SAN GABRIEL BLVD 101
(909)386-3650 (858)536-5550 (858)675-1180 (626)288-9055
F/T I (SR EI) FIT 2 PIT 5 FIT 2 P/T I (SP,FR) HT I (SR CH)
SAN BERNARDINO #000142 SAN DIEGO #002539 SAN DIEGO #3C0001 SAN GABRIEL #371901
DR AHUJAS DENTAL OFFICE SMILECARE DENTAL GROUP MESA FAMILY DENTAL LAS TUNAS FAMILY DENTAL
1584 W BASELINE STE 103 3820 CONVOY STREET 5450 CLAIREMONT MESA C 1107 E LAS TUNAS DRIVE
(909)885-3100 (858)569-1100 (858)503-6789 (626)285-0031
F/T I (SP.CH.EI) FIT I P/T 2(SP,TA) F/T I (SP,PE) F/T 2(VI,CA) 61
SAN BERNARDINO #000217 SAN DIEGO #002826 SAN DIEGO #3CO401 SAN JUAN CAPIST #001924
LUIS VARGAS,DDS NASER OSTAD,DDS APPLE DENTAL CAPISTRANO DENTAL GROUP
965 SOUTH E STREET STE N 12330 CARMEL MOUNTAIN RD#C4 1540 FERN STREET 31878 DEL OBISPO ST STE#105
(909)885-6262 (858)(85-0555 (619)236-9549 (949)487-3273
F/T 3(CH,SP) FIT t SP) P/T I (SP,CH) P!T I (SP,) &
SAN BERNARDINO #000220 SAN DIEGO #003121 SAN DIEGO #3C8101 SAN JUAN CAPIST #OC9701
SOUTHLAND DENTAL GROUP PREMIER FAMILY DENTAL DR SHIH AND ASSOCIATES MEHRVARZI MEHRDOKHT DTL CORP
399 E HIGHLAND STE 120 4230 30TH STREET 12112 SCRIPPS SUMMIT DR#C 31952 CAMINO CAPISTRANO
(909)881-0645 (619)282-1007 (858)689-6088 (949)240-6888
FIT I (SR AR) FIT I (SR) F/T 2(SP,TA) F/T I (SP)
SAN BERNARDINO #093201 SAN DIEGO #008101 SAN DIMAS #199901 SAN LUIS OBISPO #130901
WALTER ANDERSON,DDS RICHARD KATNIK,DDS PLAZA DENTAL OFFICE CAMPUS DENTAL
1879 N WESTERN AVE 7319 CLAIRMONT MESA BLVD 1120 VIA VERDE 21 SANTA ROSA RD STE 50
(909)887-1212 (858)569-9651 (909)599-2444 (805)547-7010
FIT I (SP) FIT 3(SP,TA,IT) F/T 2(SR FR,GE) & FIT 2(SP) 61
SAN BERNARDINO #160101 SAN DIEGO #030501 SAN DIMAS #3C6601 SAN MARCOS #003532
JAMES CHO,DDS MISSION VALLEY DENTAL GROUP BOUZ DENTAL CORPORATION MISSION FAMILY DENTAL
2130 N ARROWHEAD AVE STE 201 2650 CAMINO DELRIO N STE 102 639 E FOOTHILL BLVD#A 1344 EAST MISSION RD STE C
(909)882-7211 (619)298-0521 (909)599-2029 (760)740-0070
F/T I (SP,KO) FIT I P/T 2(SP,TA) FIT 1 (SP.AR,RU) FIT I (SP,FR,RU)
SAN BERNARDINO #193501 SAN DIEGO #OC1601 SAN FERNANDO #002380 SAN PEDRO #227301
BRENDA EVANS-LOUKA,DDS SORRENTO VALLEY DENTAL TOOTH FAIRY DENTAL SAN PEDRO FAMILY DENTAL CTR
1 1 13 S EST 11230 SORRENTO VALLEY RD 130 556 SOUTH BRAND BLVD 204 N PACIFIC AVE
(909)885-0969 (858)458-9126 (818)365-3004 (310)832-0291
F/T I (AR,SP) F/r I FIT I (SP,) FIT I (SP) &
SAN BERNARDINO #193801 SAN DIEGO #OC2001 SAN FERNANDO #066801 SAN PEDRO #396501
CITRUS DENTAL SUNSHINE DENTAL OFFICE JERRY MALLEUS,DDS MILENA TASIC,DDS
2015 DINERS COURT 9888 B CARMEL MOUNTAIN RD 125 S BRAND BLVD 601 W 6TH STREET
(909)890-0050 (858)780-8870 (818)365-6321 (310)831-1211
F/T I (SP) C1i HT I (SP) F/T I (SR PE) F/T I (GE) &
SAN BERNARDINO#IC7601 SAN DIEGO #189S01 SAN FERNANDO #32S301 SAN PEDRO #3C8301
INLAND DENTAL CENTER RANCHO DENTAL GROUP SAN FERNANDO DENTAL CARE HAMID COHEN-KHERADYAR,DDS
599 INLAND CENTER DRIVE 116 1442 UNIVERSITY AVE 1315 SAN FERNANDO ROAD 400 S GAFFEY STREET
(909)384-1 111 `� F�9`297-6104 (818)365-7107 (310)548-1665
F/T 6 P/T I FIT I (SP,CH) F/T I
SAN BERNARDINO #212801 SAN DIEGO #192201 SAN FERNANDO #373401 SANTA ANA #002491
AMERICAN FAMILY DENTAL CARE MORAGA FAMILY DENTAL MIGUEL MONTES, DDS AMISTAD DENTAL OFFICE
695 W HIGHLAND AVE 3737 MORAGA AVE STE B31 1 11273 LAUREL CANYON BLVD 1028 W FIRST STREET STE E
(9,09)881-2545 (858)490-4281 (818)365-7191 (714)542-5421
F/T I (VI,KO,SP,FR) & FIT I FIT I (SP) F/T I (SP) 61
SAN BERNARDINO #284301 SAN DIEGO #231301 SAN GABRIEL #001455 SANTA ANA #003168
D STREET DENTAL GROUP GENE MOORE,DDS DEL MAR FAMILY DENTAL DENTAL 4
1579-1581 NORTH D ST 286 EUCLID AVE STE 201 702 S DELMAR AVE 102 E 4TH STREET 2ND FLOOR
(909)889-1977 (619)263-6683 (626)287-9781 (714)558-1464
FIT I (SR KO) F/T I P/T I (SP,VI,TA) I I F/T I (SP,CH,AR) & F/T 3(SP)
Gk- The wheelchair symbol indicates functional accessibility for individuals with limited mobility. Information regarding dental office
accessibility for patients with mobility impairments is available by calling PMI's Customer Relations department at(800)422-4234.
SANTA ANA #005201 SANTA MONICA #200401 SOUTH GATE N #003543 TARZANA #356401
LOUIS COHEN, DDS EUGENE AND VICTORIA FIELD YOUNG CHIL KIM DDS FARA SALEHI, DDS
1913 E 17TH ST 113 2825 SANTA MONICA BLVD 101 8200 LONG BEACH BLVD STE E 18740 VENTURA BLVD STE 105
F714) (SP)9751 (310)453-5436 (323)581-0707 (818)344-3357
F/T 2(SR AP,TA,PE) Ck FIT I (SP,KO) & F/T I
SANTA ANA #160501 SANTEE #219501 SOUTH GATE #013201 TEHACHAPI #2C8901
BAY DENTAL EDWARD REIDY,DDS CASTLE DENTAL VALLEY FAMILY DENTISTRY
3620 S BRISTOL AVE STE 307 9280 MAST BOULEVARD 4433 TWEEDY BLVD 20300 VALLEY BLVD SUITE A
HT41(SP,GE)6 & ��9f 449-8530 (323)567-1227 ` FIT
(�1)812-1134
F/T 2 P/T 1
SANTA ANA #I CO201 SANTA #354201 SOUTH GATE #1 14601 TEMECULA #001605
UNIVERSAL CARE DENTAL SANTEE COTTONWOOD DENTAL ADULT&CHILDRENS DENTAL GRP SHAILESH PATEL,DDS
1400 N MAIN 9715 MISSION GORGE RD 4444 TWEEDY BOULEVARD 40335 WINCHESTER RD STE G
(714)480-0434 (619)448-7444 (323)564-2444 (909)296-9063
FIT I P/T I (SP,TA,VI) & FIT I P/L 2(SP,TA) FIT 14 P/T 3(SP,TA,CH,PE) & P/T I (SP)
SANTA AN #305801 SAUGUS #203401 SOUTH GATE #28S201 TEMECULA #253101
BRISTOL FAMILY DENTISTRY GOLDEN TRIANGLE DENTAL WEST COAST DENTAL TEMECULA DENTAL GROUP
2707 N BRISTOL STE F 1 21700 GOLDEN TRIANGLE RD 201 4149 TWEEDY BLVD STE G 41593 WINCHESTER RD STE 211
(714)569-0021 (661)259-5540 (323)567-3333 (909)296-3366
F/T I P/T I (SP) CK F/T 3 P/T I (SP,TA) FIT 5(SP) FIT I PR 6(SP)
SANTA ANA #327801 SEAL BEACH #000056 SOUTH GATE #373001 TEMECULA #364901
JOSEPH DI CAPRIO,DDS MAGED ZAKY NESSIM DDS INC KAPIL FAMILY DENTISTRY PALM PLAZA DENTAL
1500 N GRAND AVE STE 102 1058 BOLSA AVENUE 2639 SANTA ANA STREET 26475 YNEZ ROAD
(714)667-5945 (562)594-4885 (323)583-1481 (909)296-9661
F/T i (SP) PR I (SP,VI) F/T I (SP) & F/T 3 P/T I (SP)
SANTA ANA #377101 SEAL BEACH #144701 SPRING VALLEY #396601 TEMECULA #3C7101"i
IRAJ EBRAMI, DDS GILBERT UNATIN,DDS CHARUE CARMICHAEL, DDS LYNDA WATANABE DTL CORP
1125 E 17TH ST STE E227 1900-A ST ANDREWS 8300 PARADISE VLY RD STE 122 27487 YNEZ ROAD
(714)543-7770 (562)430-1054 (619)479-9143 (909)699-2144
P/T I(GE,PE) F/T I,P/T I F/T I (SP,TA) F/T I P/T I (SP)
SANTA BARBARA #OC6701 SHERMAN OAKS #316701 STANTON #001892 TEMPLE CITY #001722
SEA BREEZE DENTAUDR ZAK HEIDI CHIN, DDS SMILE ACADEMY FRIENDLY DENTAL CARE
5168 HOLLISTER AVE SUITE A 13732 VENTURA BOULEVARD 12793 BEACH BLVD 10455 LOWER AZUSA
(805)683-5300 (818)907-9533 (714)903-9963 (626)444-3744
PIT I C>< F/T 3(CH,SP) ( P/T 2(SP,VI) & F/T 1 (SP,AR)
SANTA BARBARA #199701 SHERMAN OAKS #3C5101 STANTON #003203 THOUSAND OAKS #147501
MISSION DENTAL PRACTICE KAREN ARAKELIAN,DDS JEFFREY CHU,DDS PETER SABOLCH, DDS
330 STATE STREET SUITE A 4940 VAN NUYS BLVD#102 7025 KATELLA AVE 1459 THOUSAND OAKS BLVD D
(805)963-1533 (818)995-3377 (714)229-1234 (805)379-5222
F/T I (SP) F/T I (SP,RU,AM) F/T I PIT I (CH,SP) F/T 3(SP)
SANTA BARBARA #2C2201 SIMIVALLEY #002379 SUN VALLEY #128001 THOUSAND OAKS #244501
LA CUMBRE DENTAL CARE ANIT NATT,DDS UNIVERSAL CARE DENTAL LOMBARD DENTAL GROUP
200 N LA CUMBRE ROAD STE H 1420 E LOS ANGELES AVE#D 9375 SAN FERNANDO RD STE 602 245 LOMBARD STREET
HT 51 (SP,RU,7 Ck F/T
581-1191 (818)504-9876 (805)495-2431
Ck P/T 6(FR,IT,SP,CH) FIT 4 P/T I (SP,AR,GE)
SANTA BARBARA #2C4001 SIMIVALLEY #176101 SUNVALLEY #2C7901 THOUSAND OAKS #363301
DENNIS DIERENFIELLD, DDS DENTAL CARE OF SIMI VALLEY FRESH SMILE DENTAL MOJGAN HASHEMI, DDS
16 W MISSION STE A 1687 ERRINGER RD STE 201 8215 SUNLAND BOULEVARD 313 S MOORPARK ROAD
(805)569-2338 (805)527-3534 (818)252-7222 (805)449-9952
F/T 2(SP) F/T 1 (SP,PE,AM) & F/T I (SR PE,AM) & F/T I
SANTA FIE SPRING #000227 SIMIVALLEY #253401 SUNVALLEY #379901 TIIUANA #322301
GENTLE DENTAL CARE RALPH MAIELLO DDS, INC FAMILY DENTISTRY DENTICENTER
10805 ORR AND DAY ROAD 495 E LOS ANGELES AVENUE 8805 SUNLAND BOULEVARD AVE PASEO TIJUANA 8903202
(562)929-8399 (805)584-2228 (818)767-5243 (619)428-0690
F/T I P/T 1 (SP) F/T 4 P/T 3(SP) F/T I PIT I (SP,TA) & F/T I (SP)
SANTA FE SPRING #002239 SIMIVALLEY #333101 SUNLAND #003125 TOLUCA LAKE #OC4401
SANTA FE DENTAL BORIS ZAK,DDS SUNLAND FAMILY DENTISTRY ESTEBAN BONILLA. DDS
10009 ORR&DAY RD 4537 ALAMO STREET STE A 8522 FOOTHILL BLVD 10745 RIVERSIDE DRIVE STE B
(562)484-0808 (805)520-1100 (818)352-8888 (818)980-2887
F/T 1 (SP TA) FIT I C, FIT 2 CFi F/T I (SR CH) &
SANTA MONICA #002304 SOLANA BEACH N#003478 SUNLAND #134101 TOLUCA LAKE #3C3001
PARKSIDE DENTAL GROUP DEL MAR DENTAL GROUP SUNLAND DENTAL CARE TINA GHOTANIAN,DDS
2428 SANTA MONICA BLVD#403 512 VIA DEL LA VALLE#101 7902 FOOTHILL BLVD 10916 RIVERSIDE DRIVE
(310)453-7737 (858)7554221 (818)353-5520 (818)762-9966
P/T I (SR PE) Ck PR I (SP,IT) F/T I PR I (SP) C FIT 2(SRAM)
SANTA MONICA #004701 SOUTH EL MONTE #003135 SYLMAR #001456 TORRANCE #001370
DOUGLAS OSWELL, DDS DURFEE DENTAL OFFICE ALI SAEGHI, DDS ALL SMILES FAMILY DNTL GROUP
3231 PICO BOULEVARD 1723 DURFEE AVE 13203 GLADSTONE AVE 18506 HAWTHORNE BLVD
(310)828-7429 (626)443-3915 (818)833-0444 (310)370-7500
F/T 6(SP) F/T I P/T 2(SP) FIT I (SP,PE) 61 FIT I P/T I (SP,CA) CFi
SANTA MONICA #OC9801 SOUTH EL MONTE #3C7601 SYLMA #160301 TORRANCE #001810
SANTA MONICA DENTAL ROBERT PHAM,DDS CALIFORNIA DENTAL ASSOCIATES JOSHUA C H CHILI DDS INC
1244 7TH ST STE 101 10050 GARVEY AVE#105 2040 GLENOAKS BLVD STE F 21320 HAWTHORNE BLVD 212
(310)393-0743 (626)444-4220 (818)361-3889 (310)543-1003
F/T 2(SP) F/T 1 (SP,VI) FIT I (SP) F/T 1 (CH,JA) &
SANTA MONICA #1 1 1301 SOUTH GATE #002S44 TARZANA #002101 TORRANCE #001812
BENJI BEHROOZAN,DDS DR R SALWAN INC W A STOMEL,DDS DENTAL GROUP OF TORRANCE
2221 LINCOLN BLVD STE 200 8536 B LONG BEACH BLVD 19525 VENTURA BLVD 21229 HAWTHORNE BLVD
(310)396-9999 F�3)581-0754 (818)342-3233 (310)792-5600
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F/T I (SR TA) & 12F/T 2(SR RU) P/T 2(SP) Ck
ek- The wheelchair symbol indicates functional accessibility for individuals with limited mobility. Information regarding dental office
accessibility for patients with mobility impairments is available by calling PMI's Customer Relations department at(800)422-4234.
TORRANCE #OC8701 UPLAND #367301 VENTURA #002338 WALNUT #000652
TORRANCE DENTAL ARTS YUEN SIANG HUNG,DDS DENTAL CARE OF VENTURA WALNUT HILLS FAMILY DENTI5TRY
23326 HAWTHORNE BLVD STE 190 1268 W FOOTHILL BLVD 178 S VICTORIA AVE#A 18758 E AMAR ROAD
(310)378-8209 (909)981-4111 (805)677-5900 (626)912 5599
FIT 2 PIT 3(SP) Chi F/T 2(SP) FIT I (SR TA) F/T I (SP,FR)
TORRANCE #127901 VALENCIA #00021S VENTURA #199601 WALNUT #364401
UNIVERSAL CARE DENTAL VISTA VILLAGE DENTAL GROUP VENTURA DENTAL GROUP TE1N CHUN WANG.DDS
21840 S NORMANDIE STE 400 25864 TOURNAMENT RD.STE F 1001 PARTRIDGE ROAD STE 210 18800 AMAR ROAD STE B 16
(310)618-1522 (661)259-5001 (805)644-9501 (626)912-9590
P/T 7(SR IT,FR.CH) C F/T I (SP) & FIT 3(SP) Gk FIT I (SP,CH,TA.PE,CA)
TORRANCE #159701 VALENCIA 0 #003542 VENTURA #285301 WEST COVINA #002091
ALL CARE DENTAL NILDA WOOL-AM DMD MARVIN BROWN DDS MSD INC DENTAL CARE BY BLANCO
19019 HAWTHORNE BLVD 100E 23369 LYONS 3037 MARTHA DRIVE: 1031 AMAR ROAD
(310)P7T-0(SP) `1 (661)259-7702 (805)656-6911 (626)330.6655
FIT I (SR TA) 61 FIT I (SP) Ck F(T I (SP,) (1k
TORRANCE #288501 VALENCIA #121701 VENTURA #2C5201 WEST COVINA #00271 1
DAVID SCHINNERER,DDS VALENCIA DENTAL CARE AMERIDENT GROUP KULDIP HANJAN, DDS
2055 TORRANCE BOULEVARD 23838 VALENCIA BLVD STE 301 6555 E TELEPHONE ROAD 8 906 S SUNSET AVE STE 105
(310)320-0707 (661)291-1412 (805)642-2790 (626)962-5243
F/T I P/T I (SP,TA) 6% F/T I P/T I (SP) C1i F/T 3(AR) C1i FIT I (SP) (Fi
TORRANCE #2C4201 VALENCIA #131 101 VENTURA #2C9701 WEST COVINA #003510
VILLAGE FAMILY DENTAL ZAK DENTAL CARE MISSION DENTAL GROUP NEWPORT DENTAL GROUP
1235 WEST SEPULVEDA BLVD 26324 BOUQUET CANYON ROAD 26 S GARDEN STREET STE 1 151 N AZUSA AVE
(310)530-9656 (661)253-4000 (805)648-1090 (626)331-0076
F/T 2 P/T 2(SP,TA) (k, F/T I P/T I (SRAM,RU) C% F/T 2(SR FR,VI) & F/T 2(SP)
TORRANCE #347301 VALLEYVILLAGE #388101 VICTORVILLE #193401 WEST COVINA ■ #003512
TORRANCE DENTAL ASSOCIATES FAMILY DENTISTRY VICTOR VALLEY DENTAL PLAZA SMILECARE DENTAL GROUP
17305 CRENSHAW BLVD 12037 RIVERSIDE DRIVE 15165 7TH ST STE 1 1215 W COVINA PKWY
(310)327-4166 (818)762-8393 (760)245-1015 (626)962-8911
FIT I (SP) Ck FIT 2(SR TA) F/T I (SR KO) F/T 3 P/T I (SP,V) Cfi
TORRANCE #356001 VAN NUYS #002327 VICTORVILLE #222501 WEST COVINA #160201
WEST COAST DENTAL PLAZA DENTAL CLINIC FREDERICK MEYERS&ASSOCIATES WEST COVINA FAMILY DENTISTRY
1730 W SEPULVEDA STE 1 7028 112 VAN NUYS BLVD 15366 1 ITH ST STE E 450 S GLENDORA AVE STE 106
(310)325-8888 (818)780-8555 (760)245-8616 (626)856-3317
F/T I P/T I (SR CH) 61 F/T I FIT 3(SR FR) P/T 1 6%
TORRANCE #361 101 VAN NUYS #002492 VICTORVILLE #306401 WEST COVINA #221001
CABRILLO DENTAL GROUP GEORGIA FERREIRA. DDS S M BHATT,DDS RANK YANNI,DDS
1509 CAB_RILLO AVE 14100 VICTORY BLVD 14495 SEVENTH STREET SUITE A 2365 S AZUSA AVE
F/T01 (SP) 644 & F/T8I(S j 9199 61 FIT I P/T 3(SP)245-7800 F/T 2(SP,AR)'
TUSTIN #000188 VAN NUYS #002747 VICTORVILLE #390901 WEST COVINA #232501
NADIA REZAIAMIRI, DDS SHERMAN WAY DENTAL ASSOCIATES DESERT VALLEY DENTAL GROUP AMERICAN DENTAL GROUP
13372 NEWPORT AVENUE STE F 15333 SHERMAN WAY STE O 13622 BEAR VALLEY RD STE 10 436 N SUNSET AVE
(714)665-0898 (818)909-0200 (760)245-2010 (626)337-7271
F/T I FIT I (AM,SR RU,FR) 61 FIT 3 (SR ATA) L� F/T 3(SP)
TUSTIN #002827 VAN NUYS #002801 VISTA #002708 WEST COVINA #314801
AA FAMILY DENTISTRY HAMLIN DENTAL GROUP BREEZ HILL FAMILY DENTAL CARE MANINDER SINGH, DDS
18102 IRVINE BLVD STE 205 14401 HAMLIN STREET SUITE D 610 S MELROSE DRIVE 1312 W FRANCISQU►TO AVE D4
(174)731-5656 (818)782-6919 (760)941-9000 1626)918-0171
F/T 2(SP) Chi F/T 2 PIT I (SP,TA,) FIT I PIT I (SP,) FIT I (SR IN)
TUSTIN #003200 VAN NUYS #072401 VISTA #003104 WEST COVINA #329601
ELVIS BAQUERO,DDS RICHARD KRATOCHVIL DDS INC SMILECARE DENTAL GROUP QUEENS DENTAL GROUP
14122 REDHILL AVE 7136 HASKELL AVE STE 217 1010 E VISTA WAY STE A AND B 910 S SUNSET AVE STE 4
(714)665-1554 (818)787-6060 (760)940-8811 (626)337-6166
FIT 2(SP) Chi FIT I & F/T I PR 2(SP) FIT I PIT I (TA.SP)
TUSTIN #I C6201 VAN NUYS #12770I VISTA #1 C6301 WEST COVINA #35500I
TUSTIN DENTAL OFFICE UNIVERSAL CARE DENTAL PALOMAR PARK DENTAL SOUTHERN CALIF DTL SER
13721 NEWPORT AVE STE 1 14600 SHERMAN WAY STE 100 3211 BUSINESS PARK DR 1014 S GLENDORA AVE
(714)368-1400 (818)909-9277 (760)598-8881 (626)918-2886
F/T i P/T I (SP) & FIT I PIT 6(FR,IT,SR CH) & F/T 2(SP) F/T I (SR VI.CH)
UPLAND #000232 VAN NUYS #I C8001 IV STA #275901 WEST COVINA #370301
ERIC CHIANG,DDS SHERMAN WAY DENTAL GROUP DONALD FELLARS, DDS ILDEFONSO ALCANTRARA.DMD
1273 WEST 7TH STREET 7120 HAYVENHURST AVE 205 1000 EAST VISTA WAY 358 N AZUSA AVE
(909)920-9543 (818)988-1642 (760)940-4266 (626)9664514
F/T I (SR CH) FIT 1 (AR,AM) F/T 2 PIT I (SP) FIT I (TA)
UPLAND ■■ #003588 VAN NUYS #394601 VISTA #389301 WESTHOLLYWOOD#393001
JANE CHERN: DDS THE DENTAL CARE CENTER MATTHEW DI MATTEO,DDS EVA DLOOMY,DDS
288 S MOUNTAIN AVE 7068 SEPULVEDA BOULEVARD 319 ESCONDIDO AVE 9201 SUNSET BLVD STE 501
(909)920-5222 (818)781-IS33 (760)630-6527 (310)278-9121
F/T I (SR CH) & FIT 2(SR TA) FIT I F/T I (SR HE,FR,AR) 6%
UPLAND #017301 VAN NUYS #3CO301 WLOSANGELES #120201 WESTCHESTER #002782
DOUGLAS JOHNSON. DDS FIROUZEH BANKI,DDS DAVID DANESHRAD,DDS BENJAMIN ROSENBERG,DDS
2345 W FOOTHILL BLVD 10 13 15243 VAN OWEN ST 411 11850 WILSHIRE BLVD STE 101 8540 SEPULVEDA BLVD STE 1000
(9.09)981-3341 (818)781-4260 (3 10)477-8766 (310)649-2430
F/T I (SR KO) F/T I P/T I (SP) FIT 1 (TA,SP) F/T I (SP) C�
UPLAND #317501 VENICE #267701 W LOSANGELES #393401 WESTCHESTER #161001
INLAND EMPIRE DENTAL CASTLE DENTAL CENTER SAEID SOELMANIAN, DDS WESTCHESTER DENTAL CARE
1049 W FOOTHILL BOULEVARD 1440 LINCOLN BOULEVARD 1620 WESTWOOD BOULEVARD 8930 S SEPULVEDA BLVD STET 17
(909)985-1966 (310)396-5986 (310)475-5598 (310)641-8890
F/T I (SP,PE) & FIT I P/T 2(SP,TA) 13 FIT I FIT 2(SP,TA)
&- The wheelchair symbol indicates functional accessibility for individuals with limited mobility. Information regarding dental office
accessibility for patients with mobility impairments is available by calling PMI's Customer Relations department at(800)422-4234.
WESTCHESTER #3C5401 WHITTIER #002501 WILMINGTON #002867 WOODLAND HLS #002824'
KREST FAMILY DENTAL SO CAL FAMILY DENTISTRY WILMINGTON FAMILY DENTISTRY NADER AHDOUT,DDS
8740 S SEPULVEDA BLVD#130 14412 E WHITTIER BLVD 851 W PACIFIC COAST HWY 221 16 VENTURA BLVD
310 410-9494 562 693-0788 (310)830-3620 (818)340-3062
F/T I (SP,TA,EI) Ck F/T 2(VI,SP) F/T I (SP,KO) & F/T I (SP,)
WESTLAKEVLG #001508 WHITTIER #251801 WILMINGTON #388401 YORBALINDA #160401
GHOTANIAN DDS PC DARREL DAGDIGIAN,DDS LARRY ROBINSON,DDS YORBA UNDA DENTAL CENTER
870 HAMPSHIRE RD#C 16406 E WHITTIER BOULEVARD 207 W G STREET 21560 YORBA LINDA BLVD STE C
779-7675
F/T 2(AM,SP) &497-2260 F/T 2 P (SP) &694-0396 FIT 3 P/T I (SP)549-2400 F/T 2(SP,CH)
WESTMINSTER #001916 WHITTIER #283501 WINCHESTER #I C5101 YORBA LINDA -304701
HEATHER DANG,DMD WHITTIER DENTAL CENTER WINCHESTER DENTAL CENTER KISHORI MODI, DDS
14022 SPRINGDALE ST STE E&F 14564 E WHITTIER BLVD 33040 SIMPSON ROAD 19831 YORBA UNDA BLVD STE A
(714)799-2803 (562)693-8202 (909)926-2489 (714)693-0990
F/T 1 (SP,VI,CA,) 61 F/T 3 P/T I (SPAR) HT I (KO,SP) F/T 2 611
WESTMINSTER #115401 WHITTIER #363601 WINNETKA #002853 YUCAIPA #000925
THANH NGOC NGUYEN DMD INC WHITTIER DENTAL OFFICE WINNETKA PLAZA DENTAL IMPERIAL DENTAL PRACTICE
15355 BROOKHURST ST STE 101 8317 S PAINTER AVE STE 4 7616 WINNETKA AVE#I 34980 YUCAIPA BOULEVARD
F/T 2(VI)5175 Litt F/T 2(TA-8790 61 F/T81 (SP,AM) 6%772-6222 F�3(SPA i 136
WESTMINSTER #203001 WHITTIER #396701 WOODLAND HILLS#OC8001 YUCAIPA #157601
CHRISTOPHER WONG,DDS FRIENDLY HILLS FMLY DENTISTRY PIVNICK AND ROSEN DDS YUCAIPA FAMILY DENTISTRY
9900 MCFADDEN AVE STE 102 14544 E WHITTIER BLVD 6325 TOPANGA CNYN BLVD 518 34488 YUCAIPA BLVD STE F
F�4)531-1131 (562)698-9855 (818)346-8840 (909)797-0303
& F/T 2(SR EI) 6% 61 F/T I (KO,SR JA)
WHITTIER #000026 WILDOMAR #0031 15 WOODLAND HILLS#134301 YUCCA VALLEY #I C4901
RODOLPHO BURQUEZ,DDS CLINTON KEITH DENTAL GROUP THOMAS BARTLE,DMD YUCCA FAMILY DENTAL CARE
10420 WHITTIER BLVD 23905 CLINTON KEITH RD#108 22554 VENTURA BLVD STE 117 54663 29 PALMS HWY
(562)699-3838 (909)304-9700 (818)224-2095 (760)365-2351
FIT I (SP) CK P/T I (SP) F/T 2(SP) F/T I
14
ck- The wheelchair symbol indicates functional accessibility for individuals with limited mobility. Information regarding dental office
accessibility for patients with mobility impairments is available by calling PMI's Customer Relations department at(800)422-4234.
Southern California Closed Offices
These offices are presently serving members,but are dosed to further enrollment at this time.These offices may open to new enrollment in the future if of Tice capacity permits.
ALHAMBRA #376401 COSTA MESA #187301 GRANADA HILLS #128101 LA HAS RA #355701
ERWIN LEE,DDS TURQUOISE DENTAL GROUP CATHERINE ALFONSO,DDS JULIET CHUA, DDS
1430 S ATLANTIC BLVD 2969 HARBOR BLVD 16917 DEVONSHIRE STREET 1441 W WHITTIER BLVD
(626)576-7797 (714)424-9393 (818)360-0957 (562)691-7438
F/T 2(CA) FIT I F/T I (TA,SP) & FIT I (SP,TA,CH) &
ALISOVIEIO #271701 COSTA MESA #274401 HACIENDAHGTS #201401 LA MIRADA #080301
ROBERT MURRAY,DDS CALIFORNIA DENTAL GROUP ANDREW KING WONG,DDS VICTOR ISRAEL,DDS
24S41 PACIFIC PK DR STE 240 1755 ORANGE AVE STE D 15534 E GALE AVE 12675 LA MIRADA BLVD STE 315
(949)831.4655 (949)646-9671 (626)330-7705 (714)521-2881
F/T I(RU,GE,SP) F/T I P/T I (SP) F/T I (SP). F/T 3 P/T 2(SP) 61%
ANAHEIM #021501 COVINA #111401 HACIENDAHGTS #230201 LA PALMA #347501
DERRICK BROWN,DDS JOHN F MACK DDS INC VALLEY DENTAL CENTER LICAUCO-TAN DENTAL CORP
853 N HARBOR BLVD 558 W BADILLO 1607 1/2 S AZUSA AVE 30 CENTERPOINTE DRIVE STE 10
(714)535-2487 (626)331-0506 (626)964-8305 (714)994-0888
FIT I F/T I PIT 1 (SP) F/T I P/T I (SR CH,TA) & F/T 2 P/T 1 6%
ANAHEIM #360301 CULVER CITY #041701 HACIENDA HGTS #324801 LEMON GROVE #193001
JANNA TRAN,DDS DRS BILLENS AND KAUFMAN RONALD NICHOLS,DDS E GARNEL MARTIN,DDS
250 W LINCOLN AVE 10760 WASHINGTCNJ BLVD 1850 S AZUZA AVE STE 108 7040 BROADWAY
(714)535-3154 (31 a)838-7780 (626)912-9394 (619)667-1088
F(r I Pfr I (SP,VI) & F/T 3 F/T I (SP) (LI F/T i (SP)
ANAHEIM #364201 CULVER CITY #381601 HACIENDAHGTS #361501 LOMITA #042101
DAE HUR,DDS STEVEN SELDON, DDS APPLE DENTAL CENTER ROBERT JONES DDS INC 1
40 E ORANGETHORPE 10310 CULVER BLVD 2219 S HACIENDA BLVD STE 102 25124 NARBONNE AVE STE 202
(714)870-6611 (310)204-0700 (626)369-5225 (310)530-3260
F/T I (KO) FIT I FIT 2(SP,CH,FR) Ok F/T I (SP)
ANAHEIM HILLS #183301 DELANO #IC0501 HAWTHORNE #122601 LOMPOC #234701
DTL ARTISTRY IN ANAHEIM HILLS CAJIMAT DENTAL OFFICE HAWTHORNE DENTAL CARE VINCENT SIEFE, DDS
145 CHAPARRAL COURT STE 201 416 11 TH AVE 4477 W 118TH STREET STE 500 1201 EAST OCEAN AVE STE G
F714) (SR AM) & PIT 1725- 6 (310)970-9255 (805)735-2702
(T SP) FIT 2 PR I (SP) & F/T 1 &
ARROYO GRANDE #286501 DIAMOND BAR #198101 HAWTHORNE #286801 LONG BEACH #046101
JEFFREY WILLIAMS,DDS GRAND AVENUE DENTISTRY BURTON SCHNIEROW,DDS DRS GANZ&BATEMAN
236 S HALCYON I I 1 I S GRAND AVE STE G 13450 S HAWTHORNE BOULEVARD 2618 LOS COYOTES DIAGONAL
��5'489-1495 F/T 39 7474 (310)679-0106 (562)425-1196
(SP) F/T 4(SP,CH,AR,FR,TA) 61 HT I (SP) ek
BAKERSFIELD #1 C5601 DOWN EY #354801 HEM ET #368001 LONG BEACH #084001
G STREET FAMILY DENTAL THOMAS DILLON, DDS LARRY GRIMALDI,DDS VILLAGE DENTAL CENTER BLDG
2611 G ST 11411 BROOKSHIRE AVE STE 406 1600 E FLORIDA AVE STE 311 4200 LAKEWOOD BLVD
f�li 859-0192 (562)861-6737 (909)658-7251 (562)420-1701
F/T 2(SP) Gk F/T I (SP,GE) F/T 4(SP) &
BAKERSFIELD #308901 LONG BEACH #185201
STEWART DENTAL CORPORATION SALEH K #366801 THOMAS N A N BCH ISTE SE WILLARD HANKINS, DDS
SALEH KHOLAKi, DDS THOMPSON AND CHRISTENSEN DDS
1518 NILES STREET 1230 E HUNTINGTON DR STE 5 6968 WARNER AVE 5509 E SPRING ST
(661)326-0766 (626)301-4220 (714)842-5593 (562)421-8206
FIT 2(SP) & F(r I (SP,AR) F/T 2 P/T I (SP) F/T I (SP)
BAKERSFIELD #373S01 EL CAJON #369501 HUNTINGTON BCH#151801 LONG BEACH #242401
GREGORY HANFORD,DDS DR KOREL FAMILY DENTISTRY GABRIEL CAPDEVILA, DDS GARY TROMBATORE,DDS
3130 UNION AVENUE 1265 AVOCADO BLVD STE 102 6082 EDINGER AVE STE A 3840 WOODRUFF AVE STE 104
F�1;327-8473 (619)444-3393 (714)846-2895 (562)421-7177
L FIT I (SP,AR) F/T I (SP) FIT I P/T i
BELLFLOWER #354901 FULLERTON #174601 HUNTINGTON BCH#305601 LONG BEACH #359201
BENJAMIN WOO,DDS FAMILY DENTAL ARTHUR CABRERA,DDS MARK COCCHI, DDS
17802 S CLARK 2442 E CHAPMAN AVE 18542 BEACH BLVD 2865 ATLANTIC AVE STE 119
(562)925-3715 (714)525-4538 (714)965-6025 (562)426-0778
F/T 2(SP,CH) F/T 1 (AR,SP) 6% F/T 1 (SP) FIT I (GE,IT)
BEVERLY HILLS #255201 GLENDALE #091401 HUNTINGTON BCH#31 S 101. LOS ANGELES #000634
STEVEN GOLDY AND ASSOC DDS WILLIAM FONG, DDS GOLDEN WEST DENTAL GEORGE TAY FAMILY DENTISTRY
416 N BEDFORD DR STE 409` 3532 OCEAN VIEW BLVD 16900 GOLDENWEST ST STE A 4607 N HUNTINGTON DRIVE
(31 2 50-1511 (818)957-7711 (714)375-7700 (323)227-9885
FrrF/T 1 6% F/T I P/T I (CH) 61 F/T I (SP,CH)
BREA #032401 GLENDALE #162301 INGLEWOOD #37SS01 LOSANGELES #360901
VAUGHN G STEWART DDS INC BROADWAY DENTAL OFFICE RAYMONT JOHNSON JR,DDS JONI FORGE,DDS
2500 E IMPERIAL STE 166 727 E BROADWAY 808 E MANCHESTER BOULEVARD 231 W VERNON AVE STE 107
F714)/T I (SP)S920 & )(818)24 5888 (310)671-1234 (323)233-5906
F/T I (SP) 61 F/T 1 (SP) (I. F/T I (SP)
BURBANK #005301 GLENDALE #235901 I VINE #304501 LOSANGELES #372601
CASTLE DENTAL CENTER JOHN YEKIKIAN,DDS JEFFEREY KIM, DDS FRANDSEN MAXWELL, DDS
140 N VICTORY BLVD STE 101 1 128 N BRAND BOULEVARD 4902 IRVINE CTR DRIVE 200 6713 LA TIJERA BOULEVARD
(818)841-1634 (818)242-4703 (949)733-8011 (310)216-0971
F/T 2 PR I (SP,TA) FIT I (AR,SP) FIT I (KO) FIT I (SP) &
BURBANK #236001 GLENDORA #380201 LA CANADA #152001 LOSANGELES #374401
JOHN YEKIKIAN,DDS 369 DENTAL CENTER DOUGLAS LANGELL, DDS GARY WIRTSCHAFTER,DDS
2601 W ALAMEDA AVE STE 406 SOS E ARROW HIGHWAY 1370 FOOTHILL BLVD STE 101 11965 VENICE BLVD STE 209
(818)843-7841 (626)335-2899 (818)952-6193 (310)397-1206
F/T I (AM,SP) FIT 2(SP,TA) FIT I (SP) F/T I (SP,FR) L�
15
&- The wheelchair symbol indicates functional accessibility for individuals with limited mobility. Information regarding dental office
accessibility for patients with mobility impairments is available by calling PMI's Customer Relations department at(800)422-4234.
i-
LOSANGELES #374501 PASADENA #230501 SAN DIEGO #231701 SIMIVALLEY #002463
DAVID YORK,DDS WILLIAM KATES,DDS RONALD PETRILLO,DDS TED CHAFFEE, DDS
2472 OVERLAND AVE 903 E DEL MAR BOULEVARD 7440 BEAGLE STREET 2950 SYCAMORE DR STE 103
FIT I 38- 8)4 (626)792-6195 (858)560-5222 (805)527-6400
(
L� F/T 2(SP,TA) & FIT I FIT I (SP) (�
LOS OSOS #180901 PASO ROBLES #000940 SAN DIEGO #2C3401 TOLUCA LAKE #120301
MICHAEL JANICH, DDS DAVID KRILL,DDS RGB DENTAL NAJARIAN AND NAJARIAN DDS
1205 4TH ST 1920 CRESTON ROAD#B 16471 BERNARDO CENTER DRIVE 10724 RIVERSIDE DRIVE
F�5)528-1695 ` F�5)239-2146 (858)673-9200 (818)769-1111
C FIT I (FR,SP,IT) F/T I PIT I (SP)
MISSION HILLS #147901 POMONA #348001 SAN DIEGO #3C6901 TORRANCE #177501
ANTHONY HOLCOMB,DDS DONALD HODSON, DDS MISSION BAY DENTAL CAROLYN DOHERTY.DDS
15501SAN FERNANDO MISSION 104 1956 INDIAN HILL BOULEVARD 4295 GESNER ST STE 2B 23451 MADISON ST STE 260
F�8)365-8600 (909)621-5848 (619)275-2750 (310)373-7743
L F/T I (SP) F/T I (SP) Frr 1 (SP) 61
MONTEBELLO #383101 REDLANDS #1 14501 SAN DIMAS #023401 WEST COVINA #002401
GREGORY ROBINS FMLY DNSTRY ORANGE PLAZA DENTISTRY SAN DIMAS DENTAL GROUP EDISON DER, DDS
1400 W WHITTIER BOULEVARD 470 ORANGE ST 1 I I I COVINA BOULEVARD 200 148 N GRAND AVE
(323)721-0799 (909)793-4585 (626)966-1671 (626)858-3305
F/T 3(SP,TA) & F/T I (SR CH) & F!T 2 & F/T I (SP) &
MORENO VALLEY #202601 REDLANDS #259801 SAN IACINTO #390101 WEST COVINA #066401
WILLIAM KOHL,DDS REDLANDS DENTAL ASSOC CRAIG SMITH, DDS JOHN THOMPSON,DDS
24270 SUNNYMEAD BLVD 860 REDLANDS BLVD STE 105 182 S RAMONA BLVD 126 S GLENDORA AVE
(909)924-9831 (909)793-5170 (909)654-7393 (626)918-8513
FIT I F/T 2 P/T I (SP,GE) FIT I (SP) FIT I P/T I (SP,VI)
MORENO VALLEY #2C4301 RESEDA #356301 SAN WAN CAPIST #285601 WEST COVINA #370401
INLAND DENTAL OF MORENO VLY GREGORY TURK,DDS KIRK HOBOCK,DDS KATHERINE FORBES,DDS
24655 SUNNYMEAD BLVD 19231 VICTORY BLVD STE 215 32382 DEL OBISPO STE C2 415 S GLENDORA AVE STE A
(909)924.2999 (818)705-6600 (949)493-6006 (626)919-0135
F/T I FIT 1 6% FIT I (SP) CILI F/T I (SP)
NEWHALL #002901 RIALTO #1 17801 SAN MARCOS #268801 WEST COVINA #383201
MARVIN SAGERMAN,DDS JOSEPH/SUSANE LEE-HONG DDS MICHAEL NELSON, DDS GREGORY ROBINS FMLY DNSTRY
25061 PEACHLAND AVE 1734 N RIVERSIDE AVE STE 3 365 S RNCHO SANTA FE RD 105 1129 S GLENDORA AVE
(661)255-7530 (909)875-1279 (760)471-9560 (626)919-7707
F/T I (CH,SP) FIT I PIT I (KO) FIT 2(SP) FIT 2 P/T 2(SP,TA,GE) L�
NEWPORT BEACH #317701 RIALTO #386601 SANTA AN A #202101 WEST HILLS #369301
NEWPORT CENTER DENTAL GROUP DOUGLAS DUNN, DDS CECILIA GROVER.DDS RICHARD MCKEE, DDS
1401 AVOCADO AVE STE 404 1590 N RIVERSIDE 2200 E FRUIT STREET STE 206 7325 MEDICAL CENTER DR 207
(949)640-1122 (909)875-2050 (714)547-7379 (818)703-6315
FIT I P/T 5(SP) F/T I (SP) Lk` FIT I (SP) FIT I (SP) 61
NORTHRIDGE #000501 RIVERSIDE #153101 SANTA MARIA #286701 WESTMINSTER #357801
W LOW,DDS NAT SHAIN,DDS ROBERT EVANS,DDS BOYD JOYER JR,DDS
17022 DEVONSHIRE STREET 4151 BROCKTON AVE 2151 S COLLEGE DRIVE#103 15310 GOLDENWEST STREET
(818)363-7469 (909)788-4500 (805)928-5871 (714)893-2411
FIT I PIT I FIT I FIT I C F/T 2 Chi.
NORWALK #283601 RIVERSIDE #268601 SANTA MONICA #060401 WHITTIER #037701
RALPH NICASSIO,DDS CLAYTON CHING,DDS ALAN RUBENSTEIN, DDS KC PRASAD DDS INC
11936 E IMPERIAL HWY STE A/B 6086 BROCKTON AVE STE 1 1260 15TH ST STE 703 1 1610 SLAUSON AVE
(562)868-7768 (909)684-5191 (310)393-8284 (562)692-1330
FIT 3(TA,SP 6% F/T 2 F/T I PIT I (SP,TA) F/T I (SP) 6%
PALM DESERT #129201 SAN BERNARDINO #356901 SHERMAN OAKS #366301 WOODLAND HILLS#395901
DESERT DENTAL CARE DENTAL CARE OF SAN BERNARDINO 57EVEN BLEIER, DDS VIKEN TOUTOUNJIAN,DDS
44139 MONTEREY AVE STE E 322 N H ST 4910 VAN NUYS BLVD STE 107 6325 TOPANGA CANYON BLVD 204
FIT02(SP VIVI 94 & FIT 2(SP) F/T
F/T 1501 6000 (1% F/T81 (SR AR)I 6%
PALOS VERDES #340001 SAN BERNARDINO #396401 SHERMAN OAKS #391701
SOUTH BAY FAMILY DENTAL GROUP WATERMAN DENTAL CENTER GUS HUERTA,DDS
927 DEEP VALLEY DR STE 220 1428 N WATERMAN STE A 4910 VAN NUYS BLVD STE 204
FIT02 PIT 1566(SR RU,TA) FIT91(SP)I 1 I I & FIT I(S5-8484 &
PARAMOUNT #002713 SAN DIEGO #171301
KAIS CHEBBI DENTAL OFFICE CLAIREMONT FAMILY DENTAL
16260 PARAMOUNT BLVD STE G 3670 CLAIREMONT DRIVE STE 14
(562)633-5070 (858)273-0540
FIT I (FR,SP,AR) L FIT I Visit us at our website:www.deltadentaica.org/pmi
PASADENA #002785 SAN DIEGO #181601 NOTE:The "01" listed at the end of each provider number shown
BELEJ GUERRERO,DMD GREG MCELROY,DDS is for internal use only. The provider selection will be honored
(650-8 EWAL5-1739 STREET (619 ORANGE AVE whether OR NOT the"01" is noted on the enrollment form.
(626)585-1739 (619)280-4861
FIT I (TA) & FIT 2
This list is subject to change without notice. Additional Dental F/T-Full Time Dentist PIT-Part Time Dentin ■-New Offices
Offices will be added as required. You may call the DeltaCare Foreign languages spoken in the dental office are listed by code in().
Customer Relations Department at(800)422-4234 for updates
Below is a key to the foreign language codes.
to the provider list,or to obtain information regarding a particular AM-Armenian FR-French IT-Italian RU-Russian
provider,including if they are accepting new patients. If any office AR-Arabic GE-German J q-Japanese SP-Spanish
CA-Cantonese GR-Greek KO-Korean TA-Tagalog
is closed to further enrollment,PMI reserves the right to assign I CH-Chinese
you another dental office as close to our home as possible. All I HE-Hebrew PE-Persian V I-Vietnamese
y y p EI-East Indian IN-Indian PO-Polish
members of your family must be treated at the same facility.
16
d%- The wheelchair symbol indicates functional accessibility for individuals with limited mobility. Information regarding dental office
09/19/02 accessibility for patients with mobility impairments is available by calling PMI's Customer Relations department at(800)422-4234. PLCASOU
LIMITATIONS1
EXCLUSIONSOF
• Limitations of Benefits
1. Prophylaxis is limited to one treatment each six-month period (in- 13.Dispensing of drugs not normally supplied in a dental office;
cludes periodontal maintenance following active therapy); 14.Accidental injury. Accidental injury is defined as damage to the hard
2. Full maxillary and/or mandibular dentures including immediate den- and soft tissues of the oral cavity resulting from forces external to the
tures are not to exceed one each in any five year period from initial mouth. Damages to the hard and soft tissues of the oral cavity from
placement; normal masticatory(chewing)function will be covered at the normal
3. Partial dentures are not to be replaced within any five-year period schedule of benefits;
from initial placement, unless necessary due to natural tooth loss 15.Cases which,in the professional judgment of the attending dentist,a
where the addition or replacement of teeth to the existing partial is not satisfactory result cannot be obtained,or where the prognosis is poor
feasible; or guarded;
4. Crown(s) and bridges are not to be replaced within any five-year 16.Dental services received from anydental office otherthan the assigned
period from initial placement; DeltaCare office,unless expressly authorized in writing by DeltaCare
5. Denture relines are limited to one per denture during any 12 con- or as cited under"Provisions for Emergency Care";
secutive months; 17.Prophylactic removal of impactions(asymptomatic/nonpathological);
6. Periodontal treatments(root planing/subgingival curettage)are lim- 18."Specialist consultations"for noncovered benefits;
ited to four quadrants during any 12 consecutive months; 19.Implant placement or removal, appliances placed on or services
7. Full mouth debridement(gross scale)is limited to one treatment dur- associated with implants,including but not limited to prophylaxis and
ing any 12 consecutive month period; periodontal treatment.
8. Bitewing x-rays are limited to not more than one series of four films in 20.Crown lengthening procedures.
any six-month period; • Summary of Orthodontic Limitations and Exclusions
9. Full mouth x-rays are limited to one set every 24 consecutive months;
10.Sealant benefits include the application of sealants onlyto permanent The program provides coverage for orthodontic treatment plans provided
first and second molars with no decay,with no restorations and with through DeltaCare Network orthodontists.The start-up fees and the cost
the occlusal surface intact,for first molars up to age nine and second tothe enrolleeforthe treatment plan are listed in the Description of Benefits
molars up to age fourteen.Sealant benefits do not include the repair and Copayments,subject to the following:
or replacement of a sealant on any tooth within three years of its 1. Orthodontic treatment must be provided bya DeltaCare orthodontist.
application. 2. Plan benefits cover 24 months of usual and customary orthodontic
• Exclusions treatment.
The following services are not covered benefits of this program: 3. Should an enrollee's coverage be canceled or terminated for any
reason,and at the time of cancellation ortermination be receiving any
1. General anesthesia and the services of a special anesthesiologist; orthodontic treatment,the enrollee and not DeltaCare will be responsible
for payment of balance due for treatment provided after cancellation
2. Cosmetic dental care; or termination. In such a case the enrollee's payment shall be based
3. Dental conditions arising out of and due to enrollee's employment or on a maximum of$2,300for dependent children to age 19 and$2,500
for which Workers'Compensation is payable. Services which are for covered full time students and adults.The amount will be prorated
provided to the enrollee by State government or agency thereof or over the number of months to completion of the treatment and,will be
are provided without cost to the enrollee by any municipality,county or payable bythe enrollee on such terms and conditions as are arranged
other subdivision,except as provided in Section 1373(a)of the Cali- between the enrollee and the orthodontist.Start-upfees are included
fornia Health and Safety Code; in these amounts.
4. Treatment required by reason of war; 4. Start-up fees coverthe initial examination,diagnosis,consultation and
5. Dental services performed in a hospital and related hospital fees; the retention phase of treatment of up to two years maximum. Thisincludes initial construction,placement and adjustments to retainers
6. Treatment of fractures and dislocations; and office visits for a maximum period of two years.
7. Loss or theft of fixed and removable prosthetics(crowns,bridges,full The/o/%wing services are not covered
or partial dentures); 1. Pre,mid-and post-treatment records which include cephalometric x-
8. Dental expenses incurred in connection with any dental procedures rays,tracings,photographs and study models;
started after termination of eligibility for coverage; 2. Lost,stolen or broken orthodontic appliances,functional appliances,
9. Any service that is not specifically listed as a covered expense; headgear,retainers and expansion appliances;
10.Dental expenses incurred in connection with any dental procedure 3. Retreatment of orthodontic cases;
started prior to enrollee's eligibility with the DeltaCare program.Ex- 4. Treatment that extends more than 24 months from the point of banding
ample:teeth prepared for crowns,root canals in progress,orthodon- dentition will be subject to an office visit charge at orthodontist's usual,
tic treatment; customary and reasonable fee;
11.Congenital malformations (e.g., congenitally missing teeth, 5. Treatment in progress at inception of eligibility;
supernumerary);
12.Cysts and malignancies; 6. Transfer after banding has been initiated.
r
GETTING TO KNO%
YOUR DeltaCare
• What is PMI? • How long does it take to get an appointment with a
PMI is a dental HMO that has administered DeltaCare programs for DeltaCare dentist?
nearly 30 years.PMI contracts with network dentists,works with Two to four weeks is a reasonable amount of time to wait for a
your group to design your benefits program and handles all routine,non-urgent appointment.If you require a specifictime,you
customer service inquiries Today,more than a million enrollees may have to wait longer.In addition,most DeltaCare dentists are in
are covered by DeltaCare programs. private group practices,which means greater appointment
• What is the difference between PMI and Delta? availability and extended office hours.
PMI administers DeltaCare dental HMO programs and is an • 1 have a pre-existing dental condition.Can I still join
affiliate of Delta Dental Plan of California. DeltaCare?
Yes,treatment for pre-existing conditions such as extracted
• How do I know if my dentist is a PMI dentist? teeth is not excluded under the DeltaCare program.
When you enroll in DeltaCare,you select a primary care dentist However,benefits are not provided for any dental treatment
from the list of DeltaCare network dentists.With more than 2,500 started before joining the program(that is,work in progress,such
general and specialist dentists,the DeltaCare network is one of the as preparations for crowns,root canals,impressions for dentures
largest in California. and orthodontic treatment).
• My dentist is a Delta dentist but is not on the list of • How does the DeltaCare program encourage preventive
DeltaCare network dentists.Can I still receive treatment care?
from this dentist? Your DeltaCare program is designed to encourage regular visits to
No,you must receive treatment from your selected DeltaCare the dentist by having no copayments(fees you pay to the network
network dentist.Please note that Delta dentists are not necessarily dentist)on most diagnostic and preventive services. See the
DeltaCare dentists. enclosed"Description of Benefits and Copayments"
• How do I know DeltaCare dentists provide quality • Does my DeltaCare program cover specialists'services?
care? Yes.Your primary care network dentist will coordinate your
DeltaCare dentists are reviewed for quality,availability and safety specialty care needs with an approved network specialist. There
before joining the network.PMI maintains quality standards by is no additional charge to you for receiving care from a specialist.
visiting each network dental office every three months. If there's no network specialist within your service area,PMI will
authorize a referral to an out-of-network specialist at no extra cost,
• Do my family members receive treatment from the same other than the applicable copayment.If you or your dependent is
DeltaCare network dentist? assigned to a dental school clinic for specialty services,those
services may be provided by a dentist,a dental student,a clinician
Yes,you and all eligible dependents receive care from the same or a dental instructor.
primary care network dentist.
• Can I change my primary care network dentist?
Yes.You may change network dentists by notifying PMI either by
® DENTAL HEALTH PLAN An ARliae of Delu D enial Plan phone or in writing,or by visiting our website
duif_n (www.deltadentalca.orgJpmi). If you contact us by the 21 st of the
If you have any questions or need additional information,call or write to: month,the change will become effective the first of the following
PMI Dental Health Plan month.
12898 Towne Center Drive •Cerritos,CA 90703-8579 What if I have questions about my DeltaCare program?
(800)422-4234 Call PMI Customer Relations at(800)422-4234.We have
or visit our website at www.deftadentalca.org/pmi multilingual representatives available from 5 a.m.to 6 p.m.,
Note:THIS IS ONLY A BRIEF SUMMARY OF THE PLAN. Monday through Friday.Our Customer Relations representatives
The Group Dental Service Contract must be consulted to determine the exact have worked in dental offices and can answer benefits questions,
terms and conditions of coverage.An Evidence of Coverage will be sent to you as well as arrange office transfers and urgent care referrals.
upon enrollment. If you wish to review an Evidence of Coverage prior to
enrollment,you may request a copy by calling PMI's Customer Relations
Department at(800)422-4234.
09/01 SCCA700
USING THIS BOOKLET A STATEMENT DESCRIBING OUR POLICIES
AND PROCEDURES FOR PRESERVING THE
This booklet has been written with you in mind. It CONFIDENTIALITY OF MEDICAL RECORDS
is designed to help you make the most of your Delta IS AVAILABLE AND WILL BE FURNISHED TO
dental program. This combined Evidence of . YOU UPON REQUEST.
Coverage/Disclosure form discloses the terms and
conditions of your coverage.
The Combined Evidence of Coverage\Disclosure This Combined Evidence of Coverage
form should be read completely and carefully and and Disclosure Form constitutes only a
individuals with special health care needs should summary of the dental plan. The dental
read carefully those sections that apply to them(see Contract must be consulted to determine
CHOOSING YOUR DENTIST section). You have the exact terms and conditions of
a right to review it prior to your enrollment.
coverage.
Please read the"DEFINITIONS" section. It will
explain to you any words which have special or
technical meanings under your group Contract. A
copy of the Contract will be furnished upon request.
Please read this summary of your dental Benefits
carefully. Keep in mind that YOU means the
ENROLLEES whom Delta covers. WE,US and
OUR always refers to Delta Dental Plan of
California(Delta).
If you have any questions about your coverage that
are not answered here,please check with your
personnel office, or with Delta.
DELTA DENTAL PLAN OF CALIFORNIA
P.O. Box 7736
San Francisco, California 94120
For claims,eligibility and benefits inquiries,or
additional information, call Delta's Customer and
Member Service Department toll-free at:
1-888-335-8227.
Or contact us on the Internet at:
e-mail: cros@delta.org
web site: www.deltadentalca.org
1
TABLE OF CONTENTS
DEFINITIONS.........................................................3 SECOND OPINIONS............................................12
WHO IS COVERED?..............................................3 ORGAN AND TISSUE DONATION...................12
WHO ARE YOUR ELIGIBLE COMPLAINT PROCEDURE, CLAIMS
DEPENDENTS?.... ...................I..............................4 APPEAL AND ARBITRATION...........................12
ENROLLING YOUR DEPENDENTS....................4 IF YOU HAVE ADDITIONAL
COVERAGE..........................................................13
COVERAGE COSTS..............................................4
OPTIONAL CONTINUATION
WHEN YOU ARE NO LONGER OF COVERAGE....................................................14
COVERED ..............................................................5
CANCELING THIS PROGRAM ...........................5
YOUR BENEFITS ..................................................5
LIMITATIONS........................................................6
EXCLUSIONS/SERVICES WE DO
NOT COVER ............................... ...... ......... .........8
DEDUCTIBLES .... .................................................9
COVERED FEES ....................................................9
CHOOSING YOUR DENTIST...............................9
CONTINUITY OF CARE.....................................10
PUBLIC POLICY PARTICIPATION
BY ENROLLEES..................................................10
SAVING MONEY ON YOUR
DENTAL BILLS .........................
YOUR FIRST APPOINTMENT...........................10
PREDETERMINATIONS.....................................I I
PAYMENT............................................................I I
IF YOU HAVE QUESTIONS ABOUT
SERVICES FROM A DELTA DENTIST.............I2
� 2
DEFINITIONS Participating Plan—Delta and any other member
of the Delta Dental Plans Association with whom
Certain words that you will see in this booklet have Delta contracts for assistance in administering your
specific meanings. These definitions should make Benefits.
your dental program easier to understand.
Primary Enrollee any group member or
Attending Dentist's Statement-a form used by employee who is eligible to enroll for Benefits in
your dentist to request payment for dental treatment accordance with the conditions of eligibility
or predetermination for proposed dental treatment. outlined in this booklet.
Benefits-those dental services available under the Single Procedure- a dental procedure to which
Contract and which are described in this booklet. Delta has assigned a separate procedure number; for
example, a three-surface amalgam restoration of one
Contract- the written agreement between your permanent tooth(procedure 02160) or a complete
employer or sponsoring group and Delta to provide upper denture, including adjustments for a six-
dental Benefits. The Contract together with this month period following installation(procedure
g i
P g (P
booklet, forms the terms and conditions of the 05110).
Benefits you are provided.
Usual, Customary and Reasonable (UCR)=
Covered Services -those dental services to which
Delta will apply Benefit payments, according to the A Usual fee is the amount which an individual
Contract. dentist regularly charges and receives for a given
service or the fee actually charged,whichever is
Delta Dentist-a Dentist who has a signed less.
agreement with Delta or a Participating Plan,
agreeing to provide services under the terms and A Customary fee is within the range of Usual fees
conditions established by Delta or the Participating charged and received for a particular service by
Plan. dentists of similar training in the same geographic
area.
Dependent- a Primary Enrollee's Dependent who
is eligible to enroll for Benefits in accordance with A Reasonable fee schedule is reasonable if it is
the conditions of eligibility outlined in this booklet. Usual and Customary. Additionally, a specific fee
to a specific patient is Reasonable if it is justifiable
Effective Date-the date this program starts. considering special circumstances, or extraordinary
difficulty, of the case in question.
Enrollee- a Primary Enrollee or Dependent
enrolled to receive Benefits or a person who WHO IS COVERED?
chooses to pay for OPTIONAL CONTINUATION
OF COVERAGE. All present and future regular employees are
required to enroll and will become eligible to
Maximum-the greatest dollar amount Delta will receive Benefits on the first day of the month
pay for covered procedures in any calendar year and following 30 days of continuous employment.
lifetime for Orthodontic Benefits.
New Dependents should be enrolled as soon as they
Premiums -the money paid to Delta each month become Dependents, and they will then immediately
for you and your Dependents' dental coverage. be covered for dental Benefits.
3
You are not eligible if you are not reporting to work physical or mental handicap that occurred before
on a regular basis and are not actively employed. he or she turned 19, if the child is mostly
Coverage resumes on the first day of the month dependent on you for support. Proof of this
after you return to active employment,report to handicap must be given to Delta or your
work employer within 31 days,if it is requested.
Proof will not be required more than once a year
regularly and amounts due to Delta for coverage after the child has reached age 21.
have been paid. But, coverage can continue without
interruption if your employer continues to report "Dependent children" also means stepchildren,
you as a Primary Enrollee and amounts due Delta adopted children,children placed for adoption and
for your coverage continue to be paid. foster children,provided that they are dependent
upon you for support and maintenance.
Family and Medical Leave Act of 1993
Dependent coverage is also extended to any child
You can continue your coverage if you take a leave who is recognized under a Qualified Medical Child
governed by the Family and Medical Leave Act of Support Order(QMCSO).
1993. If you do not continue your coverage during
the governed leave, it will be reinstated at the same No Dependent in the military service is eligible.
Benefit level you received before your leave.
ENROLLING YOUR DEPENDENTS
Uniformed Services Employment and Re-
employment Rights Act of 1994 A payroll deduction is required for your enrolled
Dependents. Your group can only provide coverage
You can continue coverage for up to 18 months,if for your Dependents if at least half of the Primary
you take a leave governed by the Uniformed Services Enrollees who have Dependents enroll all of them
Employment and Re-employment Rights Act of in this program.
1994. If you make this election,you must submit
any Premiums necessary, which may include Your Dependents must be enrolled when you first
administrative costs,to your employer. If you do not become eligible or on the first day of the month
continue your coverage during a military leave,it will after they become Dependents. However,
be reinstated at the same Benefit level you received Dependents who are covered under another group
before your leave. dental program are not required to enroll under this
Delta program. If the other coverage ends,the
WHO ARE YOUR ELIGIBLE DEPENDENTS? Dependents may enroll under this program within
30 days of the loss of the other coverage. Proof of
• Your legal spouse; prior coverage is required.
• Your unmarried dependent children until their Dependent children up to four years of age may be
19th birthday; enrolled at the beginning of any Contract year
including the Contract year immediately following
• Your unmarried dependent children until their their fourth birthday. If you drop coverage for your
23rd birthday if enrolled full-time in an Dependents, you may not re-enroll them in this
accredited school, college or university, or live program•
at home and are dependent upon parent(s) for at
least 50%of their support; COVERAGE COSTS
• An unmarried dependent child aged 19 or older Your employer pays Delta monthly Premiums for
who is incapable of self-support because of a coverage of you and your enrolled Dependents.
4
You do not pay for your own coverage but a payroll Procedures begun while the Contract was in effect
deduction is made for monthly Premiums required which are otherwise Benefits under the Contract.
for your Dependent's coverage.
If this program is canceled, you and your
The amount of Premiums may change at each Dependents have no right to renewal or
renewal of the Contract between your employer and reinstatement of your Benefits..
Delta. Premiums will not increase during the
contract year unless new taxes or tax rates are YOUR BENEFITS
imposed upon Delta for this program or unless there
is an agreement between your employer and Delta Your dental program covers several categories of
to change the Premiums rate. Benefits,when the services are provided by a
licensed dentist, and when they are necessary and
WHEN YOU ARE NO LONGER COVERED customary under the generally accepted standards of
dental practice. After you have satisfied any
l. If you stop working for your employer,your deductible requirements,Delta will provide 4
dental coverage will end on the last day of payment for these'services at the percentage
the month in which you stop working,unless indicated up to a Maximum of$1,000 for each
you qualify for and pay for OPTIONAL Enrollee in each calendar year. Payment for
CONTINUATION OF COVERAGE. Your Orthodontic Benefits for Enrollee is limited to a
Dependents' coverage ends when yours lifetime Maximum of$3,000. An agreement
does, or as soon as they are no longer between your employer and Delta is required to
Dependents, unless they choose to pay for change Benefits during the term of the contract.
OPTIONAL CONTINUATION OF
COVERAGE. The following Benefits are limited to the applicable
percentages of dentist's fees or allowances specified
2. When the Contract between Delta and your below. You are required to pay the balance of any
employer is discontinued or canceled,your such fee or allowance,known as the"patient
coverage ends immediately. copayment." If the dentist discounts,waives or
rebates any portion of the patient copayment to the
CANCELING THIS PROGRAM Enrollee,Delta only provides as Benefits the
applicable allowances reduced by the amount that
Delta may cancel this program only on an such fees or allowances are discounted,waived or
anniversary date(period after the program first rebated.
takes effect or at the end of each renewal period
thereafter), or any time your group does not make I. DIAGNOSTIC AND PREVENTIVE
payment as required by the Contract. BENEFITS-85%
If you believe that this program has been terminated Diagnostic-oral examinations(including
or not renewed due to your health status or initial examinations,periodic examinations
requirements for health care services(or that of your and emergency examinations); x-rays;
Dependents),you may request a review by the diagnostic casts; examination of biopsied
California Director of the Department of Managed tissue;palliative(emergency)treatment of
Health Care. dental pain; specialist consultation
If the Contract is terminated for any cause,Delta is Preventive-prophylaxis (cleaning); fluoride
not required to predetermine services beyond the treatment; space maintainers
termination date or to pay for services provided
after the termination date, except for Single
5
II. BASIC BENEFITS- 85% V. ORTHODONTIC BENEFITS - 60%
Oral surgery- extractions and certain other Procedures using appliances or surgery to
surgical procedures,including pre- and post- straighten or realign teeth,which otherwise
operative care would not function properly.
Restorative - amalgam, silicate or composite VI DENTAL ACCIDENT BENEFITS-
(resin)restorations(fillings)for treatment of 100%
carious lesions (visible destruction of hard
tooth structure resulting from the process of Any services which would be covered under
dental decay) other Benefit categories (subject to the same
limitations and exclusions) are covered
Endodontic - treatment of the tooth pulp instead by your dental accident coverage
when they are provided for conditions
Periodontic -treatment of gums and bones caused directly by external, violent and
that support the teeth accidental means.
Sealants-topically applied acrylic,plastic or LINIITATIONS
composite material used to seal
developmental grooves and pits in teeth for 1. Only the first two oral examinations,
the purpose of preventing dental decay including office visits for observation and
specialist consultations, or combination
Adjunctive General Services- general thereof, in a calendar year are Benefits while
anesthesia; office visit for observation; you are eligible under any Delta program.;
office visit after regularly scheduled hours; Oral examinations provided by a California
therapeutic drug injection; treatment of post- dentist are Benefits only when the dentist is
surgical complications (unusual a Delta Dentist with an accepted fee on file
circumstances); limited occlusal adjustment with Delta.
III. CROWNS,JACKETS,INLAYS, 2. Full-mouth x-rays are a Benefit once in a
ONLAYS AND CAST RESTORATION five-year period while you are eligible under
BENEFITS -85% any Delta program.
Crowns, Jackets, Inlays, Onlays and Cast 3. Bitewing x-rays are provided on request by
Restorations are Benefits only if they are the dentist,but no more than twice in any
provided to treat cavities which cannot be calendar year for children to age 18 or once
restored with amalgam, silicate or direct in any calendar year for adults age 18 and
composite(resin)restorations. over,while you are eligible under any Delta
program.
IV. PROSTHODONTIC BENEFITS -60%
4. Diagnostic casts are a Benefit only when
Construction or repair of fixed bridges, made in connection with subsequent
partial dentures and complete dentures are orthodontic treatment covered under this
Benefits if provided to replace missing, program.
natural teeth.
6
5. Only the first two cleanings, fluoride 10. Delta will pay its percentage of the dentist's
treatments, or Single Procedures which fee for a standard partial or complete denture
include cleaning, or combination thereof, in up to a maximum fee allowance. This fee
a calendar year are Benefits while you are allowance is the fee that would satisfy the
eligible under any Delta program. majority of Delta's Dentists. A standard
partial or complete denture is one made from
6. Sealant Benefits include the application of accepted materials and by conventional
sealants only to permanent first molars up to methods. The maximum fee allowance is
age nine and second molars up to age 14 if revised periodically, as dental fees change.
they are without canes (decay), or If your dentist's accepted fee on file with
restoration on the occlusal surface. Sealant Delta for a partial or complete denture is
Benefits do not include the repair or higher than this maximum allowance,you
replacement of a sealant on any tooth within must pay that portion of his or her fee that
three years of its application. exceeds Delta's allowance in addition to
your portion of the allowance.
7. Direct composite(resin)restorations are
Benefits on anterior teeth and the facial 11. Implants (appliances inserted into bone or
surface of bicuspids. Any other posterior soft tissue in the jaw,usually to anchor a
direct composite(resin)restorations are denture) are not covered by your program.
optional services and Delta's payment is However, if implants are provided along
limited to the cost of the equivalent with a covered prosthodontic appliance,
amalgam restorations. Delta will allow the cost of a standard partial
or complete denture toward the cost of the
8. Crowns, Jackets, Inlays, Onlays and Cast implants and the prosthodontic appliances
Restorations are Benefits on the same tooth when the prosthetic appliance is completed.
only once every five years,while you are If Delta makes such an allowance,we will
eligible under any Delta program,unless not pay for any replacement for five years
Delta determines that replacement is following the completion of the service.
required because the restoration is
unsatisfactory as a result or poor quality of 12. If you select a more expensive plan of
care,or because the tooth involved has treatment than is customarily provided, or
experienced extensive loss or changes to specialized techniques, an allowance will be
tooth structure or supporting tissues since made for the least expensive,professionally
the replacement of the restoration. acceptable, alternative treatment plan. Delta
will pay the applicable percentage of the
9. Prosthodontic appliances are Benefits only lesser fee for the customary or standard
once every five years,while you are eligible treatment and you are responsible for the
under any Delta program, unless Delta remainder of the dentist's fee.
determines that there has been such an
extensive loss of remaining teeth or a change For example: a crown where a silver filling
in supporting tissues that the existing would restore the tooth; or a precision
appliance cannot be made satisfactory. denture where a standard denture would
Replacement of a prosthodontic appliance suffice.
not provided under a Delta program will be
made if it is unsatisfactory and cannot be
made satisfactory.
7
13. If orthodontic treatment is begun before you 3. Services for cosmetic purposes or for
become eligible for coverage,Delta's conditions that are a result of hereditary or
payments will begin with the first payment developmental defects, such as cleft palate,
due to the dentist following your eligibility upper and lower jaw malformations,
date. congenitally missing teeth and teeth that are
discolored or lacking enamel.
14. Delta's orthodontics payments will stop
when the first payment is due to the dentist 4. Services for restoring tooth structure lost
following either a loss of eligibility, or if from wear(abrasion, erosion, attrition,or
treatment is ended for any reason before it is abfraction), for rebuilding or maintaining
completed. chewing surfaces due to teeth out of
alignment or occlusion, or for stabilizing the
15. X-rays and extractions that might be teeth. Examples of such treatment are
necessary for orthodontic treatment are not equilibration and periodontal splinting.
covered by Orthodontic Benefits,but may be
covered under Diagnostic and Preventive or 5. Any Single Procedure,bridge, denture or
Basic Benefits. other prosthodontic service which was
started before the Enrollee was covered by
16. Delta will pay Dental Accident Benefits this program.
when services are provided within 180 days
following the date of accident and shall not 6. Prescribed drugs, or applied therapeutic
include any services for conditions caused drugs,premedication or analgesia.
by an accident occurring before your
eligibility date. 7. Experimental procedures.
EXCLUSIONS/SERVICES WE DO NOT 8. Charges by any hospital or other surgical or
COVER treatment facility and any additional fees
charged by the Dentist for treatment in any
Delta covers a wide variety of dental care expenses, such facility.
but there are some services for which we do not
provide Benefits. It is important for you to know 9. Anesthesia, except for general anesthesia
what these services are before you visit your dentist. given by a dentist for covered oral surgery
procedures.
Delta does not provide benefits for:
10. Grafting tissues from outside the mouth to
1. Services for injuries covered by Workers' tissues inside the mouth ("extraoral grafts").
Compensation or Employer's Liability
Laws. 11. Implants(materials implanted into or on
bone or soft tissue)or the repair or removal
2. Services which are provided to the Enrollee of implants, except as provided under
by any Federal or State Governmental LIMITATIONS.
Agency or are provided without cost to the
Enrollee by any municipality,county or
other political subdivision, except Medi-Cal
benefits.
8
12. Diagnosis or treatment by any method of corresponding services for Delta Dentists in
any condition related to the California.
temporomandibular(jaw)joints or
associated muscles,nerves or tissues. Payment to a California dentist, or an out-of-state
dentist,who is not a Delta Dentist will be based on
13. Replacement of existing restoration for any the applicable percentage of the lesser of the Fee
purpose other than active tooth decay. Actually Charged, or the fee which satisfies the
majority of Delta's Dentists.
14. Intravenous sedation, occlusal guards and
complete occlusal adjustment. CHOOSING YOUR DENTIST
15. Charges for replacement or repair of an PLEASE READ THE FOLLOWING
orthodontic appliance paid in part or in full INFORMATION SO YOU WILL KNOW
by this program. FROM WHOM OR WHAT GROUP OF
PROVIDERS HEALTH CARE MAY BE
DEDUCTIBLES OBTAINED.
You must pay the first$25 of Covered Services for More than 18,000 dentists in active practice in
each Enrollee in your family in each calendar year, California are Delta Dentists. You are free to
up to a limit of$75 per family. choose any dentist for treatment,but it is to your
advantage to choose a Delta Dentist. This is
COVERED FEES because his or her fees are approved in advance by
Delta, Delta Dentists have treatment forms on hand
It is to your advantage to select a dentist who is a and will complete and submit the forms to Delta
Delta Dentist, since a lower percentage of the free of charge.
dentist's fees may be covered by this program if you
select a dentist who is not a Delta Dentist. If you go to a non-Delta Dentist,Delta cannot
assure you what percentage of the charged fee may
A list of Delta Dentists (see DEFINITIONS) is be covered. Claims for services from non-Delta
available in a directory at your group benefits Dentists may be submitted to Delta at the address
office, or by calling 1-800-427-3237. listed on page 1.
Payment to a Delta Dentist will be based on the Dentists located outside the United States are not
applicable percentage of the lesser of the Fee Delta Dentists. Claims submitted by out-of-country
Actually Charged, or the accepted Usual, dentists are translated by Delta staff and the
Customary and Reasonable Fee that the dentist has currency is converted to U.S. dollars. Claims
on file with Delta. submitted by out-of-country dentists for patients
residing in California are referred to Delta's Quality
Payment to a dentist located outside the United Review department for processing Delta may
States will be based on the applicable percentage of require a clinical examination to determine the
the lesser of the Fee Actually Charged, or the fee quality of the services provided, and Delta may
which satisfies the majority of Delta's dentists. decline to reimburse you for Benefits if the services
are found to be unsatisfactory.
Payment to a dentist outside of California who
agrees to be bound by Delta's rules in the A list of Delta Dentists can be obtained by calling
administration of the program will be based on the 1-800-427-3237. This list will identify those
applicable percentage of the lesser of the Fee dentists who can provide care for individuals who
Actually Charged or the Customary Fee for have mobility impairments or have special health
9
care needs. You can obtain specific information policy in writing to: Delta Dental Plan of California,
about Delta Dentists by using our web site— Customer and Member Service Department,P. O.
www.deltadentalca.org or calling the Delta Box 7736, San Francisco, CA 94120.
Customer and Member Service Department at the
number shown on page 1. A printed list of the SAVING MONEY ON YOUR DENTAL BILLS
Delta Dentists in your area is also available by
calling 1-800-427-3237. You can keep your dental expenses down by
practicing the following:
Services maybe obtained from any licensed dentist
during normal office hours. Emergency services are 1. Comparing the fees of different dentists;
available in most cases through an emergency
telephone exchange maintained by the local dental 2. Using a Delta Dentist;
society which is listed in the local telephone
directory. 3. Having your dentist obtain predetermination
from Delta for any treatment over$300;
Services from dental school clinics may be provided
by students of dentistry or instructors who are not 4. Visiting your dentist regularly for checkups;
licensed by the state of California.
5. Following your dentist's advice about
Delta shares the public and professional concern regular brushing and flossing;
about the possible spread of HIV and other
infectious diseases in the dental office. However, 6. Avoiding putting off treatment until you
Delta cannot ensure your dentist's use of have a major problem; and
precautions against the spread of such diseases,or
compel your dentist to be tested for HIV or to 7. By learning the facts about overbilling.
disclose test results to Delta, or to you. Delta Under this program, you must pay the
informs its panel dentists about the need for clinical dentist your copayment share (see YOUR
precautions as recommended by recognized health BENEFITS)_ You may hear of some
authorities on this issue. If you should have dentists who offer to accept insurance
questions about your dentist's health status or use of payments as"full payment. You should
recommended clinical precautions, you should know that these dentists may do so by
discuss them with your dentist. overcharging your program and may do
more work than you need,thereby
CONTINUITY OF CARE increasing program costs. You can help
keep your dental Benefits intact by avoiding
If you are undergoing a course of treatment and such schemes.
your dentist no longer is a Delta Dentist,you may
continue to receive treatment from that dentist. YOUR FIRST APPOINTMENT
PUBLIC POLICY PARTICIPATION BY During your first appointment, be sure to give your
ENROLLEES dentist the following information:
Delta's Board of Directors includes Enrollees who 1. Your Delta group number(on the front of
participate in establishing Delta's public policy this booklet);
regarding Enrollees through periodic review of
Delta's Quality Assessment program reports and 2. The employer's name;
communication from Enrollees. Enrollees may
submit any suggestions regarding Delta's public
10
3. Primary Enrollee's social security number PAYMENT
(which must also be used by Dependents);
Delta will pay Delta Dentists directly. Our
4. Primary Enrollee's date of birth; agreement with our Delta Dentists makes sure that
you will not be responsible to the dentist for any
5. Any other dental coverage you may have. money we owe. However, if for any reason we fail
to pay a dentist who is not a Delta Dentist,you may
PREDETERIVIINATIONS be liable for that portion of the cost. If you have
selected a non-Delta Dentist, Delta will pay you.
After an examination,your dentist will talk to you Payments made to you are not assignable(in other
about treatment you may need. The cost of words,we will not grant requests to pay non-Delta
treatment is something you may want to consider. Dentists directly).
If the service is extensive and involves crowns or
bridges, or if the service will cost more than$300, Delta does not pay Delta Dentists any incentive as
we encourage you to ask your dentist to request a an inducement to deny, reduce, limit or delay any
predetermination. appropriate service. If you wish to know more
about the method of reimbursement to Delta
A predetermination does not guarantee payment. Dentists,you may call Delta's Customer and
It is an estimate of the amount Delta will pay if Member Service Department for more information.
you are eligible and meet all the requirements of
your program at the time the treatment you have Payment for claims exceeding $500 for services
planned is completed. provided by dentists located outside the United
States may, at Delta's option,be conditioned upon a
In order to receive predetermination, your dentist clinical evaluation at Delta's request(see Second
must send an Attending Dentist's Statement tows Opinions). Delta will not pay Benefits for such
listing the proposed treatment. Delta will send your services if they are found to be unsatisfactory.
dentist a Notice of Predetermination which
estimates how much you will have to pay. After Payment for any Single Procedure which is a
you review the estimate with your dentist and Covered Service will only be made upon
decide to go ahead with the treatment plan,your completion of that procedure. Delta does not make
dentist returns the statement to us for payment when or prorate payments for treatment in progress or
treatment has been completed. incomplete procedures. The date the procedure is
completed governs the calculation of any
Computations are estimates only and are based on Deductible (and determines when a charge is made
what would be payable on the date the Notice of against any Maximum)under your program.
Predetermination is issued if the patient is eligible.
Payment will depend on the patient's eligibility and If there is a difference between what your dentist is
the remaining annual Maximum when completed charging you and what Delta says your portion
services are submitted to Delta. should be, or if you are not satisfied with the dental
work you have received, contact Delta's Customer
Predetermining treatment helps prevent any and Member Service Department. We may be able
misunderstanding about your financial to help you resolve the situation.
responsibilities. If you have any concerns about the
predetermination, let us know before treatment Delta may deny payment of any Attending Dentist's
begins so your questions can be answered before Statement for services submitted more than six
you incur any charges. months after the date the services were provided. If
a claim is denied due to a Delta Dentist's failure to
make a timely submission, you shall not be liable to
11
that dentist for the amount which would have been Delta will authorize such an examination prior to
payable by Delta(unless you failed to advise the treatment when necessary to make a Benefits
dentist of your eligibility at the time of treatment). determination in response to a request for a
Predetermination of treatment cost by a dentist.
The process Delta uses to determine or deny Delta will also authorize a second opinion after
payment for services are distributed to all Delta treatment if an Enrollee has a complaint regarding
Dentists. They describe in detail the dental the quality of care provided. Delta will notify the
procedures covered as Benefits,the conditions Enrollee and the treating dentist when a second
under which coverage is provided, and the opinion is necessary and appropriate, and direct the
limitations and exclusions applicable to the Enrollee to the Regional Consultant selected by
program. Claims are reviewed for eligibility and Delta to perform the clinical examination. When
are paid according to these processing policies. Delta authorizes a second opinion through a
Those claims which require additional review are Regional Consultant,we will pay for all charges.
evaluated by Delta's dentist consultants. If any
claims are not covered, or if limitations or Enrollees may otherwise obtain second opinions
exclusions apply to services you have received from about treatment from any dentist they choose, and
a Delta Dentist,you will be notified by an claims for the examination or consultant may be
adjustment notice on the Notice of Payment or submitted to Delta for payment. Delta will pay such
Action. You may contact Delta's Customer and claims in accordance with the Benefits of the
Member Service Department for more information program.
regarding Delta's processing policies.
This is only a summary of Delta's policy on
IF YOU HAVE QUESTIONS ABOUT second opinions. A copy of Delta's formal policy
SERVICES FROM A DELTA DENTIST is available from Delta's Customer and Member
Service Department upon request.
If you have questions about the services you receive
from a Delta Dentist, we recommend that you first ORGAN AND TISSUE DONATION
discuss the matter with your dentist. If you
continue to have concerns, call our Quality Review Donating organ and tissue provides many societal
Department at 1-888-335-8227. If appropriate, benefits. Organ and tissue donation allows
Delta can arrange for you to be examined by one of recipients of transplants to go on to lead fuller and
our consulting dentists in your area. If the more meaningful lives. Currently,the need for
consultant recommends the work be replaced or organ transplants far exceeds availability. If you are
corrected,Delta will intervene with the original interested in organ donation,please speak to your
dentist to either have the services replaced or physician. Organ donation begins at the hospital
corrected at no additional cost to you or obtain a when a patient is pronounced brain dead and
refund. In the latter case, you are free to choose identified as a potential organ donor. An organ
another dentist to receive your full Benefit. procurement organization will become involved to
coordinate the activities.
SECOND OPINIONS
COMPLAINT PROCEDURE, CLAIMS
Delta obtains second opinions through Regional APPEAL AND ARBITRATION
Consultant members of its Quality Review
Committee who conduct clinical examinations, If you have any questions about the services you
prepare objective reports of dental conditions, and receive from a Delta Dentist, we recommend that
evaluate treatment that is proposed or has been you first discuss the matter with your dentist. If you
provided. continue to have concerns, call our Quality Review
Department at 1-888-335-8227.
12
We will provide notification if any dental services resolution procedures that may be available to you,
or claims are denied, in whole or in part, stating the and your failure to use these processes does not
specific reason or reasons for denial. If you have a preclude your use of any other remedy provided by
question or complaint regarding eligibility,the law.
denial of dental services or claims,the policies,
procedures and operations of Delta, or the quality of Disputes relating to your plan, including claim
dental services performed by a Delta Dentist,you denials,may be settled by arbitration if they cannot
may contact us at the telephone number shown on be settled by this complaint process. Arbitration
page 1. You have 60 days after you receive notice will follow the Commercial Rules of the American
of denial to appeal. If you write,you must include Arbitration Association(AAA). You can begin this
the name of the patient, the group name and process by giving written notice to each party(for
number,the Primary Enrollee's name and social example,Delta and your dentist)with whom you
security number or identification number and your want to arbitrate, explaining the dispute and the
telephone number on all correspondence. You amount involved, if any, and the solution you wish.
should also include a copy of the treatment form, You must then file two copies of the notice with the
Notice of Payment and any other relevant Association's regional office in Los Angeles or San
information. Clearly explain your complaint and Francisco, along with the fee required by the
send it to us at the address shown on page 1. Association.
We will review your complaint and will resolve the In the event of extreme hardship on the part of an
matter within 30 days of receipt or inform you of Enrollee or subscriber, and upon an application for
the pending status of the complaint if more relief presented to the AAA,Delta shall assume all
information or time is needed to resolve the matter., or a portion of the arbitration fees and expenses as
We will respond within three days of receipt to determined by the AAA in accordance with
complaints involving severe pain and imminent and procedures established and administered by the
serious threat to a patient's health. AAA.
The California Department of Managed Health Care IF YOU HAVE ADDITIONAL COVERAGE
is responsible for regulating health care service
plans. The department has a toll-free number It is to your advantage to let your dentist and Delta
1-888-HMO-2219 to receive complaints regarding know if you have dental coverage in addition to this
health plans. The hearing and speech impaired may Delta program. Most dental carriers cooperate with
use the California Relay Service's toll-free one another to avoid duplicate payments,but still
telephone numbers 1-800-735-2929 (TTY)or allow you to make use of both programs-
1-888-877-5378 (TTY)to contact the department. sometimes paying 100%of your dental bill. For
The department's Internet web site example,you might have some fillings which cost
(http://www.hmohelp.ca.gov)has complaint forms $100. If the primary carrier usually pays 80%o for
and instructions online. If you have a grievance these services, it would pay$80. The secondary
against the plan, you should first telephone the plan carrier might usually pay 50% for this service. In
at 1-888-335-8227 and use the plan's grievance this case, since payment is not to exceed the entire
process before contacting the department. If you fee charged, the secondary carrier pays the
need help with a grievance involving an emergency, remaining$20 only. Since this method pays 100%
a grievance that has not been satisfactorily resolved of the bill,you have no out-of-pocket expense.
by the plan, or a grievance that has remained
unresolved for more than 30 days,you may call the Be sure to advise your dentist of all programs under
department for assistance. The plan's grievance which you have dental coverage and have him or
process and the department's complaint review her complete the dual coverage portion of the
process are in addition to any other dispute Attending Dentist's Statement, so that you will
13
receive all benefits to which you are entitled. For misconduct), or the reduction in
further information,contact the Delta Customer and work hours, by your employer;
Member Service Department at the number in the
USING THIS BOOKLET section. Event 2. your death;
S
OPTIONAL CONTINUATION OF Event 3. your divorce or legal separation from
COVERAGE (COBRA OR CAL-COBRA) your spouse;
The federal Consolidated Omnibus Budget Event 4. your Dependents' loss of dependent
Reconciliation Act(or COBRA,pertaining to status under the plan, and
certain employers having 20 or more employees)
and the California Continuation Benefits Event 5. as to your Dependents only, your
Replacement Act (or Cal-COBRA, pertaining to entitlement to Medicare.
employers with 2-19 employees),both required
continued health care coverage be made available to You means the Primary Enrollee.
"Qualified Beneficiaries"who lose health care
coverage under the group plan as a result of a PERIODS OF CONTINUED COVERAGE
"Qualifying Event". You or your Dependents may
be entitled to continue coverage under this program_, Qualified Beneficiaries may continue coverage for
at the Qualified Beneficiary's expense, if certain 18 months following the month in which Qualifying
conditions are met. The period of continued Event 1 occurs.
coverage depends on the Qualifying Event.
This 18 month period can be extended for a total of
DEFINITIONS 29 months,provided:
The meaning of key terms used in this section are 1. a determination is made under Title II or
shown below. Title XVI of the Social Security Act that an
individual is disabled on the date of the
Qualified Beneficiary means: Qualifying Event or becomes disabled at any
time during the first 60 days of continued
1. you and/or your Dependents who are coverage; and
enrolled in the Delta plan on the day before
the Qualifying Event, or 2. notice of the determination is given to the
employer during the initial 18 months of
2. a child who is bom to or placed for adoption continued coverage and within 60 days of
with you during the period of continued the date of the determination.
coverage,provided such child is enrolled
within 30 days of birth or placement for This period of coverage will end on the first day of
adoption. the month that begins more than 30 days after the
date of the final determination that the disabled
Qualifying Event means any of the following individual is no longer disabled. You must notify
events which, except for the election of this the employer within 30 days of any such
continued coverage,would result in a loss of determination.
coverage under the dental plan:
If, during the 18 months continuation period
Event 1. the termination of employment resulting from Qualifying Event 1,your
(other than termination for gross Dependents,who are Qualified Beneficiaries,
experience Qualifying Events 2, 3,4,or 5,they may
14
choose to extend coverage for up to a total of 36 Premiums for each month since the loss of
months (inclusive of the period continued under coverage. Failure to pay the required Premiums
Qualifying Event 1). within the 45 days will result in the loss of the right
to continue coverage, any Premiums received after
Your Dependents, who are Qualified Beneficiaries, that will be returned to the Qualified Beneficiary.
may continue coverage for 36 months following the
occurrence of Qualifying Events 2,3, 4 or 5. CONTINUED COVERAGE BENEFITS
Under federal COBRA law only, when an employer The Benefits under the continued coverage will be
has filed for bankruptcy under Title H,United States the same as those provided to active employees and
Code,benefits may be substantially reduced or their Dependents who are still enrolled in the dental
eliminated for retired employees and their plan. If the employer changes the coverage for
Dependents, or the surviving spouse of a deceased active employees,the continued coverage will
retired employee. If this benefit reduction or change as well. Premiums will be adjusted to
elimination occurs within one year before or one reflect the changes made.
year after the filing, it is considered a Qualifying
Event. If you are the retiree, and you have lost TERMINATION OF CONTINUED
coverage because of this Qualifying Event,you may COVERAGE
choose to continue coverage until your death. Your
Dependents who have lost coverage because of this A Qualified Beneficiary's coverage will terminate at
Qualifying Event may choose to continue coverage the end of the month in which any of the following
for up to 36 months following your death. events first occurs:
ELECTION OF CONTINUED COVERAGE 1. the allowable number of consecutive months_
of continued coverage is reached;
Your employer will notify Delta in writing within
30 days of Qualifying Event 1. A Qualified 2. failure to pay the required Premiums in a
Beneficiary must notify Delta in writing within 60 timely manner;
days of Qualifying Events 2, 3, 4, or 5 or within 60
days of receiving the election notice from the 3. the employer ceases to provide any group
employer. Otherwise, the option of continued dental plan to its employees;
coverage will be lost.
4. the individual first obtains coverage for
Within 14 days of receiving notice of a Qualified dental Benefits, after the date of the election
Event, Delta will provide a Qualified Beneficiary of continued coverage,under another group
with the necessary benefits information,monthly health plan(as an employee or Dependent)
Premiums charge,enrollment forms, and which does not contain or apply any
instructions to allow election of continued coverage. exclusion or limitation with respect to any
pre-existing condition of such a person,if
A Qualified Beneficiary will than have 60 days to that pre-existing condition is covered under
give Delta written notice of the election to continue this program;
coverage. Failure to provide this written notice of
election to Delta within 60 days will result in the 5. entitlement to Medicare; or
loss of the right to continue coverage.
6. the individual becomes eligible for coverage
A Qualified Beneficiary has 45 days from the under the federal COBRA law. The
written election of continued coverage to pay the employer shall notify Delta within 30 days
initial Premiums to Delta, which includes the
15
of the date when a Qualified Beneficiary
becomes so eligible.
Once continued coverage ends,it cannot be
reinstated.
TERMINATION OF THE EMPLOYER'S
DENTAL CONTRACT
If the dental Contract between the employer and
Delta terminates prior to the time that the
continuation coverage would otherwise terminate,
the employer shall notify a Qualified Beneficiary
under Cal-COBRA either 30 days prior to the
termination or when all Enrollees are notified,
whichever is later, of the ability to elect
continuation coverage under the employer's
subsequent dental plan, if any. The continuation
coverage will be provided only for the balance of
the period that a Qualified Beneficiary would have
remained covered under the Delta program had such
program with the former employer not terminated.
The employer shall notify the successor plan in
writing of the Qualified Beneficiaries receiving
continuation coverage so they may be notified of
how to continue coverage. The continuation
coverage will terminate if a Qualified Beneficiary
fails to comply with the requirements pertaining to
enrollment in, and payment of Premiums to the new
group benefit plan.
OPEN ENROLLMENT CHANGE OF
COVERAGE
A Qualified Beneficiary under Cal-COBRA may
elect to change continuation coverage during any
subsequent open enrollment period,if the employer
has contracted with another plan to provide
coverage to its active employees. The continuation
coverage under the other plan will be provided only
for the balance of the period that a Qualified
Beneficiary would have remained covered under the
Delta program.
16
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BENEFIT HIGHLIGHTS FOR CITY OF HUNTINGTON BEACH GROUP NO. 4729
dDELTAPREMIER® DELTAPREMIER IS EASY TO USE
Managed Fee-for-Service Program
DeltaPremier is a fee-for-service plan with freedom to choose any licensed
dentist.The program pays a percentage for covered services;you may be
ABOUT DELTAPREMIER charged only what Delta determines is the"patient share.—
The DeltaPremier plan allows you to: To use the plan,just call the dental office of your choice and make an
appointment. During your first appointment,give your dentist your group number,
• Visit any licensed dentist of your choice which is at the top of this page,and the primary enrollee's social security
• Change dentists at any time number.
• Go to a dental specialist of your choice For a list of Delta dentists in your area, search the dentist directory on our web
• Receive dental care anywhere in the world site at www.deltadentaica.org or call our toll-free automated telephone service at
(800)4-AREA-DR(800-427-3237).You can also check with your benefits
Under the DeltaPremier plan,you may visit any licensed dentist you wish. Nearly administrator,who has a complete list of Delta dentists.
22,000 dental offices in California—92%of all dentists statewide—are Delta You can also view your eligibility and benefits information on our web site,
dentists.'There are several advantages to choosing a Delta dentist: including remaining deductible and maximum amounts for you and your family.
DELTA DENTIST NON-DELTA DENTIST Or, you can have the information faxed to you by calling toll-free(888) DELTA
CS(888-335-8227).
Claim forms are completed and You may have to complete and Delta Dental Plan of California offers you what no other dental plan can—The
submitted for you at no charge. . submit your own claim forms or pay Delta Difference®. Here's what makes us unique:
a service fee.
♦ We prenegotiate dentists'fees. Delta dentists agree to charge you the
Your dentist's fees have been Delta has not certified the dentist's lowest fees usually charged in their office. `
certified by Delta as usual, fees—you are responsible for the
customary and reasonable—you're difference if your dentist charges • Copayments are guaranteed. Delta dentists charge you only what Delta
responsible only for the patient more than Delta's preapproved fees. determines to be your share of the treatment cost. If your share is 20
share." percent, you pay 20 percent of the Delta-approved fee—and no more.
♦ We require professional treatment standards.Delta dentists must meet
You maybe charged only the patient You may have to pay the entire bill professional standards for hygiene, radiation safety and other areas related
share`at the time of treatment,not at the time of treatment and wait for to quality care.
Delta's portion. reimbursement. These are just a few of the reasons that one in three Californians counts on
Delta for dental care benefits.
'Patient share'is the copsyment,any deductible and any amount over the annual maximum.Some
services may not be covered,please refer to your Evidence of Coverage.Some examples of services not
covered are cosmetic dentistry,experimental procedures and services to correct congenital
malformations.
BENEFIT HIGHLIGHTS FOR CITY OF HUNTINGTON BEACH GROUP NO. 4729
PRINCIPAL BENEFITS AND COVERED SERVICES* SERVICES THAT ARE NOTCOVERED
Although your plan covers many of the most commonly needed
WHO'S COVERED Primary enrollee and spouse as well as services, some services are not covered. If you are unsure
dependent children to age 19 and full- whether a particular procedure is covered,or how much of it is
time students to age 25. paid for by your plan,check with Delta before proceeding.
The following are not covered by the plan:
DEDUCTIBLES AND $25 per person,$75 per family per • Services for injuries or conditions covered under Workers'
BENEFITS MAXIMUM calendar year. The maximum benefit Compensation or Employer's Liability Laws . . .
paid per calendar year is$1000 per • Cosmetic surgery or dentistry or services to correct
person. congenital malformation
♦ Experimental procedures
DIAGNOSTIC AND PREVENTIVE 85%of Delta dentist's fee • Therapeutic drugs,premedication or pain relievers
BENEFITS*—oral examinations, • Hospital costs or extra charges for.hospital treatment
cleanings, x-rays,examinations of tissue ♦ Anesthesia(except for general anesthesia for oral surgery)
biopsy,fluoride treatment, space • Extra-oral grafts,implants and implant removal
maintainers, specialist consultations ♦ Treatment related to the temporomandibular joint(TMJ)
The preceding Information Is not Intended for use as a
BASIC BENEFITS*—oral surgery 85%of Delta dentist's fee summary plan description,nor is it designed to serve as an
(extractions),tissue removal (biopsy), Evidence of Coverage for the plan..
fillings, root canals, periodontic(gum)
treatment, sealants This DeltaPremier plan Is administered by Delta Dental Plan of
California.If you have specific questions regarding benefit
structure, limitations or exclusions,consult the Evidence of
CROWNS,JACKETS AND OTHER CAST 85%of Delta dentist's fee Coverage or contact Delta's Customer and Member Service
RESTORATIONS* department.
PROSTHODONTIC BENEFITS*— 60%of Delta dentist's fee (denture DELTA DENTAL®
bridges, partial dentures,full dentures subject to a maximum allowance) Delia Dental Plan of California
ORTHODONTIC BENEFITS*—for adults 60%of Delta dentist's fee(subject to a P.O.Box 7736
and eligible dependent children $3000 lifetime maximum per person) San Francisco;California 94120
DENTAL ACIDENT BENEFITS* 100%of Delta dentist's fee For customer service and eligibility/benefits information:
(888)DELTA CS(888-335-8227)or
"Please refer to your Evidence of Coverage for limitations on these benefits. cros@delta.org
Some examples of limitations on services are the number of cleanings and oral exams For online or faxed eligibility/benefits information:
covered in a calendar year,and time limitations on filling and crown replacements. www.deltadentalca.org or
(888)DELTA CS(888-335-8227)and press 1
For a list of Delta dentists:
(800)4-AREA-DR(800-427-3237)or
www.deltadentaica.org
(Group 4729.99)1 spl Ulaitcr Rev.h,4tl i
:
1,218 08/01 HSM
Res. No. 2002-122
EXHIBIT F — VISION (VSP) PLAN BROCHURE
A copy of the Vision (VSP) Brochure
may be obtained from the
Administrative Services Department
2003 FMA MOU Final.doc 4� 04/02/02 7:54 AM
If you have problems with your eligibility, contact the VSP • v
n� �,
�•:,� � j Customer Service phone number listed in this brochure.
For More Information
This information is a summary of your VSP benefit. Note: In
the event of a conflict between this brochure and your
f°t' group or health Ian's contract with VSP, the terms of the
contract will prevail. For more information,call the VSP
Customer Service phone number, or log on to our Web site
j:
at www.vsp.com, and click on the Information for Members
button. =__
lo�v To Use Your Bettel'it5
1. c Al your VSP doctor�uul in,ike in ippointmoill. _ R
49 c
2. When you call, tell the doctor you are a VSP member
and give the following information: '
•Your name and date of birth
•l lie name of the group that provides your t� 5`.
VSP coverage(This may be your or your spouse's
employer, organization, health plan,trust fund, etc.)
• Covered member's VSP identification number VSP Customer Service, 24-hour,
(usually the Social Security number)* toll-free phone number:
*The covered member is the person whose group provides your VSP 1-800-877-7195
coverage.If it's not your group that provides you with VSP, then it's
probably your spouse or a parent. T.D.D. for the hearing impaired. >..
1-800-428-4833
3. After you make an appointment, your doctor and Web site address: www.vsp.com
VSP will handle the rest.The doctor will check your Vision Service Plan is an Equal Opportunity "''' fi�' •
eligibility for services and plan coverage. and Affirmative Action Employer.
During your doctor visit, ask whether the services and
materials—such as eyewear—that you want are covered
by your VSP plan. Help Prevent Insurance Fraud
Tints, special lenses and scratch-resistant coatings are VSP's Fraud Watch Hotline
some of the cosmetic options that may be covered under 1-800-877-7236
your plan or available to you at discounted prices. using your
Pay your doctor for any copayments and other costs V 1 s 1 O n
not covered by your VSP plan. VSP pays the doctor for " , _,
services and materials covered by your VSP plan. w service plan
b nef
IC0_, 45 li-MIN MGU
t O the AS a Vision Service flan nternl►et, {''tn(Illtr a VSP Do(-tot-
Welcome
Vou {rave: Yore, cca►l easily f i►ul cr VSP cloclor• by:
Nations Premier Grew rrcv•ess to (boors • Asking your organization's benefits representative
We have the nation's largest eyecare doctor network,with • Calling the VSP Customer Service phone number
l� ye (' are thousands a 1 l 1 P a t1 . thousands of doctors located in metropolitan as well as • Logging on to the VSP Web site at www.vsp.com, and
rural areas. using the Doctor Directory
, . Set-vic o ut•es Fr-o►rr re O -o/'Nel.ruo►•k I'r-ovirlvt-
/;scv llerrl Ireolllr 1►rolr c lio►r
_ All of our plans provide a thorough eye examination,which is Typically, more than 90 percent of our patients receive care
important to your overall health. Eye examinations can from VSP doctors. If you wish to see an out-of-network
r detect and diagnose numerous medical problems, including provider, VSP will reimburse you up to the amount allowed
under our Ian's out-of-network provider reimbursement
diabetes, glaucoma, high blood pressure and certain Y P
E1.• !t` rate. Be aware that our out
provider
cancers. y I
.. � reimbursement rate does not guarantee full payment, and
} Iliti Vol'(mmot gu,1r nwe lmlient satisLlction when st,rvu(
We were onto of the first eyecare health plans to use are received from an out-of-network provider. If your plan
Nj
stringent National Committee for Quality Assurance allows such reimbursements, pay the entire bill when you
guidelines to credential all of our doctors. These guidelines M.. g g see the out-of-network provider and gather the following
are increasingly becoming the national benchmark for information:
evaluating the quality of health plans. •The provider's bill, including a detailed list of the
Your.• VSP benefits at a Glance services you received
VSP benefits are designed to protect your visual wellness. Consequently, you may have to pay extra if you choose certain cosmetic •The covered member's VSP member identification
or elective eyewear options. Before selecting your eyewear, ask your doctor what is fully covered by your VSP plan. The following number(usually the Social Security number)
summarizes the main benefits of your plan. • The covered merTlber's name, phone number
and address
BENEFIT FREQUENCY CO-PAY FROM VSP DOCTOR FROM OUT-OF-NETWORK PROVIDER , •The name of the organization that provides your
VSP coverage
Examination 12 months' Covered Covered up to$40 • Your name, date of birth, phone number and
address
Lenses' 12 months' Covered Covered up to$40/single vision • Your relationship to the covered VSP member
Covered up to$60/bifocal (such as "self," "spouse," "child," etc.)
$10 for Covered up to$80/trifocal Claims must be filed with VSP within six months after
covered benefit Covered up to$125/lenticular seeing the provider.
(services&materials) A wide selection of
Frame' — -- 12 months' attractive frames Covered up to$45 Please keep a copy of the information for your records and
are covered in full send the originals to:
Contact Lenses'^ Vision Service Plan
Medically Necessary' 12 months' Covered Covered up to$210 Attn.: Out-of-Network Provider Claims
Elective 12 months' None Covered up to$105 Covered up to$105 P.O. Box 997100
Sacramento, CA 95899-7100
1 0a5ed on your last date of service.
2 Your plan provides a 20 percent discount on non-covered complete pairs of prescription glasses when provided by a VSP doctor.
3 Patients choosing contacts use their eligibility for a franie and lenses.
4 Your pian includes a 15 percent discount off of the VSP doctor's professional services when buy,ng contact lenses.Matenmis are provided at the customary fees. City of I.f u r Iting tort Beach
S Medically necessary contact lenses must be prescribed by a VSP eloctor for certain conditions.Your VSP doctor must get prior approval from VSP for medically necessary contact lenses 00105162 1140404
�w
VISION SERVICE PLAN
Benefit Summary for
CITY OF HUNTINGTON BEACH
LLI
BENEFITS: Examination Once every 12 months
Lenses Once every 12 months
Frame Once every 12 months
COPAYMENT: Examination and/or Materials $10.00
Services from a Services from a
VSP Participatine Provider Non-Participatine Provider
Examination Paid-in-Full up to$ 40.00
Single Vision Lenses Paid-in-Full up to$ 40.00
Bifocal Lenses Paid-in-Full up to$ 60.00
Trifocal Lenses Paid-in-Full up to$ 80.00
Lenticular Lenses Paid-in-Full up to$125.00
Frame(') VSP fully covers a wide
selection of attractive frames. up to$ 45.00
Tint Paid-in-Full up to$ 5.00
Contact Lenses(3) (Instead of a complete pair of prescription glasses)
Necessary Paid-in-Full less copayment up to$210.00
Elective up to$ 105.00 up to$105.00
Obtaining services from a VSP doctor:When you want to obtain vision care services,call a VSP doctor to make an appointment.For details
on how you locate a VSP doctor,contact your benefits representative or call VSP at 800-877-7195 to request a VSP doctor listing. Make sure
you identify yourself as aVSP member,and be prepared to provide the covered member's social security number.The VSP doctor will
contact VSP to verify your eligibility and plan coverage,and will also obtain authorization for services and materials.If you are not currently
eligible for services,the VSP doctor is responsible for communicating this to you.VSP will pay the doctor directly for covered services and
materials.
Obtaining services from an out-of network provider:Services and materials obtained from an out-of-network provider will be reimbursed up
to amounts on the above schedule less any copayments.For out-of-network reimbursement,pay the entire bill when you receive services,then
send your itemized receipts and full patient and member information to VSP.Claims must be submitted to VSP within six months from your
date of service.Please keep a copy of the information for your records and send the originals to the following address:Vision Service Plan,Out-
of-Network Provider Claims,P.O.Box 997105,Sacramento,CA 95899-7105.
ADDITIONAL BENEFITS:
Laser Vision Correction:VSP's Laser VisionCares'program is also available to those covered under this VSP WellVision®Plan.It is
designed to provide members with a discount off laser surgery when obtained through VSP contracted doctors,surgeons and laser centers.This
program includes the two most common laser vision correction procedures,laser-assisted in-situ keratomileusis(LASIK)and photorefractive
keratectomy(PRK).Call your VSP doctor to check if he or she is participating in the program.Doctors can also be located on VSP's Web site at
www.vsp.com or by calling 888-354-4434.
1 When an exam and/or materials are received from a VSP doctor,the patient will have no out-of-pocket expense other than the copayment,unless
optional items are selected. Optional items include,but are not limited to,oversize lenses(61 mm or larger),coated lenses,no-line multifocal
lenses,treatments for cosmetic reasons or a frame that exceeds the plan allowance. VSP doctors offer valuable savings including a 20 percent
discount on non-covered pairs of prescription glasses(lenses and frame).Services must be received within 12 months from the same VSP doctor
who provided your last covered eye exam.You can also save 15 percent off the cost of your contact lens exam when you receive contact lens
services from VSP.(This discount does not apply to the contact lens materials.)
2 Your VSP benefit provides guaranteed savings whether you choose a frame that is covered in full or one that exceeds the plan allowance.If you
choose a frame valued at more than the plan's allowance,the difference you'll pay is based on VSP's low,discounted member pricing. Have
your doctor help you choose the best frame for you based on your VSP coverage.
3 The allowance is in addition to the 15 percent discount on the contact lens exam.The allowance is applied to both the contact lens exam(fitting
and evaluation)and the contact lenses.Any costs exceeding this allowance are the patient's responsibility.The contact lens exam is a special
exam for ensuring proper fit of your contacts and evaluating your vision with the contacts.Medically necessary contact lenses must be prescribed
by your doctor(as required for certain medical conditions)and approved by VSP.
Aoes ��� 1�r
THIS IS ONLY A SUMMARY
FOR FURTHER INFORMATION,SEE YOUR EMPLOYER'S BENEFIT REPRESENTATIVE
VISIONSERVICE PLAN CUSTOMER SERVICE (800)877-7195
Visit our Web site at http://www.vsp.com
' CALIFORNIA, SECTIO
Southern California
Except Los Angeles
i
VSP
LIST OF PARTICIPATING DOCTORS
Counties:
Imperial
Orange
.Riverside
San Diego
This list is also available on our Web site
at www.vsp.com and is updated weekly.
PLEASE NOTE
By acceptance and use of this VSP doctor list, recipient recognizes and
agrees that the information contained herein is protected proprietary
information and publication or dissemination of the information contained.
herein for any purpose other than the normal and necessary implementation
of the VSP vision care plan is prohibited. VSP
All VSP doctors accept new patients.The VSP doctors contained in this list 3333 Quality Drive
were VSP doctors at the time the list was created. However, this list is Rancho Cordova, CA 95670
subject to change without notice. Please check with the VSP doctor of your (800) 877-7195
choice when making your appointment to ensure he or she is currently
participating with VSP and provides the services you require. 01005 09/02
I11lpErld) County K.
A.Munroe,O.D.................................. 7960 Orangethorpe Ave., G714) 521-3:..
K.Leo Uyeda,O.D.....................................................5426 Beach BIN d., (714) 522-,.-
Brawley Helen L.Yoon,O.D.....................................................5319 Beach Blvd.,(714) 523
Donald L.Barniske,O.D..................................................260 Main St., (760)351-2020 Cerritos
George K.Ching,M.D.................................................116 N.Plaza St.,(760)344-4330 Justin T.Abo,O.D.........................................................11420 South St., (562) 860-1
David W.Gayle,O.D.........................................................537 Main SL, (760)344-1293 Thomas L.Blake,O.D..................................................11847 South St., (562) 865-c
Calexico Darlyne H.Fujimoto,O.D...........................................11420 South St., (562) 860-13.
Bill G.Bell,M.D..................................2451 Rockwood Ave.,Ste. 114,(760)357-4200 Helena Kim,O.D..........................................11900 South St.,Ste.121,(562)809-4",
David R.Boniface,O.D...................................................329 W.2nd SL,(760)357-2712 Jenny Y Kim,O.D.........................................................11420 South St., (562) 860-13'
EI Centro Larissa A.Murakami,O.D........................................11420 South St., (562) 860-1=?
George K.Ching,M.D......................................................444 S.8th St.,(760)336-3980 Sheldon B.Pitluk,O.D................................................11243 183rd St., (562) 924-0f
David P.Espinosa,O.D.......................................828 N.Imperial Ave.,(760)352-7460 David B.Rosenblum,O.D...............................326 Los Cerritos Mall, (562) 860-447
William F.Middleton,Jr.,O.D........................................496 Main St., (760) 353-1190 Seymour A.Rosenblum,O.D.........................326 Los Cerritos Mall, (562) 860-447-
Narendra J.Patel,M.D...................................................1461 State St., (760) 352-6234 Costa Mesa
Janina Soto,O.D............................................................215I Ross Ave., (760)352-3505 Jeffrey H.Brown,O.D...........,.........................1175 Baker St.,Ste.E16,(714)979-1Si;
Christopher M.Wright,O.D.............................................534 S.8th St.,(760)352-4361 Ronald V.Craig,O.D......................................234 E.17th St.;Ste-110,(949)548-163'
Orange County Melina Friedman,O.D 2706 Harbor Blvd.,Ste.B,(714)545-916=
Robert S.Glass,O.D.. ......... ........:1696 Newport Blvd.,Ste.D,(949)574 02t'"
Aliso Viejo - Steven S.Grant,O.D........................................................3140 Bear St., (714) 557-202a
Michael T.Bvwater,O.D...............27792 Aliso Creek Rd.,Ste-B124,(949)362-3300 Boban A.Joseph,M.D......................................3033 Bristol St.,Ste.E.,(714)957-270
Laura Giampiccolo,O.D................27001 Moulton Pky.,Ste.A'_04, (949)362-6552 Bob Kamkar,O.D.................................................1796 Newport Blvd.,(949) 642-202C
Peter L.Rich,O.D...................................26611 Aliso Creek Rd.,Ste.B,(949)362-2200 Dan E.Quart,O.D................................S.Coast Plaza Mall,Ste.1872,(714)540-202C
Anaheim Jack C.Shea,O.D...................................2200 Harbor Blvd.,Ste.D130,(949)642-78S2
Daniel W Berry,O.D......... 1092 N.State College Blvd.,(714)635-8671 Alissa S.Wald,O.D.....................................2706 Harbor Blvd.,Ste.B,(714)545-9162
David B.Ciminski,O.D......................................2091 W.Lincoln Ave.,(714)533-0960 Cypress
Suzanne M.Day,O.D.......................1211 W.La Palma Ave.,Ste-201,(714)533-3126 Ralph F.Hutter,O.D.........................................................4049 Ball Rd., (714) 828-060t
Robert Everakes,M.D........................3055 W.Orange Ave.,Ste.104,(714)826-6480 Noemi D.Larragoid,O.D...............................10145 Vallev View St., (714)229-19S,c
Carlos E.Green,O.D............................................2117 E.Lincoln Ave.,(714)776-8770 Joy T.Nakabayashi,O.D................................................4049 Ball Rd., (714)828-060('
Paul E.Habener,O.D...............................................220 W.Cypress St.,(714)774-3890 C.Gene Wilkins,O.D.......................................................5021 Ball Rd., (714)995-457]
Tony K.Huynh,O.D.................................1105 N.State College Blvd.,(714)998-3535 Dana Point
Stanley T.Kawai,O.D..........................................10502 Katella Ave., (714) 776-2020 Thomas C.Kopan,O.D................32585 Golden Lantern St.,Ste.H,(949)493-'160C
Eric J.Kawata,O.D................................101 E.Lincoln Ave.,Ste-103,(714)535-7515 William L.Petersen,O.D...........34179 Golden Lantern St.,Ste.201,(949)661-1181
Lulu Y.Kim,O.D.................................1150 N.Harbor Blvd.,Ste.118,(714)758-0185 Diana K.Thein,O.D........................................24692 Del Prado,Ste.B,(949)661-8884
Ian M.Lane,O.D.........................................................731 N.Euclid St.,(714)533-8240 Bruce T.Wagner,O.D.....................24040 Camino Del Avion,Ste.E.,(949)443-911(
A.J.Marchin,O.D...........................................2571 W.La Palma Ave.,(714)821-4666 Fountain Valley
Milton M.Nakano,O.D..........................2795 W.Lincoln Ave.,Ste.L,(714)527-5060 Del F.Barrett,O.D.................................................16341 Harbor Blvd., (714) 839-2021
Bao-Thu Nguyen,M.D.....................1211 W.La Palma Ave.,Ste.201,(714)533-3126 Dan B.Carver,O.D.................................10900 Warner Ave.,Ste.119,(714)963-3664
Nelson N.Noguchi,M.D....................3055 W.Orange Ave.,.Ste.203,(714)527-9347 James L.Cooperman,O.D.....................18449 Brookhurst St.,Ste.6,(714)963-2111
Joseph R.Occhipinti,O.D.....................................10502 Katella Ave., (714) 776-2020 Tina U.Dao,O.D...................................16027 Brookhurst St.,Ste.E.,(714)210-2393
Robert A.Reynolds,O.D.................330 N.State College Bl,Ste.205,(714)535-6777 Deep R.Dudeja,M.D................................................9940 Talbert Ave., (714) 964-370(
Robert S.Ross,O.D...............................................10502 Katella Ave., (714) 776-2020 Barbara B.Fineberg,O.D.......................18449 Brookhurst St.,Ste.6,(714)963-2111
Rodman F.Sandoval,O.D..................................2174 E.Lincoln Ave.,(714)772-1300 Harvey R.Goldstone,O.D...................................9107 Garfield Ave., (714) 963-202(
Steven A.Schmidt,M.D..................1211 W.La Palma Ave.,Ste.201,(714)533-3126 Nina H.Ha,O.D..................................18430 Brookhurst St.,Ste.100, (714)968-9121
David M.Shigekuni,O.D...................................2378 W.Lincoln Ave.,(714)635-6680 Sanford Koyama,O.D.......................18430 Brookhurst St.,Ste.100, (714)968-9121
Theo D.Tran,M.D.............................................1739 W.Romneva Dr.,(714)502-9393 Ronald F.Kuykendall,O.D...............................18120 Brookhurst St., (714) 963-834C
Patricia Uyekawa,O.D.................................2571 W.La Palma Ave.,(714)821-4666 Van T.Ly,O.D....................................... 16341 Harbor Blvd., (714) 839-2024
Garrett S.Wada,O.D..................................................2933 W.Ball Rd.,(714)827-9780 Lincoln Manzi,Jr.,M.D................ ....11100 Warner Ave.,Ste.214,(714)546-2020
Hershel B.Welton,O.D ...................303 W.Lincoln Ave.,Ste.120,(714)535-8404 Debra McLaurin,O.D............................... .........9940 Talbert Ave., (714) 964-3700
Timothy H.Welton;O.D......................303 W.Lincoln Ave.,Ste.120,(714)535-8404 Anh-LinhT.Nguyen,O.D..................................16125 Harbor Blvd.; (714) 53I-990C
Anaheim Hills Trung M.Nguyen,M.D........................11180 Warner Ave.,Ste. 151, (714)444-0303
Arthur D.Charap,M.D..............................500 S.Anaheim Hills Rd.,(714)921-0232 Lee H.Novick,M.D............................18837 Brookhurst St.,Ste.110, (714)378-0333
Harry J.Charm,O.D.........................6200 Canyon Rim Rd.,Ste.101,(714)998-2020 Gordon K.Ota,O.D.....................................10130 Warner Ave.,Ste.J,(714)965-513C
Robert E.Downs,O.D...........5701 E.Santa Ana Canyon Rd.,Ste.H,(714)998-8710 Harriet G.Stallings,O.D...........................10130 Warner Ave.,Ste.J,(7I4)965-5130
Ronald LaCroix,O.D.......................................5753 E.La Palma Ave.,(714)779-2596 S.Eugene Terada,O.D................................10130 Warner Ave.,Ste.J,(714)965-5130
Gary M.Lovcik,O.D..............5701 E.Santa Ana Canyon Rd.,Ste.H,(714)637-1640 Brittany A.To,O.D..........................................., 10968 Warner Ave., (714) 962-1 94
Rebecca M.Maravilla,O.D..........781 S.Weir Canyon Rd.,Ste.195,(714)282-2888 Yvonne V.To,O.D...................................................10968 Warner Ave., (714) 962-1794
Kari V.Nguyen,O.D..............................1081 N.Tustin Ave.,Ste.113,(714)632-1616 Hoai T.Tran,O.D.............................................15972 Euclid St.,Ste.G,(714)531-7626
Artesia Fullerton
Ken Imoto,O.D.........................................11436 Artesia Blvd.,Ste.D,(562)860-1717 V.Sanford Agarth,O.D.........1912 W.Commonwealth Ave.,Ste.D,(714)526-1513
Thomas C.Kang,O.D.... ..............................17617 Pioneer Blvd., (562)924-6271 Christopher G.Albaugh,O.D..........1321 N,Harbor Blvd.,Ste.300,(714)871-257C
Cheng-Hong J.Lee,O.D.......................................18371 Pioneer Blvd., (562)865-4190 Christopher T.Allred,O.D.............................1342 E.Chapman Ave.,(714)526-5515
Alvin Y.Quan,O.D...............................................18107 Pioneer Bh-d., (562)865-6017 Alvin M.Arellano,O.D..................................1909 W.Malvern Ave.,(714)992-802C
Brea J.Nickolas Berbos,M.D....................1321 N.Harbor Blvd.,Ste.300,(714)879-002(
David G.Kirschen,O.D............................................428 S.Brea Blvd.,(714)529-8228 Steven J.Chian,O.D.............................1839 W.Orangethorpe Ave.,(714)879-202C
Edgar A.Lucidi,M.D............................410 W.Central Ave.,Ste.101,(714)256-9170 Southern CA College of OptES.................2575 E.Yorba Linda Blvd.,(714)449-7401
Jan S.Lukac,M.D...................................410 W.Central Ave.,Ste.109,(714)529-9563 John E.Esser,O.D..............................301 W.Bastanchury Rd.,Ste.10,(714)879-737
Benjamin K.Marumoto,O.D...................................526 S.Brea Blvd.,(714)529-1676 Carleton S.Fong,O.D....................................,.2001 E.Chapman Ave.,(714)738-690
Stanley M.Matsuoka,O.D.........................................2170 Brea ball, (714) 990-9311 Ngoc Yen Hoang,O.D....._....................................501 N.Cornell Ave.,(714)525-3351'
Mark J.Piekarski,O.D................:.......255 E.Imperial Hwy.,Ste.DI,(714)990-2782 Sung S.Kim,O.D.................................................1028 Rosecrans Ave., (714) 738-5864
Laurie B.Stern,O.D..................................2500 E.Imperial H;,v-W8,(714)257-0399 Clyde K.Kitchen,M.D.......................1321 N.Harbor Blvd.,Ste.300,(714)879-0023
Nhan T.Tran,O.D.............................................110 W.Birch St.Unit 3,(714)529-9907 Nathan Kvetny,O.D.........................................2001 E.Chapman Ave.,(714)738-690=
Buena Park Thomas B.Law,O.D...........................1321 N.Harbor Blvd.,Ste.300,(714)871-257C'
James S.Cohen,O.D..................................................5811 Beach Blvd., (714)521-7582 Maryanne Marcolivio, O.D..................270 W.Laguna Rd.,Ste.100,(714)525-237
Osamu Ikeda,O.D...............................................8751 Valley Vies. St-,(714)827-7191 William D.Mosier,M.D...................1321 N.Harbor Blvd.,Ste.300,(714)871-257C
Sally I.Kim,M.D........................................5730 Beach Blvd.,Ste-201,(714)562-5857 Connie M.Park,O.D.................................................1425 S.Euclid St.,(714)680-500f'
Robert A.Lafont,O.D._.............................7960 Orangethorpe Ave., (714) 521-3002 William H.Peloquin,M.D............301 W.Bastanchury Rd.,Ste.115,(714)525-2251
John J.Monteleone,O.D. ...............................82SS Buena Park Mall,(714)828-7373 Robert T.Rice,O.D...........................................1342 E.Chapman Ave.,(714)526-5515
George P Saleen,O.D........................................612 E.Chapman Ave.,(71 k)525-5727 Kelly H.Dinh,O.D...................................4_55 Campus Dr.,Ste.112,(Q44)854-7122
Ramin Tayani,M.D................................270 W.Laguna Rd.,Ste.100,(714)525-2375, .Eran Duzman,M.D...........................................27 Mauchlev, Ste. 206, (9411t 450-0793
Clifford M.Terry,M.D...........................270 W.Laguna Rd.,Ste.100,(714)525-2375 Eran Duzman,M.D..............................4605 Barranca Pkv.,Ste. 100,(949)733-2002
John D.Zdral,M.D...........................301 W.Bastanchury Rd.,Ste.10,(714)879-7372 Keith A.Farson,O.D................................4940 Irvine Blvd.,Ste. 102,(714)730-9580
Garden Grove Dan W.Gilbert,O.D......._..........................4940 Irvine Blvd.,Ste.102,(714)730-9580
James D.Boyce,M.D......................12665 Garden Grove BI,Ste.401,(714)534-8373 Raymond Z.Huang,O.D...........................4230 Barranca Pky.,Ste.J,(949)559-8838
Robert H.Collier,NLD...................12663 Garden Grove BI,Ste.401,(714)534-8373 Christopher P.Likens,O.D...................4040 Barranca Pky.,Ste. 110,(949)857-0676
Donald W.Cook,O.D.............................12902 Brookhurst St.,Ste.A,(714)530-5050 Michael B.Lipman,O.D................................2030 Main St.,Ste. 115,(949)833-8446
Sally H.Dang,O.D........................12302 Garden Grove Blvd.,Ste.6,(714)590-2020 Mark A.Robin,O.D........................................14210 Culver Dr.,Ste.F,(949)857-1060
Michael P.De Carlo,O.D.................................10931 Chapman Ave., (714) 741-3937 Julie B.Ryan,O.D...................................4950 Barranca Pky,Ste.310,(949)733-1400
Carmen Jan,O.D......................................12620 Brookhurst St.,Ste. 1,(714)530-5720 Richard A.Sarlitt,O.D........................................5327 University Dr., (949) 786-7888
Stanley S.Kim,M.D...................................8736 Garden Grove Blvd., (714)534-8100 Michael N.Spitzer,O.D............................2646 DuPont Dr.,Ste.240,(949)955-3937
Shervn S.Lee,O.D............................9636 Garden Grove Blvd.,Ste.5,(714)537-1313 Zen-Ni So,O.D............................................14785 Jeffrev Rd.,Ste.107,(949)733-3390
Soo t.Lee,O.D. 9520 Garden Grove Blvd.,Ste.3,(714)530-2557 Ruth Tang,O.D............_..........................17585 Harvard Ave.,Ste.E.,(949)477-2424
Norman H.Liu,M.D......................12665 Garden Grove BI,Ste.401,(714)534-8373 Karen K.Toki,O.D................................4040 Barranca Pky.,Ste. 110,(949)857-0676
Joel K.Marutam,O.D.......................................12432 Brookhurst St., (714) 539-0100 Billy L.Tran,O.D..-........................... .'_967 Michelson Dr.,Ste..M,(949)250-7071
Terry Metsovas O.D..................... .........10931 Chapman Ave., (714)741-3937 Terry Y.Tsang,O.D...............................4950 Barranca Pky.,Ste.310,(949)733-1400
Dawn M.Miller,O.D..: ..................12620 Brookhurst St.,Ste.1,(714)530-5720 UC Irvine School of Opth:........... ..........Gottschalk Medical Plaza,.(949) 824-2020
Mai-HuongT.Nguyen,O.D. 13192 Harbor Blvd., (714)534-3100 David Wakabavashi,O.D ......:.............4200 Trabuco Rd.,Ste. 170,(949)552-2020
Mai-Huong T.Nguyen,O.D. ........................9191 Westminster Ave:, (714) 698-8100 John M.Walcott,M.D...........................4950 Barranca Pky,Ste.304,(949)857-1216
Ngoc-Thuy T.Nguyen,O.D........10872 Westminster Ave.,Ste. 112,(714)636-9585 Nancy L.Wilson,O.D...........................4040 Barranca Pky.,Ste. 110,(949)857-0676
Richard L.Nguyen,M.D..................9746 Westminister Ave.,Ste.A,(714)638-4433 Pamela Wu,O.D....................................:.......5414 Walnut Ave.,Ste.B,(949)262-9393
Than P.Nguyen,O.D..........................................14322 Brookhurst St., (714) 839-9996 La Habra
Ladan Nilforoushan,O.D..........8942 Garden Grove Blvd.,Ste.104,(714)638-0852 Mary E.Anagnost,O.D..................................1009 E.La Habra Blvd.,(562)697-1600
Huong T.Pham,O.D..................................14251 Euclid St.,Ste.F101,(714)265-2197 Lawrence Fromm,O.D.......................601 E.Whittier Blvd:,Ste.102,(562)697-6733
Thao T.Pham,O.D.......................10872 Westminster Ave., Ste. 112, (714)636-9585 Joseph C.Peters,LLD............................481 E.Whittier Blvd.Suite D,(5c2)690-8887
Tiffanv T.Pham,O.D...........................................13192 Harbor Blvd., (714) 534-3100 Lisa M.Shimada,O.D........................601 E.Whittier Blvd.,Ste.105,(562)691-2999
Tiffanv T.Pham,O.D.....................................9191 Westminster Ave., (714) 698-8100 Cynthia Tjahjadi,O.D....................................1339 W.Whittier Blvd.,(562)697-3995
Charles R.Soltes,O.D..................12302 Garden Grove Blvd.,Ste.6,(714)590-2020 Bennett A.Weiner,O.D...................................1339 DV. Whittier Blvd., (362)697-3995
Murrav Taubman,O.D...................................12568 Valley View St., (714)894-3353 La Mirada
Dieu Nga T.Truong,O.D..........................14251 Euclid St.,Ste.F101,(714)265-2197 Mark Forman,O.D..........................................15066 Rosecrans Ave., (714) 739-2020
Steven S.Yoo,O.D........................9042 Garden Grove Blvd.,Ste.110,(714)530-6611 Daniel Kimura,O.D........................................15066 Rosecrans Ave., (714) 739-20�0
Hawaiian Gardens Lynne D.Louie,O.D.........................12675 La'vtirada Blvd.,Ste.301,(rot)204-3003
Richard R.Ambrose,O.D........................................12525 Carson St., 562) 860-1255 .................15076 Imperial Hwy., (56'_) 943-0386
( David E.Mont,O.D..........................
Huntington Beach Stephen P.Sokol,O.D....................................12819 Valley View Ave.,(562)921-6659
Linda Arboleda,O.D.............................................10041 Adams Ave., (714)962-9377 Jeffrey V.Winston,\LD..................12675 La Mirada Blvd.,Ste.301,(`ti2)204-3003
Leslie C.Bender,O.D..........................20932 Brookhurst St.,Ste. 205,(714)962-3371 La Palma
Robert I.Blau,M.D...................................17742 Beach Blvd.,Ste.305,(714)842-0651 Michael S.Bold,O.D..--........................................5422 La Palma Ave.,(714)995-1144
Paul A.Blaze,O.D....................................................5092 Warner Ave., (714)846-2897 Yadavinder Dang,M.D..........................5451 La Palma Ave.,Ste.15,(714)521-2290
Byron M.Fennema,O.D.......................16152 Beach Blvd.,Ste.173E,(714)841-5051 Ilan Hartstein,M.D.................................5451 La Palma Ave.,Ste.44,(714)522-4862
Kevin J.Germundsen,O.D....................................10041 Adams Ave., (714) 962-9377 Laguna Beach
Kenneth W.Hardy,O.D.....................................19030 Brookhurst St., (714)962-6601 David N.Cler,O.D......................................................265 Laguna Ave.,(949)494-1892
Carmen Jan,O.D................................................16450 Balsa Chica St.; (714)846-1366 Michael D.Cook,O.D...............................................265 Laguna Ave.,(949)494-1892
Timothy C.Jankowski,O.D............................16450 Balsa Chica St., (714)840-1366 William D.Harrison,O.D......................:; 0 S.Coast Hwy.,Ste.202,(949)497-1769
Masami Jitosho,O.D.......................................18685 Main St.,Ste.E.,(714)847-1271 Susan M.Hartley,O.D.........................................330 Park Ave.,Ste.4,(949)494-2546
Michael J.Jones,O.D.. ..............................15786 Springdale St., (714) 892-2987 Andrew Henrick,M.D.... ..........31832 S.Coast Hwy.,Ste.101,(949)499-8276
Michael R.Kaplan,M.D ........................17742 Beach Blvd.,Ste.305,(714)842-0651 Laguna Hills
Vicken H.Karageozian,M.D...... .........17742 Beach Blvd.,Ste.305,(714)842-0651 q
.19030 Brookhurst St., Shahla R.Alessi,
D .- 15 Maia Pk Ste. .E.,(94,)951-8001
Joy E.Kataoka,O.D...;. .::...... (714)962-6601 Randall R.Alessi,O.D.... ......b401 Alicia Pky,Ste.E.,(949)951-8001
Richard D.Klotz,M.D ................................18800 Main St.,Ste. 101,(714)847-5900 Scott T.Anderson,O.D............24331 Ave.De La Carlota,Ste.N13,(949)768-4601
George Kusztyk,O.D..........................................19066 Magnolia St., (714) 593-9900 Terra J.Barnes,O.D................................ 24361 El Toro Rd.,Ste.180,(949)458-2040
Khanhtrang T.Le,C.D.............._.....19051 Goldenwest St.,Ste. 102,(714)698-2626 ...
Timothy S.Liegler,O.D...........................19582 Beach Blvd.,Ste.322,(714)965-9696 Terra J.Barnes,O.D......_.......................3961 Ca Moulton Pky. ale Fl,(949)458-2020
Cleve S.MacKenzie,M.D.......................19582 Beach Blvd.,Ste.322,(714)965-9696 James R.Brinkley,, M.D................. 2 Calla Magdalena,(949)586-8200
J.Harvey Marklinger,C.D..........................18800 Main St.,Ste. 108,(714)842-5537 Richard N.Frieder,O.D.............................25252 McIntyreklty St.,Ste.D,(549)586-8200
Dru Ann J.McCluskey,M.D...................19582 Beach Blvd.,Ste.322,(714)965-9696 Michael M.Goldman,O.D.....24135 Laguna Hills Mall,Ste.1640,(949)586-8980
Donald J. McMillan,M.D...........................82 each Magnolia 322 (714) 593-9996 John A.Hovanesian,NLD..........24401 Calle De La Louisa,Ste.300,(949)951-20_0
Hironobu Mori,O.D.....................................18700 Main St.,Ste. 105,(714)596-1210
Thuy-Uyen D.Hua,O.D.....................................23161 Moulton Pky., (949) 951-4641
Ngoc-Thuy T.Nguyen,O.D............19051 Goldenwest St.,Ste. 102,(714)698-2626 Edward e Kim,..-.. ................24901 Calla De La Louisa,Ste. 7C,(949)472-3937
Mark J.Levy,O.D......._................24953 Paseo De Valencia,Ste.17C,(949)472-3937
Dennis K.Noda,O.D...............................................8931 Atlanta Ave., (714)960-4330 Charles C.Manger,III,M.D................................23161 Moulton Pky., (949)951-4641
Alpa J.Patel,O.D..........................................7251 Warner Ave.,Ste.H,(714)596-2258 William L.McCarthy,Jr.,M.D.........24411 Health Ctr.Dr.,Ste.340,(949)770-1322
Joseph S.Powell,O.D.............................................19746 Beach Blvd.,(714)964-3811 Bert L.McCov,O.D.. ...............................24191 Paseo De Valencia, (949)586-3180
Glenda B.Secor,O.D................................17742 Beach Blvd.,Ste.305,(714)842-0651 Rebecca Ng,O.D............................24022 Calla De La Plata,Ste.305,(949)951-1457
Michael H.Sigband,M.D.........................7677 Center Ave.,Ste.204,(714)893-7576
4641
Deric C.Simmons,O.D...........................8907 Warner Ave.,Ste. 125,(714)962-6400 Hiep Nguyen,O.D.....................................Call
....e La Moulton Pky0 (,49) 951-2020
V.
David N.Stein,O.D......................................7251 Warner Ave.,Ste.H,(714)596-2258 Roger n D.Peterson,
M.D...........24 40 CCal De La Louisa,Ste.303,(949)951-1457
S.Victor Stella,O.D.........................................15057 Goldenwest St., (714)894-5556 Norman re Peterson,YLD...........24239 Calla De La Plata;Ste.305,(949)588-2020
Paul L.Prendivi le,�f.D...................23961 Calla De La Magdalena, (949)588-2626
Douglas R.Williams,...D....................................Warnarn Warner Ave., (714)846-2258 RobynS.Rakov,O.D..................................25301 Cabot Rd.,Ste.112,(949)768-72'_5
Norman K.Wong,O.D.................................7251 Warner Ave.,Ste.H,(714)596-2258 Aaron M.Sako,O.D...................................23252 McIntyre St.,Ste.D,(949)586-8200
Irvine Mary Sciarra,O D ......... ..................
.. 23161 Moulton Pky.. (949) 951-4641
.
Shahla Abedi,M.D. 16300 Sand Canyon Ave.,Ste.602,(949)753-8880 Nicoletta Stefanidis,O.D ......24401 Calle De La Louisa,Ste.300,(949)951-2020
Mohsen Alinaghian,O.D.............................18124 Culver Dr.,Ste.C,(949)857-8213 Wendy U.Tran,O.D..............................22972 Moulton Pky.,Ste. 104,(949)581-8222
Larry Bowes,M.D............................4330 Barranca Prkwy, Ste. 232, (949)451-0035 John M.Walcott,M.D........................23961 Calle De La Magdelena,(949)581-1770
LenaB.Chang,O.D....................................15333 Culver Dr.,Ste.690,(949)552-4271 JeanJ.Yoo,O.D............................................25252 McIntyre St.,Ste.D,(949)586-8200
Li-Li S.Chia,M.D........................16300 Sand Canvon Ave.,Ste.604,(949)753-1163 Laguna Niguel
David N.Cler,O.D......................................17885 Sky Park Cir.,Ste.F,(949)250-1415 Patrick A.Griffin,O.D......................30100 Town Center Dr.,Ste.H,(949)495-3031
Michael D.Cook,O.D...............................17885 Sky Park Cir.,Ste.F,(949)250-1415 T.Powers Griffin,Jr.,O.D..................30100 Town Center Dr.,Ste.H,(949)495-3031
Arthur B.Corish,O.D...........................4950 Barranca Pky.,Ste.301,(949)559-5905
Sanford G.Feldman,M.D...................3737 Moraga Ave.,Ste.A105, (858)273-0200 Pacific beach
Jeffrey H.Gold,O.D.................5450 Clairemont Mesa Blvd.,Ste.D,(858)292-1700 Christv Chu Park,O.D..............................................1939 Grand Ave., (858) 272-2211
Robert M.Howard,O.D..........................7841 Balboa Ave.,Ste.201,(858)278-3937 Lisa M.Galstian,O.D. .............................................1330 Garnet Ave.,(858) 272=6414
Michael A.Kling,O.D................................5222 Balboa Ave.,Ste.42,(858)650-6800 John E.Gartner,O.D..................................................1330 Garnet Ace., (858) 272-6k14
Ellie E.Samadani,M.D.......................3737 Moraga Ave.,Ste.A105,(858)273-0200 Kristie M.Homuth,O.D...............................2168 Balboa Ave.,Ste.1,(858)274-3-7
Ronald W.Schisler,O.D............7420 Clairemont Mesa BI,Ste. 109,(858)560-8581 Robert M.Homuth,O.D................................2168 Balboa Ave.,Ste.1,(858)274-3777
Gary G.Schwab,O.D..............................3670 Clairemont Dr.,Ste.1,(858)274-2020 Stephen A.Luskin,O.D.............................................1018 Grand Ave.,(858)272-6843
Gary Sneag,O.D.......................................4310 Genesee Ave.,Ste.101,(858)560-5181 David C.Park,O.D.................................................... 1939 Grand Ave., (858) 272-2-211
Chau H.Trang,O.D..............................................2354 Ulric St.,Ste.B,(858)495-0592 Point Loma
Patrick Van Hoose,O.D.........7061 Clairmont Mesa Blvd.,Ste.205,(858)571-2081 Michael A.Goldsmid,O.D..............3750 Sports Arena Blvd.,Ste.9,(619)224-2879
Timothy M.Van Kirk,O.D....................3604 Balboa Ave.,Ste.B104,(858)541-7088 Robert M.Homuth,O.D................................3445 Midway Dr.,Ste.I,(619)224-2973
Lisa M.Weiss,O.D..................................4310 Genesee Ave.,Ste.101,(858)560-5181 Stanley S.Mestman,O.D...........................3555 Kenyon St.,Ste.101,(619)221-9560
Steven T.Yuen,O.D.........................7330 Clairemont Mesa,Ste. 105, (858)2924498 Rancho Bernardo
Downtown Gregory J.Hayes,O.D...................16840 Bernardo Ctr.Dr.,Ste.150,(858)487-3504
Steven R.Larsen,O.D.................................................4096 Park Blvd.,(619) 291-5505 Steven T.Klein,O.D.......................16840 Bernardo Ctr.Dr.,Ste.150,(858)487-5504
Douglas L.Swanson,0.13.......................................287 Horton Plaza, (619) 239-1716 Suzanne P.Lee,Q.D...................................11944 Bernardo Plaza Dr.,(858) 451-1250
Douglas L.Swanson,O.D........... ....................55 Horton Plaza, (619) 544-9000 Bruce D.Rasmussen,M.D..................................16950 Via Tazon Rd.,(858)521-2301
East San Diego Area Gary R.Saks,Q.D................................17631 W.Bernardo Dr.,Ste.A,(858)487-7900
jasmine P.Nguyen,O.D ........:........:4844 University Ave.,Ste.A,(619)284-3937 Charles W.Tornatore,O.D................................16950 Via Tazon Rd.,(858)321-2301
Nikki L.Nguyen,O.D............................4748 University Ave.,Ste.C,(619)516-1730 Rancho Penasquitos
Richard N.V.Phung,O.D..................................4236 University Ave., (619) 281-3422 Barbara H.Bytomski,O.D.........9320 Carmel Mountain Rd.,Ste.E.,(858)484-1500
El Cajon Blvd.-College Area Brian Chou,O.D..........................9320 Carmel Mountain Rd.,Ste.E.,(858)484-1500
Stephen Chinn,O.D..................................4616 El Cajon Blvd.,Ste.10,(619)280-0664 Joel L.Cook,O.D..........................9320 Carmel Mountain Rd.,Ste.E.,(858)48.4-1500
Neville S.Cohen,O.D........................6760 University Ave.,Ste. 130,(619)583-4295 Glenn M.Demlinger,Q.D............13223 Black Mountain Rd.,Ste.6,(858)484-5155
Vincent R.Conlan,O.D.............................................W8 College Ave., (619) 583-5744 Kevin M.Reeder,O.D.................9320 Carmel Mountain Rd.,Ste.E.,(858)484-1500
Glenn B.Cook,M.D................................5555 Reservoir Dr.,Ste.300,(619)286-3711 Robert A.Ring,O.D.......................13223 Black Mountain Rd.,Ste.6,(858)484-5155
Barry Katzman,M.D...........................................6945 El Cajon Blvd.,(619)697-4600 Robert C.Rosa,0.D...............11495 Carmel Mountain Rd.,Ste.102,(858)675-0485
Sheiva L.Pousti,O.D.............................4185 Fairmount Ave.,Ste.E.,(619)508-5678 David N.Sherman,O.D.......12070 Carmel Mountain Rd.,Ste.292,(858)676-3926
Paul L.Treger,M.D.................................5555 Reservoir Dr.,Ste.300,(619)286-9077 Mitchell S.Shulkin,O.D...11835 Carmel Mountain Rd.,Ste.1313,(858)674-1276
Hillcrest Area Scripps Ranch
John E.Bokosky,M.D......................................................3939 3rd Ave., (619) 296-8525 Cyrus N.Rad,O.D........................10549 Scripps Poway Pky,Ste.G,(855)530-2800
Lawrence N.Cooper,M.D...............................................233 Lewis St., (619) 299-1100 Keith M.Wan,O.D.......................10549 Scripps Poway Pky.,Ste.G,(858)530-2800
Michael T.Couris,M.D..................................................3730 3rd Ave., (619) 291-6191 South San Diego Area
William H.Fulhorst,M.D._..........................................3720 3rd Ave., (619)298-7221 Christine M.Davis,O.D...........................................2935 Bever Blvd.,(619)428-2121
Christopher J.Gualtieri,M.D.......................................2558 4th Ave., (619)239-3349 Tierrasanta
Suzanne P.Handler,M.D................................3900 5th Ave.,Ste.270,(619)298-1000 Gregory J.Hayes,O.D.......................................6020 Santo Rd.,Ste.B,(858)571-8835
Leonard E.Hitchin,M.D.................................3900 5th Ave.,Ste.270,(619)298-1000 Steven T.Klein,Q.D...........................................6020 Santo Rd.,Ste.B,(558)571-8835
Steven R.Larsen,O.D......................................................907 6th Ave., 619
( )231-5799 Kimberly B.Plattner,O.D.................................6020 Santo Rd.,Ste.B,(855)571-8835
Anita R.Niederberger,O.D..............................................907 6th Ave.,(619)231-5799 University City Area
Gary D.Shute,O.D...........................................................3945 1st Ave., (619)295-4194
John E.Gartner,O.D...................................7770 Regents Rd.,Ste.104,(858)546-1940
Philip B.Smith,O.D........................................................3666 4th Ave., (619)2974331 David I.Geffen,O.D..........:..............Gordon Binder Vision Institute,(858)455-6800
Robert M.Thomas,Jr.,M.D............................3900 5th Ave.,Ste.270,(619)298-1000 Robert M.Heller,O.D.............................8650 Genesee Ave.,Ste.220,(858)452-7374
Mark E.Warlen,M.D......................................................3720 3rd Ave., (619) 298-7221 Lori L.Johnson,O.D...............................................4009 Governor Dr., (858) 453-0444
Lake Murray-San Carlos Area Dale W.Kimball,O.D................................4575 La Jolla Village Dr.,(858)455-5795
Jeffrey A.Hall,O.D..........................8312 Lake Murray Blvd.,Ste.C,(619)464-2076 Steven P.Tayman,O.D............................8650 Genesee Ave.,Ste.220,(858)452-7374
Mira Mesa Patrick Van House,O.D...............................4575 La Jolla Village Dr.,(858)455-5795
Louis E.Chesner,O.D...........................9460 Mira Mesa Blvd.,Ste.A,(858)566-1756 San Marcos
Orlando G.Guiang,O.D......................82M Mira Mesa Blvd.,Ste.B,(858)566-6670 Richard G.Clarke,O.D...........................181 S.Rancho Santa Fe Rd.,(760)744-3002
Gregory G.Hom,O.D...............11230 Sorrento Valley Rd.,Ste.115,(858)535-9835 Denton L.Kimball,O.D...........................1 Civic Center Dr.,Ste.130,(760)744-2611
Ruriko Kusumoto,O.D..................................9186 Mira Mesa Blvd.,(858)566-6262 Richard M.Skay,O.D................1903 W.San Marcos Blvd.,Ste.130,(760)727-2211
Benjamin P.Llanes,O.D.................9580 Black Mountain Rd.,Ste.G,(858)536-8952 Santee
Robert J.Okamura,O.D..................................9186 Mira Mesa Blvd., (858)566-6262 Robert L.Grazian,O.D...............................9727 Mission Gorge Rd.,(619)562-5220
Richard N.V.Phung,O.D..............................9880 Hibert St.,Ste.El,(858)693-9044 Ernest J.Grosso,O.D...................................9025 Carlton Hills Blvd,,(619)449-5252
Steven D.Satnick,O.D.........................9460 Mira Mesa Blvd.,Ste.A,(858)566-1756 Ronald W.Schisler,O.D...........9621 Mission Gorge Rd.,Ste.105A,(619)449-2000
Richard K.Simonds,O.D................6755 Mira Mesa Blvd.,Ste.141,(858)535-8282 Solana Beach
Mark P.Stanton,M.D...................................9855 Erma Rd.,Ste.130,(858)578-5220 Michael A.Foyle,O.D.................................437 S.Hwy.101,Ste.103,(858)481-7262
Marvin Weitzman,O.D.........................9450 Scranton Rd.,Ste.111,(858)555-0606 Mission Valley Center Area Ioana M.Staniciu,O.D...............124 Lomas Santa Fe Dr.,Ste.203A,(858)793-1550
Spring Valley
John L.Castiello,O.D..................................7007 Friars Rd.,Ste.371,(619)295-0537 James W.Cummins,Jr.,O.D......................10225 Austin Dr.,Ste.206,(619)670-0300
Robert M.Heller,O.D..................................7007 Friars Rd.,Ste.371,(619)295-0537 ...........9 5 Campo .,S Ste.C,(619)670-0318
David Jessop,Jr„O.D...................591 Camino De La Reina,Ste.427,(619)298-1137 John C.Fleming,O.D...........................
Gary P.Krueger,O.D...................591 Camino De La Reina,Ste.427,(619)298-1137 Donald N.Freeman,O.D....................................687 Sweetwater Rd.,(619) 466-9444
Norman C.Ratner,O.D.........................5624 Mission Ctr.Rd.,Ste.B,(619)297-6881 Joan Keddington,O.D.........................................687 Sweetwater Rd.,(619) 466-944.4
Walter R.Thomas,O.D......................7610 Hazard Ctr.Dr.,Ste.517,(619)291-7712 Vista
Mission Village In Kearney Mesa
Gary L.Barnes,0.1).............................................931 Anza Ave.,Ste.B,(760)758-3944 Eric M.White,O.D............................................5075 Ruffin Rd.,Ste.B,(858)278-4720 Stephen Chinn,O.D...............................640 Escondido Ave.,Ste.114,(760)726-2400
North Park Area K.P.Oscar Chung,O.D..............................217 Escondido Ave.,Ste.1,(760)941-0857
Glenn M.Demlinger,O.D.........................770 Sycamore Ave.,Ste.G,(760)727-1844
Jean Cheng,M.D.................................................. 3094 El Cajon Blvd.,(619)250-1277 John P Fitzpatrick,O.D........................110 Escondido Ave.,Ste.101,(760)724-2119
Louis E.Chesner,O.D................. ...........2404 Madison Ave., (619) 291-3836
"""""""` Bruce D.George,O.D................................................. .9316 Anna Ave.,(760)758-23.10
Marianne R.Decker,O.D....................................1947 Fern St.,Ste.3,(619)233-6183 Bradley W.Greider,M.D........................2067 W.Vista Way,Ste.120,(760)758-2020
Mark J.Delsman,O.D.......................................3068 University Ave., (619) 298-5524 Nicoletta Stefanidis,O.D...................:..:2067 W.Vista Way,Ste.120,(760)758-2020
Alan M.Liker,O.D.............................................3068 University Ave., (619) 298-5524 Randy L.Stone,O.D................................2067 W.Vista Way,Ste.120,(760)758-2020
Robert H.Meisel,O.D.....................................................3950 30th St., (619) 296-6361 Ronald C.Stout,O.D...............................2067 W.Vista Way,Ste.120,(760)758-2020
Ocean Beach Victor Wechter,M.D.................................................1020 E.Vista Way,(760)940-1700 1
Eli Ben-Moshe,O.D...............................................4822 Newport Ave.,(619) 222-0559
i
I
James R.Henslick,O.D..................................27451 La Paz Rd.,Ste.B,(949)643-2020 Gregory G.Char,O.D.............................850 E.Chapman Ave.,Ste.B,(714)538-1434
James M.Kane,O.D...................................30001 Crown Valley Pky..(949) 195-16lQ Thinh D.Do,O.D..................................3533 E.Chapman Ave.,Ste.H,(714)516-909f
Eric J.Kawata,O.D.............................30231 Golden Lantern,Ste.E.,(949)495-9336 Bvron M.Fennema,O.D.................1234 W.Chapman Ave.,Ste.201,(714)997-1091
Lake Forest George H.Garcia,M.D._....................1201 W.La beta Ave.,Ste.406,(714)558-8666
Rosemarie D.Bonvecchio,O.D..................23635 El Toro Rd.,Ste.J2,(949)951-8391 Ronald L.Hankins,O.D..................................4703 E.Chapman Ave.,(714)538-4803
Stephen K.Christensen,O.D_............22681 Lake Forest Dr.,Ste.A2,(949)837-2121 Charles E.Keller,M.D.........................1201 W.La Veta Ave.,Ste.408,(714)633-5696
Jacqueline M.Cullinane,O.D.............22741 Lambert St.,Ste. 1601,(949)581-6880
q Christopher Lyon,M.D.......................1201 W.La Veta Ave.,Ste.300,(714)771-1144
James R.Dugue,O.D....................................22421 El Toro Rd.,Ste.H,(949)951-1424 Joel K.Marutani,O.D....................1234 W.Chapman Ave.,Ste.201,(714)997-1091
Richard A.Kidder,O.D...................................23002 Lake Center Dr.,(949)454-1064 Byron Y.Newman,O.D...................2501 E.Chapman Ave.,Ste.105,(714)288-8282
Jon D.Morrison,O.D.............._..........2_-741 Lambert St.,Ste.1601,(949)581-6880
Cynthia T.Nguyen,O.D...........................................1964 N.Tustin St.,(714)282-0111
Kirk S.Roberts,O.D................................23811 Bridger Rd.,Ste.110,(949)830-7400 Adrian V.Pop,O.D...........................2501 E.Chapman Ave.,Ste.105,(714)288-8282
Jay E.Rofsky,O.D.............................23632 Rockfield Blvd.,Ste.103,(949)206-1360 Herman L.Rundle,M.D..:...................1201 W.La Veta Ave.,Ste.406,(714)558-8666
Grace L.Sibayan,O.D.................................23635 El Toro Rd.,Ste.J2,(949)951-8391 Keith V.Rundle,M.D...........................1201 W.La Veta Ave.,Ste.406,(714)558-8666
Mark A.Slosar,O.D.........................................23002 Lake Center Dr.,(949)454-1064 Robert F.Roper,M.D................................................436 S.Glassell St., (714)633-6060
Robert C.Tarr,O.D.......................................22421 El Toro Rd.,Ste.H,(949)7705514 H.Michael Shack,O.D......................................2198 N.Orange Mall,(714)637-4500
Melinda M.Wells,O.D..............................23700 El Toro Rd.,Ste.Al,(949)859-3180 Kauser Sharieff,O.D............:........................Inside Block at Orange,(714)937-3937
Los Alamitos Sandra L.Stevens,O.D..... .........1234 W.Chapman Ave.,Ste.201,(714).997-1091
Dominic Belletti,O.D................................10861 Cherry St.,Ste.204,(562)598-3160 Joseph Vansuch O D......... .................128 E.Katella Ave.,Ste.5,(714)997-3533
Anne M.Freeman,O.D............................10861 Cherry St.,Ste.204,(562)598-3160 Frank H.Yoon,O D .......................................311 N.Tustin St.,Ste.B,(714)997-7500
L.Wayne Freeman,M.D............:............10861 Cherry Ave.,Ste.204,(562)799-2020 Placentia
Lawrence J.Geisse,M.D...........................10861 Cherry St.,Ste.204,(562)598-3160 Jeffrey R.Dougal,O.D................................1201 N.Rose Dr.,Ste.100,(714)528-2566
Carl T.Hartman,M.D.............................3801 Katella Ave.,Ste.414,(562)598-7728
Jerry T.Lin,O.D............................................................630 N.Rose Dr.,(714)524-6688
Wayne E.Johnson,O.D..............10900 Los Alamitos Blvd.,Ste.102,(562)431-1301 John S.Marshburn,M.D............................1275 N.Rose Dr.,Ste.112,(714)792-1199
Trinh T.Nhu,M.D.....................................3801 Katella Ave.,Ste.414,(562)598-7728 Michael Swearingen,O.D.........................1201 N.Rose Dr.,Ste.100,(714)528-2566
Avani J.Patel,O.D....................................3502 Katella Ave.,Ste. 101,(562)430-6161 Robert J.Thomas,O.D................................1201 N.Rose Dr.,Ste.100,(714)528-2566
Donald N.Serafano,M.D.........................10861 Chem'St.,Ste.204,(562)598-3160 Richard L.Vermillion,O.D............................1428 N. Kraemer Blvd.,(714)996-1136
A.Cory Thies,O.D.....................10900 Los Alamitos Bh"d.,Ste.102,(562)431-1301 Rancho Santa Margarita
Sam S.Varon,O.D.....................................10771 Los Alamitos Blvd.,(562)430-7515 Kathleen M.Andersen,O.D............22461 Antonio Pkv.,Ste.A130, (949)589-6171
Giovanni Venittelli,O.D.........................................4281 Katella Ave., (714) 232-1133 Steven D.Smith,O.D.......................................29851 Aventura,Ste.I,(949)589-0900
Sharon Yamanaka, O.D..........................................4230 Katella Ave., (562) 795-6111 San Clemente "t
Mission Viejo Gabriel Dery,O.D..................638 Camino De Los Mares,Ste.A120,(949)493-2269
Jill L.Ackerman,M.D...............................26701 Crown Valley Pky.,(949)582-3009 Patrick A.Griffin,O.D......................................140 Avenida Del Mar, (949)492-1853
Teri Alpert,O.D...................................28601 Marguerite Pkv.,Ste.3,(949)364-0891
- Stephen R.Griffin,O.D......................................140 Avenida Del Mar,(949)492-1853
Thomas Amen,O.D.........................602 The Shops at Mission Viejo,(949)582-2020 T.Powers Griffin,Jr.,O.D..................................140 Avenida Del Mar, (949)492-1853
Deborah A.Bittner,O.D.....................28601 Marguerite Pkv,Ste.3,(949)364-0891 Diana H.Kersten,M.D.............665 Camino De Los Mares,Ste.102,(949)493-5411
Luis A.Chanes,M.D........................27871 Medical Ctr.Rd.,Ste.120,(949)364-6688 David J.Nota,O.D..................................224 Avenida Del Mar,Ste.A,(949)492-2029
Lucv De Moss,O.D.....................................27652 Crown Valley Pky.,(949)347-9646 Roger V.Ohanesian,M.D.........665 Camino De Los Mares,Ste.102,(949)493-5411
Keith A.Farson,O.D............................27724 Santa Margarita Pky., (949) 583-0422 Traci L.Paul,O.D................................................140 Avenida Del Mar,(949)492-1853
Lori L.Floyd,O.D.......................................24000 Alicia Pkv.,Ste. 11,(949)768-0331 Nicoletta Stefanidis,O.D.........665 Camino De Los'_Mares,Ste.102,(949)493-5411
Ribhi K.Ghosheh,M.D.............................26701 Crown Valley Pky.,(949)582-5009 San Juan Capistrano
Calvin R.Graef,O.D..................................26701 Crown Valley Pky.,(949)582-5009 Rick A.Abelson,O.D.........................31878 Del Obispo St.,Ste.122,(949)248-2590
Nicholas Green,O.D.....................27723 Santa Margarita, Ste. 131, (949) 70-8505
John A.Hovanesian,M.D..............27800 Medical Ctr.Rd.,Ste.130,(949)364-0225 Joseph G.Heinrich,O.D.......32241 Camino Capistrano,Ste. A101, (949) 661-3669
Linda Hsieh,O.D...........................:.27800 Medical Ctr.Rd.,Ste.130,(949)364-0223 Ryan K.Onishi,O.D.....................32282 Camino Capistrano,Ste.B,(949)496-0552
Donna H.Hwang,O.D...............................26701 Crown Valley Pky.,(949)582-5009 Charles M.Roberts,O.D.............32282 Camino Capistrano,Ste. B,(949)496-0552
JanS.Lukac,M.D...........................................26902 Oso Pky.,Ste.120,(949)582-77/76 Santa Ana
Jennifer R.Murray,O.D.._..................277/24 Santa (Margarita Pky., (949) 583-0422 Patricia A.Atie,O.D............................2414 S.Fairview St.,Ste. 103,(714)557-9492
William M.Berke,O.D...... ...3301 S.Harbor Blvd.,Ste.104,(714
Barbara Y.Shang,M.D 27871 Medical Ctr.Rd.,Ste.120,(949),i6-1-6688 )979-2021
William Starr,O.D..... .... M.Alexander Bonakdar,O.D 801 N.Tustin Ave:,Ste.404,(714 558-1182
...:....:25270 Marguerite Pky., (949} 581-1040 "•����� )
M:Talebi,M.D...............................23166 Los Alisos Blvd.,Ste.112B,(949)707-1181 Paul A.Brailsford,M.D.'..: .........801 N.Tustin Ave.,Ste.303,(714)547-2200
Luis A.Chanes,M.D..................................2621 S.Bristol St.,Ste.205,(714
Sidney J.Weiss,M.D.......................27800 Medical Ctr.Rd.,Ste.130,(949)-�6.1-0225 )557-5777
Bruce Winters,O.D. ......................................26902 Oso Pkv.,Ste.120,(949)582-7776 James S.Cohen,O.D.................................................1023 N.Bristol St.,(714)569-1023
Randall K.Wong,O.D...............................26701 Crown Valley Pky.,(949)582-5009 Neville S.Cohen,O.D...............................................3696 S. Bristol St.,(714)549-4343
Mary A.Cote,M.D....................................2621 S.Bristol St.,Ste.205,(714)557-5777
Newport Beach _
Arthur Astorino,Jr.,M.D......................1525 Superior Ave.,Ste.101,(949)645-2250 Alberto De La Pena,M.D.....................................1520 N.Grand Ave.,(714)558-1385
Beth E.Ballinger,O.D........................................833 Dover Dr.,Ste.9,(949)642-0292 Nina T.Do,O.D..............................................1601 W.17th St.Unit Bl,(714)953-4393
Carla D.Barnett,O.D...................400 Newport Center Dr.,Ste.404,(949)640-2023 Jeffrey S.Fimreite,O.D........................2414 S.Fairview St.,Ste. 103,(714)557-9492
Michael S.Bold,O.D...........................................2628 San Miguel Dr.,(949)644-0165 Gary Fishberg,O.D.......................................................1223 E. 17th St.,(714)972-4888
P. , . .........:................................1413 N.Bristol St.,(714
Larisa A.Canter,M.D..........................li25 Superior Ave.,Ste.101,(949)645-2250 Robert P Gonzales OD )543-9022
William A.Cies,M.D...................400 Newport Center Dr.,Ste.404,(949)640-2023 Larry J.Gottlieb,O.D........................................268 Main Place Mall,(714)973-2020
StevBruce F.Grant,O.D.........................................800 N.Tustin Ave.,Ste.J,(714)835-2424
Lou y.Cohn,O.D..............................................833 Dover Dr.,Ste.9,(949)642-0292
Lou Roy Elder,O.D...................................................1725 4t'estdiff Dr., (949)642-0720 Melvin H.Honda,O.D......................................1730 E.17th St.,Ste.G,(714)543-9489
Gregg A.Feinerman,M.D......................320 Superior Ave.,Ste.350,(949)631-4780 Jon H.Kendall,O.D....................................1125 E.17th St.,Ste.455N,(714)835.-0141
Stephen H.Johnson,M.D......................1441 Avocado Ave.,Ste.206,(949)760-9007 Charles C.Lou,O.D...............................................748 S.Harbor Blvd.,(714)839-7534
Wallace M.Landholm,M.D.............._...320 Superior Ave.,Ste.350,(949)631-4780 Sheldon L.Marshall,O.D............................2860 S.Bristol St.,Ste.D,(714)540-3993
Christopher Lyon,M.D.........................1401 Avocado Ave.,Ste.402,(949)760-3003 Rick K.Nakasone,O.D..............................2390 N.Tustin Ave.,Ste.B,(714)543-3167
Gary S.Reiter,M.D.............. ) Xavier R Ordonez,O.D............................3940 S.Bristol St.,Ste.111,(714)557-7373
....................................1901 Westcliff Dr.,(949 646-2471
_ _ Firooz R.Oskooi,M.D.............................2621 S. Bristol St.,Ste.205,(714)557-5777
Jeffrey T.Safarik,O.D...........................1325 Superior Ave.,Ste. 101,(949)645-2230
H.Michael Shack,O.D....._...........................1280 Bison Ave.,Ste.B7,(949)720-0204 Romy Park,O.D.................................................268 Main Place Mall, (714) 973-2020
Evan B.Thomas,O.D............... 522 Old Newport Blvd.,(949)650-9060 Herman L.Rundle,M.D.............................1125 E.17th St.,Ste.204E,(714)558-2822
Orange Keith V Rundle,M.D ...................
..............1125 E:17th St.,Ste.E204,(714)558-2822
Darcy C.Ryan,O D ......................3301 S.Harbor Blvd.,Ste.104,(714)979-2021
Michael J.Anderson,O.D............. .:.._...........1907 N"Tustin St.,(714)974-4400 David B.Sacks,M.D.................................999 N.Tustin Ave.,Ste.122,(714)542-3961
Allen E.Austin,O.D................................... ...1 City Blvd.IV.,Ste.111,(714)634-0033 Rodman F.Sandoval,O.D...................................431 E.lst St.,Ste.4B,(714)547-6819
Allen E.Austin,O.D...................................101 Citv Dr.S.Pavillion 2,(714)704-3990 Michael C.Satterlee,O.D.........................................3696 S.Bristol St., (714)549-4343
Howard Austin,O.D.....................................1 City Blvd.]v:,Ste.111,(714)63I 0033 Jimmy K.So,O.D...............................................400 Main Place Mall, (714) 543-3333
Howard Austin,O.D._.............................101 City Dr.S.Pavillion 2,(714)704-3990 Tonv D.Vu,O.D......................................................15'_0 N.Grand Ave.,(714)558-1385
Eric J.Bass,O.D....................................................130 S.Main St.,Ste.F,(714)939-9202 James J.Weyrich,O.D......................... 2018 E. 17th St.,(714)564-0222
Noah D.Brinley,O.D..........................1201 W.La VetaA%e.,Ste.406,(714)558-8666
Coronado Steven G.Pratt,M.D...............................9850 Genesee Ave.,Ste.310,(858)45;3010
Gerald J.Easton,O.D..........................................................1010 8th St.,(619)435-6221 Mary Terlaak-Smith, M.D....................9834 Genesee Ave.,Ste.209,(858)457-,220
C.William Harpur,O.D.....................................................1010 8th St.,(619)435-6221 Richard Trainer,O.D................................................930 Sdverado St., (858) 454-0191
John E.Kohler,O.D..................................................1021 Isabella Ave., (619) 437-4461 UCSD Shiley Eye Center..........I....................9413 Campus Point Dr.,(858)534-6290
Blake R.Shawl M.D.........................................1317 Ynez Place,Ste.A,(619)435-8800 Gordon G.Wong,O.D.....................................7825 Fav Ave.,Ste.140,(858)454-4699
Del Mar La Mesa
Gregory J.Graham,O.D.................................1349 Camino Del Mar,(858)755-5484 Caroline Guerrero Cauchi,O D......................8235 University Ave.,(619) 461-4913
El Cajon Gary R.Funk,0.D.................................................7862 El Cajon Blvd.,(619)644-6405
Kim J.Butler,O.D.........................................................1273 Broadway, (619) 579-2345 Bruce T.Haight,M.D........................5565 Grossmont Ctr.Dr.,Ste.3,(619)463-0331
Richard H.Carlson,O.D........................................2508 Fletcher Pky.,(619)463-9975 Thomas M.Hixson,O.D......................................8007 La Mesa Blvd.,(619)466-5665
Marilyn A.Carter,O.D.....................................510 S.Magnolia Ave.,(619)444-9012 David M.Kasanoff,O.D...........................7339 El Cajon Blvd.,Ste.G,(619)465J900
Randall E.Conrad,O.D_..............................................303 E.Main St.,(619)444-1153 Phillip A.Levy,O.D....................................5020 Baltimore Dr.,Ste.B,(619)464-8303
Franklin Crystal,M.D...........................225 W.Madison Ave.,Ste.1,(619)442-0844 David M.Newman,O.D.............................5642 Lake Murray Blvd.,(619)589-6263
Michael J.Guamotta,O.D...............................277 N.Magnolia Ave.,(619)442-1186 Michael A.Nyberg,M.D. ..................................7862 El Cajon Blvd.,(619)644-6405
Jay Kovtun,O.D................................................277 N.Magnolia Ave.,(619)442-1186 Steven G.Peterson,O.D...................................................7090 Pky. Dr.,(619)286-2810
Richard N.Learn,M.D...........................225 W.Madison Ave.,Ste.1,(619)412-0844 Donald M.Rasmussen,O D ..........................................7090 Pky.Dr.,(619)286-2810
Rex A.Werner,O.D......... .............2650 Jamacha Rd.,Ste. 141,(619)670-6296 Lawrence S.Rice,M-D. ........5565 Grossmont Ctr.Dr.;Ste.551,(619)465-2020
Greg K.Woodworth,O.D............................: .:.:....575 Fletcher Pky.,(619)447-5555 Kevin M.Riggs,O.D.............. 5500 Grossmont Ctr.Dr.,Ste.215,(619)469-0131
Encinitas Martin Rothschild,O.D.......................................7862 El Cajon Blvd.,(619)644-6405
Janie M.Bodman,O.D..................477 N.El Camino Real,Ste.C202,(760)631-3500 J.Michael Vidal,O.D.......................................................7090 Pky.Dr.,(619)460-2020
Victor L.Copeland,O.D.....................................1279 Encinitas Blvd.,(760)436-1877
Jeffrey B Wasserstrom,M.D.......5565 Grossmont Ctr.Dr.,Ste.551,(619)698-1088
Bessie B.Floyd,M.D.........................317 N.El Camino Real,Ste.206,(760)479-0977 Ronald M.Watson,O.D......................................3653 Avocado Blvd.,(619)660-6000
Deborah S.Haug,O.D................................................893 Santa Fe Dr.,(760)753-3500 Lakeside
Michael J.Haug,O.D..................................................893 Santa Fe Dr.,(760)753-3500 John C.Fleming,O.D..................9710 Winter Gardens Blvd.,Ste.A,(619)443-1073
Rav A.Hutchinson,O.D.......................681 Encinitas Blvd.,Ste.302,(760)753-6336 Lemon Grove
Richard A.Kramb,O.D.....................................1279 Encinitas Blvd.,(760)436-1877 Carl G.Hillier,O.D.....................................................7898 Broadway, (619) 464-7713
Jeffrey B.Morris.M.D..................477 N.El Camino Real,Ste.C202,(760)631-3500 Melissa C.Hillier,O.D...............................................7898 Broadway, (619) 464-7713
Barry R.Mozlin,O.D...........................165 S.El Camino Real,Ste.A,(760)944-9601 Robert H.Meisel,O.D................................................7850 Broadway, (619) 697-2020
Ronald M.Rosa,O.D...........................272 N.El Camino Real,Ste.A,(760)634-1957 James M.Officer,O.D....................................................3048 Main St., (619) 469-9668
Frank A.Scotti,M.D...................................320 Santa Fe Dr.,Ste.104,(760)943-7141 National City
Jeffrey P.Wmick,M.D.....................317 N.El Camino Real,Ste.402,(760)942-1488 Sheryl A.Andrews,O.D.......................1615 E.Plaza Blvd.,Ste.101,(619)477-2159
John P.Zack,M.D.............................317 N.El Camino Real,Ste.402,(760)942-1488 Donald N.Freeman,O.D......................1615 E.Plaza Blvd.,Ste.101,(619)477-2159
Escondido Joan Keddington,O.D...........................1615 E.Plaza Blvd.,Ste.101,(619)477-2159
John E.Bokosky,M.D...........................................700 W.El Norte Pky.,(760)738-7800 Greg L.Marlay,O.D...............................1132 E.Plaza Blvd.,Ste.201,(619)477-4166
Michael J.Cooper,O.D..................................................251 E.4th Ave.,(760)745-5412 Gordon J.Montgomery,M.D......................610 Euclid Ave.,Ste.302,(619)472-1010
Christine M.Davis,O.D........................330 W.Felicita Ave.,Ste.El,(760)741-5519 Richard K.Simonds,O.D......................................2411 E.Plaza Blvd.,(619)475-2184
Daniel R.Delgado,O.D...........................................613 E.Grand Ave.,(760)743-4616 Ronald M.Watson,O.D......................................1033 Highland Ave.,(619) 477-2771
- - David A.Edwards,M.D..................
.............225 E.2nd Ave.,Ste.310,(760)738-9985 Oceanside
Bruce G.Frimtzis,O.D...............................1320 E.Valley Pky.,Ste.D,(760)432-6331 Janie M.Bodman,O.D....................................3909 Waring Rd.,Ste.B,(760)631-3501
W.Joseph Gamin,O.D.............................................147 E.Grand Ave.,(760)743-2020 Thomas L.Curtin,M.D.................................3231 Waring Rd.,Ste.S.,(760)724-1800
Gina M.Grasso,O.D..................................................810 E.Ohio Ave.,(760)746-3937 Matthew W.Gentile,O.D.-........................3915 Mission Ave.,Ste.2,(760)757-8771
Dale W.Kimball,O.D.............................................201 W.Valley Pky.,(760)489-5100 Frederick W.Knapp,Jr.,D.O...........................3998 Vista Way,Ste.D,(760)941-7300
Howard I.Krausz,M.D.............................................810 E.Ohio Ave.,(760)746-3937 Kurt A.Lundquist,O.D............................,.3915 Mission Ave.,Ste.2,(760)757-8771
Kenneth R.Manell,O.D................................................251 E.4th Ave.,(760)745-5412 Jeffrey B.Morris,M.D....................................3909 Waring Rd.,Ste.B,(760)631-3501
Jeffery L.McDonald,O.D..............:...............................280 E.3rd Ave.,(760)747-2010 Donald E.Pearcy,O.D...........................4065 Oceanside Blvd.,Ste.C,(760)945-2020
Erwin M.Omens,M.D .......................................910 E.Ohio Ave.,(760)745-9500 Edward A.Richards,O.D ..............14065 Oceanside Blvd.,Ste.C,(760)945-2020
Matt T.Pham,O.D...............................:....................968 W.Valley Pky.,(760)743-5872 Robert A.Ring,O.D....... .. . .....................3231 Waring Rd.,Ste.B,(760)726-9383
David R.Plotner,M.D............................................201 W.Valley.Pky.,(760)489-5100 Ronald M.Rosa,O.D........................................2174 Vista Way,Ste.B,(760)433-9449
Norman A.Rose,O.D....................1299 E.Pennsylvania Ave.,Ste.B,(760)743-6540 David N.Sherman,O.D................................3809 Plaza Dr.,Ste.103,(760)945-0222
Basanti Shaw,O.D..........................................255 N.Elm St.,Ste.105,(760)743-1994 Jeffrey P.Winick,M.D..................................3231 Waring Rd.,Ste.M,(760)758-2550
Garrick T.Sit,O.D.....................................................324 S.Kalmia St.,(760)741-7497 Poway
Oliver E Smith,O.D.................................................201 W.Valley Pky.,(760)489-5100 Randall E.Conrad,O.D.........................13029 Pomerado Rd.,Ste.A,(858)748-6210
Marty C.Tomatore,O.D..............................225 E.2nd Ave.,Ste.310,(760)738-9985 Marianne R.Decker,O.D........................................13373 Poway Rd., (858) 748-0171
Fallbrook David A.Edwards,M.D.-..................15525 Pomerado Rd.,Ste.Cl,(858)485-5600
Gary L.Barnes,O.D........................................................131 N.Vine St.,(760)723-8417 Donald J.Janiuk,O.D............................13029 Pomerado Rd.,Ste.A,(858)748-6210
Douglas H.Clements,M.D...........................521 E.Elder St.,Ste.102,(760)728-5728 Douglas A.Morse,O.D.....,..................15525 Pomerado Rd.,Ste.Cl,(858)485-5600
John E.Cutler,LLD.........................................521 E.Elder St.,Ste.102,(760)728-5728 Robert J.Okamura,O.D..........................................13373 Poway Rd., (858) 748-0171
Robert H.Davison,O.D....................................645 E.Elder St.,Ste.D,(760)728-9440 James R.Smith,O.D.................................................13569 Poway Rd., (858) 486-2630
Eric J.Ramos,O.D..............................................645 E.Elder St.,Ste.D,(760)728-9440 Marty C.Tomatore,O.D.-..................15525 Pomerado Rd.,Ste.Cl,(858)485-5600
Imperial Beach Ramona
Helfon Hanono,O.D...........................................894 Palm Ave.,Ste.B,(619)424-9333 Susan D.Homesley,O.D................................1516 Main St.,Ste.102,(760)789-0950
Paul J.Lavin,O.D............................................655 Saturn Blvd.,Ste.H,(619)425-9001 Kenny F.Lane,O.D...........................................220 Rotanzi St.,Ste.A,(760)788-0088
Angelica M.Villa,O.D..................................655 Saturn Blvd.,Ste.H,(619)425-9001 Gary B.Myers,O.D........................................................1419 Main St., (760) 789-1191
Jamul Rancho Santa Fe
Kim J.Butler,O.D............................ 13910 Lyons Valley Rd.,Ste.G,(619)669-6414 Elizabeth A.Christensen,O.D...............................6037 La Granada, (858) 756-3210
La Jolla San Diego
Colin R.Bernstein,O.D...........................9834 Genesee Ave.,Ste.428,(858)457-1200 Allied Gardens-Del Cerro
Daniel J.Coden,M.D..............................9850 Genesee Ave.,Ste.310,(858)457-3010 Darrel D.Fullbright,O.D........................................10433 Friars Rd., (619) 283-6056
Victor L.Copeland,O.D.......................1.9850 Genesee Ave.,Ste.310,(858)457-3010 John C.Urey,O.D......................................................3175 Waring Rd., (619)583-1000
Michael S.Cypress,O.D........................9850 Genesee Ave.,Ste.310,(858)457-3010 Carmel Valley
Matthew W.Gentile,O.D..............4150 Regents Park Row,Ste.160,(858)450-9400 Kim E.Admire,O.D...........,..12750 Carmel Country Rd.,Ste.Al10,(858)350-1302
Franklin W.Lusby,M.D.................................7825 Fay Ave.,Ste. 140,(858)459-6200 Carlton L.Chan,O.D........................12857 El Camino Real,Ste.N3,(858)755-5503
David S.Michelson,M.D.......................9834 Genesee Ave.,Ste.200,(858)457-3050 Dale M.Koers,O.D..........................3830 Valley Centre Dr.,Ste.703,(858)350-4980
Paul E.Michelson,M.D..........................9834 Genesee Ave.,Ste.200,(858)457-3050 Clairemont Area
Forrest P.Murphy,M.D..........................9834 Genesee Ave.,Ste.209,(858)457-2220 Archie Ackroyd,O.D...............7307 Clairemont Mesa Blvd.,Ste.A,(858)292-7460
Padma Nanduri,M.D.............................9834 Genesee Ave.,Ste.406,(858)450-1010 Carl Archie
Boeck,O.D.D..................7420 Clairemont Mesa Bl,Ste. 109,(858)292-7460
Arthur C.Perry,M.D..............................9850 Genesee Ave.,Ste.310,(858)457-3010
Seal Beach Dennis J.Spiro,O.D__.......................11311 La Mirada Blvd.,Ste.B,(362)946-3311
Wm Randolph Hill,O.D.............................1029 Pacific Coast Hwy., (562)431-203f 'Nhan T.Tran,O.D...............................................15925 Whittier Blvd., (562) 947-8681
Scott E.Nelsen,O.D......................................1029 Pacific Coast Hwy., (562)431-2031 Yorba Linda
Stanton Lisa A.Benham,O.D........................21520 Yorba Linda Blvd.,Ste.B,(714)777 Sr'
Stacey Q.T.Le,O.D..................................................7038 Katella Ave., (714) S95-4899 Seth Bernstein,O.D..........................21520 Yorba Linda Blvd.,Ste.B,(714)777-7$o
Trabuco Canyon Charles F.Bittel,O.D...................................20399 Yorba Linda Blvd.,(714) 779-SS21
S.Nelson Jun,O.D............................21612 Plano Trabuco Rd.,Ste.C,(949)459-5687 Christine A.Matson,O.D................................18291 Imperial Hwy., (714) 717-1770
Tustin Stephanie S.Ripley,O.D......................4945 Yorba Ranch Rd.,Ste.E.,(714)692-2063
Kauser Sharieff,O.D.................................. 17524 Yorba Linda Blvd., (714) 996-6210
Amv L.Booth,O.D.....................................................1102 Irvine Blvd.,(714)838-32J0 2-2
.Booth,O.D..................................................1102 Irvine Blvd., 714 838-3_10' JohnC.Spaeth,O.D:.............................4945 Yorba Ranch Rd.,Ste.
Lowell E. (714)69__Ob3
J
Cindy K.Broady,O.D....................................17300 E.17th St.,Ste.M,(714)838-9664 Dieter Steimann,O.D.......................................18282 Imperial Hwv., (714) 777-3969
-
Walter F.Combs,O.D.............................13372 Newport Ave.,Ste.D,(714)544-4810 Riverside County
Rebecca L.Kammer,O.D..............................17300 E.17th St.,Ste.M,(714)83S-9664 AnZa
Joshua Kaye,O.D._.......................................17602 17th St.,Ste. 103,(714)832-1288 Robert I.Klemberg,O.D.:.........................2923 Tustin Market Place, (714) 731-0215 Mark A.Gillispie,O.D..........................39 100 Contreras Rd.,Ste.D,(909)763-_0_,
0
Robert J.Moeser,O.D. 13011 Newport Ave.,Ste.101,(714)544-3282 Banning
Todd J.Silverberg,O.D .............13257 Jamboree Rd., (714) 832-7575 Lewis E.Kemmerer,O.D .....6109 W. Ramsey St.,(909)845-0313
William B.Stanford,O.D....................................190 El Camino Real,(714)669-1121 Brian E.Van Dusen,O.D: ........: ......3559 W.Ramsey St.,Ste.D6,(909)849 2020
Joseph Vansuch,O.D...............................17842 Irvine Blvd.,Ste.104,(714)832-5335 Beaumont
Villa Park Blair M.Ball,O.D................................................1659 E.6th St.,Ste.A,(909)845-0272
James P.Furcolow,O.D....................................17829 Santiago Blvd., (714)998-6610 Dennis T.Hamamura,O.D................................1130 Beaumont Ave.,(909) 845-1 55
Westminster Blythe
Eric J.Bass,O.D.................................................15068 Goldenwest St., (714) 898-5631 Daniel M.Judd,O.D...............................................600 E.Hobson Way,(760)922-0284
Robert J.Bravo,O.D.........................................15068 Goldenwest St., (714) 89S-5631 Timothy R.Port,O.D.............................................836 E.Hobson Way,(760)922-3951
Michael L.Byrne,O.D. ........................................16481 Magnolia St., (714)848-0028 Canyon Lake
Sally H.Dang,O.D...........................................9600 Bolsa Ave.,Ste.C,(714)77 5-7045 Richard T.Blowers,O.D............31740 Railroad Canyon Rd.,Ste.4,(909)244-4444
Viet V.Dang,M.D...................................__10301 Bolsa Ave.,Ste.104,(714)775-0898 Corona
Linh V.Dinh,O.D.......................................................10161 Bolsa Ave., (714) 7 5-0019 Thomas L.Adams,O.D..............................2205 Vesper Cir.,Ste.104,(909)520-1212
Linh V.Dinh,O.D..........................................9131 Bolsa Ave.,Ste.202,(714)896-0788 Gary R.Bell,O.D.........................................807 W.Grand Blvd.,Ste.A,(909)735-1002_
Cuong Dung Trong Do,M.D.......................9061 Bolsa Ave.,Ste.105,(714)899-3670 Lisa A.Benham,O.D..........................2791 Green River Rd.,Ste.106,(909)736 2020
Robert S.Glass,O.D...............................................16498 Beach Blvd.,(714)848-3937 Seth Bernstein,O.D............................2791 Green River Rd.,Ste.106,(909)736-2020
DennisA.Ho,O.D.......................................................9078 Bolsa Ave., (714) 899-8991 James L.Davidian,M.D.......................1820 Fullerton Ave.,Ste.310,(909)734-8600
Ngoc Yen Hoang,O.D.................................................9022 Bolsa Ave., (714) 892-3636 Becky Fartash,O.D......................................................730 N.Main St.,(909)737-2020
Peter M.Horvath,O.D............................................16498 Beach Blvd., (714)845-3937 Morton P.Israel,M.D............................802 Magnolia Ave.,Ste.205,(909)734-9750
Tracy Bich-Tram Le,O.D............................9200 Bolsa Ave.,Ste.131,(714)903-7858 Paul H.Kim,O.D............................................1400 W.6th St.,Ste.101,(909)734-2001
Tracy Bich-Tram Le,O.D................................9393 Bolsa Ave.,Ste.C,(714)839-8581 Kenneth M.McKenzie,O.D......................1124 S.Main St.,Ste.101,(909)737-22S0
Loretta M.Li,O.D........................................................9022 Bolsa Ave., (714) 892-3636 Dena M.Mintz,O.D...............................800 Magnolia Ave.,Ste. 113, (909)737-7820
Arthur C.Lu,M.D..................................14571 Magnolia St.,Ste.205,(714)894-4599 Douglas T.Munroe,O.D..........................................464 Corona Mall, (909) 737-3881
Charles C.Luu,O.D......................................9191 Balsa Ave.,Ste.116,(714)892-4171 William M.Rogoway,O.D.:......................................730 N.Main St.,(909)737-2020
ChauP.Nguyen,O.D.............................14072 Magnolia St.,Ste. 105,(714)379-1214 Mark E.Schneider,M.D.............................................1124 S.Main St.,(909)737-6363
Diem D.Nguyen,O.D.................................................9567 Bolsa Ave., (714)7 5-8080 Francis M.Terranova,O.D..................370 W.Grand Blvd.,Ste.110,(909)737-0477
Kim-Anh T.Nguyen,0.13..................................15626 Brookhurst St., (714) 775-4553 Desert Hot Springs
LethuyT.Nguyen,O.D.................................9842 Bolsa Ave.,Ste.104,(714)775-3237 Steven A.Miller,O.D..................................................13 108 Palm Dr.,(760)329-3569
Melody T.Nguyen,O.D...............................9131 Bolsa Ave.,Ste.202,(714)896-0788 Hemet
Triet M.Nguyen,M.D........,.......................................9286 Bolsa Ave., (714) 899-0054 William P.Blase,M.D.................:.......2390 E.Florida Ave.,Ste.207,(909)652-6100
Thanh-LanT.Quart,M D ......................10362 Bolsa Ave.,Ste.201,(714)531-4804 Markus Buri,O.D..........
........................................731 E.Florida Ave.,(909)766-5:;87
Charles R.Soltes,O.D. ......... ..........9600 Bolsa Ave.,Ste.C,(714)Ti5-7045 David N.Chrisman,O.D _ 1302 W.Florida-Ave.;(909)925-7641
Frank B.Sue,O.D...........................6731 Westminster Blvd.,Ste. 102,(714)379-3495 R:Michael Duffin,'M.D.....................................
361 N.San Jacinto St.,(909)652-4343
Carolyn A.Takaesu,O.D.....................14571 Magnolia St.,Ste. 205,(714)894-4599 Arthur I.Jacobson,M.D......................2390 E.Florida Ave.,Ste.207,(909)652-6100
Yvonne V.To,O.D...........................6731 Westminster Blvd.,Ste. 102,(714)379-5495 Dean E.King,O.D.................................................900 E.Morton Place,(909)658-9409
Khanh K.Tong,O.D........................................9651 Bolsa Ave.,Ste.A,(714)839-9915 Steven R.Kleen,O.D.................................................999 E.Morton PL,(909)929-2746
Kieutien P.Tonnu,O.D..............................................10161 Bolsa Ave., (714) 775-0019 Kevin J.Lane,O.D.................................2390 E.Florida Ave.,Ste.207,(909)652-6100
Thao T.Tran,O.D..........................................2069 Westminster Mall, (714) 898-3464 David S.McCleary,O.D....................................361 N.San Jacinto St.,(909)652-4343
Michael T.Vu,M.D.........................................8860 Bolsa Ave.,Ste.B2,(714)373-8555 Daniel Navarro,O.D................................................999 E.Morton PL,(909)929-2746
Whittier Barratt L.Phillips,M.D.....................................361 N.San Jacinto St.,(909)652-4343
Aaron D.Adame,O.D....................................6537 S.Greenleaf Ave.,(562)698-9583 Gayle A.Reis,O.D......................................627 E.Florida Ave.,Ste.A,(909)766-0599
Harold H.Crum,O.D......................................13313 E.Telegraph Rd.,(562)944-9881 Thomas R.Scruggs,O.D......................................41705 Florida Ave., (909) 652-2020
Marie E.Cuadra,M.D.............................9209 Colima Rd.,Ste.3600,(562)698-1208 Steve J.Simpson,O.D...........................................41705 Florida Ave., (909) 652-2020
Suzanne M.Fabrizio,O.D......................................7749 Painter Ave.,(562)945-6391 Robert C.Sorenson,M.D..................................361 N.San Jacinto St.,(909)652-4343
Douglas F.Flor,O.D.................................. 15925 Whittier Blvd., (562)947-86SI Indian Wells
Mark A.Galvan,O.D.........................................6711 Comstock Ave., (562)698-0027 Vincent V.De Francisco,O.D..............................74927 US Hwv. 111, (760) 568-2340
David B.Golden,O.D......................11245 Washington Blvd.,Ste.E.,(562)692-1208 Indio
Sheldon M.Golden,O.D.................11245 Washington Blvd.,Ste.E.,(562)692-1208 Mark A.Gillispie,O.D...........................82227 US Hwy. 111,Ste.10,(760)347-6636
Guy K.Kato,O.D................................................6309 Greenleaf Ave., (562)698-3279
Norman S.Seto,O.D....................................................45655 Oasis St., (760) 347-5191
John A.Katzaroff,0.13......................................15925 Whittier Blvd., (562)947-8631 La QUlnta
Nicholas Kokoris, M.D..........................................7749 Painter Ave.,(562)945-6391
Barbara T.Konishi,O.D................................13313 E.Telegraph Rd.,(562)944-9881 Winston H.Alwes,O.D......................................78-560 US Hwy. 111, (760) 564-3887
David E.Marshburn,D.O.............. .15925 Whittier Blvd.,(562)947-8681 Lake Elsinore
William N.May,M.D..............................9209 Colima Rd.,Ste.2000,(562)698-3776 Richard T.Blowers,O.D......................32245 Mission Trail,Ste. D4, (909) 674-1561
Marc A.Mintz,D.O...........................................15925 Whittier Blvd., (562)947-86S1 Stephen G.Schroeder,O.D...................32245 Mission Trail,Ste. D4, (909) 674-1561
Joy T.Nakabayashi,O.D. ...................................6309 Greenleaf Ave., (562)698-9907 Moreno Valley
Sam M.Otsu}i,O.D.........................................13313 E.Telegraph Rd.,(562)944-9881 William K.Dorrance,O.D.....................................24250 Postal Ave., (909) 242-2020
William E.Overman,O.D......................................7247 Painter Ave., (562)945-3589 Eric Fennema,O.D....................................12968 Frederick St.,Ste.A,(909)924-1877
Frederick M.Raymond,M.D.................................7247 Painter Ave., (562)945-3589 Francisco J.Pabalan,M.D...............:.......12980 Frederick St.,Ste.G,(909)243-2266
Derek R.Rice,O.D..............................................16414 Whittier Blvd., (562)947-0391 Mark A.Rosa,O.D...........................11875 Pigeon Pass Rd.,Ste.B10,(909)242-3937
Robert Rosenberg,O.D.....................................16414 Whittier Blvd., (562)947-0391 Clinton K.Wong,O.D...........................12810 Heacock Sr.,Ste.B104,(909)924-2020
Paul R.Yang,O.D.......................................12980 Frederick St.,Ste.G,(909)243-2266
r
Murrieta Carol J.Tillman,O.D..............................6780 Indiana Ave.,Ste. 110,(9N)782,3091
Julie R.Anthony Arcemont,O.D............24400 Jackson Ave.,Ste.A,(909)677-5144 Anthony J.Worth,O.D..........................................3824 La Sierra Ave.,(90c' 359-3a77
David A.Dortch,O.D...............40680 California Oaks Rd.,Ste. 1A,(909)600-9226 Sun City
Jonathan M.Geller,O.D............25460 Medical Center Dr.,Ste.103,(909)698-4575 William P.Blase,M.D............................28125 Bradley Rd.,Ste. 180,(Ud 301-8888 '
Scott A.Lewis,O.D...................................24400 Jackson Ave.,Ste.A,(909)6775144 John S.Hersh,O.D...................................................27830 Bradlev Rd., (9011 672-4971
John J.McDiarmid,O.D......................25405 Hancock Ave.,Ste. 105,(909)696-5388 Kenneth James,O.D................................28125 Bradley Rd.,Ste. 180,(909)301-8888
Vernon N.Poole,O.D......................39872 Los Alamos Rd.,Ste.All,(909)698-4185 Satpal S.Multani,O.D........................................._28083 Bradley Rd., (9001 672-2010
Robert C.Sorenson,M.D....................25403 Hancock Ave.,Ste.105,(909)696-5388 Reggie L.Ragsdale,O.D.............................27994 Bradley Rd.,Ste.A,(90Q)679-0545
Norco Peter Shaw-McMinn,O.D.....................................27830 Bradley Rd., (909) 672-4971
Joseph A.Perry,Jr.,O.D..........................1700 Hamner Ave.,Ste.102,(909)735-7122 Temecula
Jay M.Wofchuck,O.D................................3179 Hamner Ave.,Ste.1,(909)734-4802 Julie R.Anthony Arcemont,O.D......................31685 US Hwy.79 S.,(909)302-5580
Palm Desert Bret E Argenbright,O.D......................41540 Winchester Rd.',Ste.B,(909)296-1822
Gordon F.Bateman,O.D.................73111 Country Club Dr.,Ste.B3,(760)340-5292 Donny R.Broyles,O.D.....................................40705 Winchester Rd., (90e) 296-2228
Greg E.Evans,O.D.......................44250 Town Center Way,Ste.C10,(760)674-8806 Markus Buri,O.D.......................................28551 Old Town Front St.,(909)676-4211
Ronald O.Jensen,O.D..........................44139 Monterey Ave.,Ste.A,(760)773-3099 K.P.Oscar Chung,O.D................................27403 Ynez Rd.,Ste. 101,(9N< 676-4121
Stephen R.Keller,O.D.....................74000 Country-Club Dr.,Ste.B2,(760)341-7373 Steven A.Cury,O.D. ............................31950 US Hwy.79 S.,Ste.B7,(eN)303-0575
Jack Lebby,O.D.:. ...... ....Palm Desert Town Ctr.Lower Lev,(760)776-9767 Mark A.Jury,O.D:..................................... ..:_27580 Ynez Rd„Ste.A,(9N)676-1955
Lawrence C.Watson,O.D..............73211 Fred Waring Dr.,Ste. 102,(760)346-1136 Todd A.Kelsch,O.D..............................41540 Winchester Rd:,Ste.B,(909)296-1822
Palm Springs Kevin J.Lane,O.D................................................31685 US Hwv.79 S.,(9(9)302-5580
Don A.Adkins,O.D._....._........................................139 S.Palm Canyon,(760)325-6326 Douglas F.Larsen,O.D.....................41238 Margarita Rd.,Ste. 105, (9091 699-1111
David R.Esquibel,O.D......................2367 E.Tahquitz Canyon Way,(760)327-8528 Scott A.Lewis,O.D. ............................................31685 US Hwy.79 S.,(909)302-5580
Wallace F.Goldban,M.D.....1180 N.Indian Canvon Dr.,Ste.W100,(760)320-8497 Thomas D.Lobue,M.D...............................40945 Winchester Road, (90Q) 719-1670
Robert B.Guss,M.D........................1180 N.Indian Canyon,Ste.130,(760)320-7051 David S.McCleary,O.D........................31950 US Hwy.79 S.,Ste.B7,(9N)303-0575
Bernard Hodgkinson,\LD...............1700 E.Tahquitz Canyon Way,(760)320-2133 Tamela A.Monteleone,M.D.............27720 Jefferson Ave.,Ste. 100,(909)693-4600
Lori L.Kirshner,M.D.....................1180 N.Indian Canyon,Ste.130,(760)320-7051 Eric J.Ramos,O.D........................................40945 Winchester Road, (90Q) 719-1670
Richard E.Kraus,O.D...............................1546 N.Palm Canyon Dr.,(760)320-4441 W.Berwyn Smith,M.D.........................41540 Winchester Rd.,Ste.B,(909)296-1822
David V.Learning,M.D._...............1180 N.Indian Canyon,Ste.130,(760)320-7051 Patrick W.Utnehmer,O.D...............................27580 Ynez Rd.,Ste.A,(9041 676-1955
George Lew,O.D..........._...............................700 N.Palm Canyon Dr.,(760)320-2333 Alan M.Winkelstein,O.D.....30520 Rancho California, Ste. A106, (909) 676-9465
Perris Wildomar
Edward B.Cooper,O.D....................................................350 E.4th St.,(909)657-4900 Mark A.Jury,O.D..........................23905 Clinton Keith Rd.,Ste. 113.(90a)304-9733
Steven H.Hilz,O.D..................................136 W.Nuevo Rd.,Ste.E&F,(909)943-4949 Yucaipa
Rancho Mirage Lewis E.Kemmerer,O.D....................................13391 California St., (901% 795-9747
Don A.Adkins,O.D...............................39700 Bob Hope Dr.,Ste.109,(760)340-3937 Norman Robert Miller,O.D..............................34806 Yucaipa Blvd., (90c)797-0134
Winston H.Alwes,O.D........................39700 Bob Hope Dr.,Ste.109,(760)340-3937 Steven A.Miller,O.D..........................................34806 Yucaipa Blvd., (9N) 797-0134
Burton C.Blaurock,O.D......................................42390 Bob Hope Dr.,(760)340-4524 Brian E.Van Dusen,O.D......................34590 County Line Rd.,Ste.1,(909)795-2416
jean T.Dinh,O.D....................................39700 Bob Hope Dr.,Ste.109,(760)340-3937 San Diego County
Janet K.Hartzler,M.D _......................39700 Bob Hope Dr.,Ste.109,(760)340-3937
Bart R Ketover,M.D..............................39700 Bob Hope Dr.,Ste.109,(760)340-3937 Bonita
Lam'G.Leiske,M.D............................39700 Bob Hope Dr.,Ste.109,(760)340-3937 Timothy A.Giles,O.D................................................4370 Bonita Rd., (619)267-5901
Albert T.Milauskas,\LD....................39700 Bob Hope Dr.,Ste.109,(760)340-3937 Edward K.Harver,O.D..............................................4502 Bonita Rd.,(619)479-7334
Redlands Carlsbad
Lewis E.Kemmerer,O.D................................................2 W.Fem Ave.,(909)793-3311 Jeffrey R.Anshel,O.D......................7130 Avenida Encinas,Ste. 103,(760)931-1390
Gavlan W.Moushon,O.D.........................1478 Industrial Park Ave., (909)793-2106 Bill G.Bell,M.D................................7130 Avenida Encinas,Ste. 103,(7601 931-0099
Daniel Navarro,O.D....................................................568 Orange St., (909) 335-0300 David A.Bloch,O.D..................................2910 Jefferson St.,Ste. 101,(760)730-3733
Steven O.Rimmer,M.D..................................................2 W.Fern Ave.,(909)793-3311 George A.Bradford,O.D..................2525 El Camino Real,Ste.165,(760)434-3308
Mark R.Stinson,O.D ..........:....................1478 Industrial Park Ave.,(909) 793-2106 Susan L.Daniel,O:D .......................2624 El Camino Real,Ste.A,(760)434-3314
Riverside Christopher Davis,O D .......................2624 El Camino Real,Ste.A,(760)434-3314
Sandra M.Akamine,O.D._....... 4313 Central Ave.,Ste. 101,(909)784-2420 John P.Fitzpatrick,O D 3044 Harding St.,(7601 729-5921
........... Howard J.Levy,O..D.. .. ..... 6949 El Camino Real,(7NDi 438-2020
John J.Allavie,M.D..............................4500 Brockton Ave.,Ste. 107,(909)686-4911 ''"'''""""'
Richard P.Bozner,O.D................................................4037 Market St., (909) 684-9700 Douglas M.Osborne,O.D.......................2910 Jefferson St.,Ste. 101,(760'729-4327
Edward B.Cooper,O.D...........................1345 University Ave.,Ste.B,(909)682-8190
John J.Riggs,O.D......................................7750 El Camino Real,Ste.P,(760)942-3937
Timothy Doran,O.D._._..................................._.._..........6405 Day St., (909) 697-5480 David W.Stemley,O.D......................................2540 El Camino Real,(760)729-9353
Cheryl M.Everitt,O.D........................6377 Riverside Ave.,Ste.190,(909)684-7822 Chula Vista
Gary Fishberg,O.D..........................5225 Canyon Crest Dr.,Ste.201,(909)788-2020 Kim E.Admire,O.D................................................320 3rd Ave.,Ste.B,(619)498-0730
Dan W.Gilbert,O.D.............................2953 Gan Buren Blvd.,Ste.H2,(909)785-1212 Kim E.Admire,O.D..........................................555 Chula Vista Mall, (619;427-6253
Ray R.Glendrange,M.D......................4500 Brockton Ave.,Ste.107,(909)686-4911 Beverly P.Bianes,O.D........................................374 E.H St.,Ste.170S,(619)425-7990
Nicole-Ninhco P Ha,O.D.....................4300 Brockton Ave.,Ste.107,(909)686-4911 Marilyn A.Carter,O.D..............................................353 H St.Suite C,(619)420-3010
Michael J.Hensley,O.D..................................................4000 Tyler St., (909) 687-7100 Christine M.Davis,O.D.........................299 Landis Ave.,Ste.101 A,(619)425-5555
Charles A.Jansen,O.D...................................................4000 Tyler St., (909) 687-7100 Robert L.Evans,O.D......................................330 Oxford St.,Ste.206,(6191 4225361
Anna S.Kame,O.D.........................................17675 Van Buren Blvd.,(909)780-0270 Robert L.Evans,O.D...................................................353 H St.Suite C,(619)420-3010
Benjamin J.Kohn,O.D.....................5051 Canyon Crest Dr.,Ste.102,(909)686-3937 Stephen E.Fry,O.D....................................................11 3rd Ave.,Ste.B,(619)420-5681
Janet Kohtz,O.D.......................................5300 Arlington Ave.,Ste.C,(909)689-9180 W.Joseph Garvin,O.D.............................531 Telegraph Canyon Rd.,(619t 482-2020
Harold W.Krajian,O.D......................9496 Magnolia Ave.,Ste. 101,(909)687-5312 Peter D.Huang,O.D.................................................................557 H St.,(619)422-0139
James K.Kreter,M.D...............................6780 Indiana Ave.,Ste.110,(909)782-3091 Gary M.Jacobs,M.D.........................................................681 3rd Nye., (619)420-2111
Anne Z.Mazer,M.D.................................6780 Indiana Ave.,Ste. 110,(909)782-3091 Lucinda Y.Li,O.D......................................................._......681 3rd Ave., (619)420-2111
Milton A.Miller,M.D...................................8990 Garfield St.,Ste.1,(909)785-5421 Efrain Mascareno,O.D..........................................340 4th Ave.,Ste.9,(6191 427-2020
N.Lome Muth,O.D..............................6377 Riverside Ave.,Ste.190,(909)684-7822 Daniel L.Mason,OLD...........................................746 Otay Lakes Rd.,(619)656-1081
Laura Uyen M.Nguyen,O.D.................9939 Magnolia Ave.,Ste.A,(909)785-0250 Anita R.Niederberger,O.D.................................1400 E.Palomar St.,(6191 397-3088
Nathaniel S.Olson,O.D..........................6780 Indiana Ave.,Ste.110,(909)782-3091 John C.Pack,O.D................................................3,'4 E.H St.,Ste.1708,(619 425-7990
Vincent K.Ragsdale,O-D...................285 E.Alessandro Blvd.,Ste.F,(909)780-5151 Robert Penner,M.D............................................................681 3rd Ave., (619)420-2111
Valerie L.Rasner,O.D.......................19530 Van Buren Blvd.,Ste.G8,(9091)656-0500 Debra A.Quick,O:D.............................................1400 E.Palomar St.,(619 397-3088
M.William Reves,M.D.......................4440 Brockton Ave.,Ste.130,(909)682-4353 Barry M.Scher,M.D............___.........................................681 3rd Ave., (619;420-2111
Mark A.Rosa,O.D....................................7900 Limonite Ave.,Ste.H,(909)681-4125 Gene R.Sieben,O.D........................................................565 Broadway, (619) 420-8011
Richard S.Rosenberg,LLD....................6780 Indiana Ave.,Ste. 110,(909)782-3091 Robert E.Thomas,O.D............................................................545 H St,(619 427-5177
Ralph H.Salisbury,O.D........................1450 University Ave.,Ste.D,(909)788-8650 Floyd L.Wergeland,M.D..................................................681 3rd Ave., (619;420-2111
Peter Shaw-McMinn,0.13.............................17675 Van Buren Blvd.,(909)780-0270 Elizabeth Yanagitani, O.D...........................................565 Broad%vav, (619) 420-8011
Bruce J.Spera,0.13............................................2296 Galleria at Tyler, (909) 689-4500
r
Res. No. 2002-122
STATE OF CALIFORNIA
COUNTY OF ORANGE ) ss:
CITY OF HUNTINGTON BEACH )
I, CONNIE BROCKWAY, the duly elected, qualified City Clerk
of the City of Huntington Beach, and ex-officio Clerk of the City Council of
said City, do hereby certify that the whole number of members of the City
Council of the City of Huntington Beach is seven; that the foregoing resolution
was passed and adopted by the affirmative vote of at least a majority of all the
members of said City Council at an regular meeting thereof held on the
18th day of November, 2002 by the following vote:
AYES: Green, Dettloff, Cook, Houchen, Winchell, Bauer
NOES: Boardman
ABSENT: None
ABSTAIN: None
CONNIE BROCKWAY
City Clerk and ex-officio Crerk of the
City Council of the City of
Huntington Beach, California