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6.1.3. 6.1.4. Effective Date: November 1, 2009 November 1, 2009 November 1, 2009 enrolled in AIM prior to July 1, 2004 include comprehensive health and do not include dental or vision benefits. Attachment B, from our actuarial consultant Leslie Paters of Cooper’s and Lybrand, states that the AIM benefit package is at least equivalent to the health benefits coverage used for our benchmark plan. Existing Comprehensive State-Based Coverage; (Section 2103(a)(3) and 42 CFR 457.440) [Only applicable to New York; Florida; Pennsylvania] Please attach a description of the benefits package, administration, date of enactment. If existing comprehensive state-based coverage is modified, please provide an actuarial opinion documenting that the actuarial value of the modification is greater than the value as of 8/5/97 or one of the benchmark plans. Describe the fiscal year 1996 state expenditures for existing comprehensive state-based coverage.

Secretary-Approved Coverage. (Section 2103(a)(4)) (42 CFR 457.450) 6.1.4.1. Coverage the same as Medicaid State plan 6.1.4.2. Comprehensive coverage for children under a Medicaid Section 1115 demonstration project 6.1.4.3. Coverage that either includes the full EPSDT benefit or that the state has extended to the entire Medicaid population 6.1.4.4. Coverage that includes benchmark coverage plus additional coverage California will provide enhanced services beyond the benchmark package, including comprehensive dental and vision coverage, screening and initial treatment services through the CHDP program and treatment services for severely ill children in a non-managed care delivery system. For a full benefits description, see Attachment 6. Infants born to mothers enrolled in the AIM Program on or after July 1, 2004 will also receive the CalPERS benefits including the enhanced services. Approval Date: HFP Family Contribution Increase HFP Co-Payment Increase HFP Limited Dental Plan Choice for New Subscribers

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