2025_Wellwise_Medicare_Retiree_PPO_Health_Plan_Document.pdf

This is a health plan document for the 2025 Wellwise Medicare Retiree PPO plan, administered by the County of Orange in California. The document outlines comprehensive health insurance coverage for Medicare-eligible retirees and their dependents under the Wellwise PPO program. The plan provides detailed benefit structures for medical services, prescription drug coverage, and related healthcare provisions. The document serves as the official plan documentation for eligible Medicare retirees participating in the County's self-insured health benefits program, with an anticipated implementation date of January 1, 2026, aligning with the broader Pharmacy Benefit Management and Claims Administration Program RFP timeline.

The Wellwise Medicare Retiree PPO plan includes prescription drug benefits managed through the pharmacy benefit management services being procured in the related RFP. The plan is designed to coordinate with Blue Shield of California for medical coverage and will integrate with the selected PBM vendor for claims administration and pharmacy network services. As an Employer Group Waiver Plan (EGWP) for Medicare retirees, this plan operates under specific Medicare regulations and requirements. The plan documentation establishes the benefit parameters, cost-sharing structures, and network provider relationships necessary for the three-year contract period with optional renewal terms, providing the operational framework within which the PBM vendor will deliver pharmacy and claims administration services to this specific retiree population.