Health Plans

Blue Shield, Health Net & Kaiser Permanente (Health Plans)

The County offers five (5) medical plan options designed to provide choices for employees. You may choose from three (3) traditional Health Maintenance Organization (HMO) plans, or two (2) High Deductible Health Plans (HDHP), one of which is an HMO plan, and the other is a Preferred Provider Organization (PPO) plan.

For detailed or specific plan information, you may call the plan’s toll-free number listed on the links/contacts page, or you may refer to the full Evidence of Coverage booklet that is maintained in the Employee Benefits Office.

Note: Employees and all family members must be eligible for, and enrolled in, the same plan option. 

"REMEMBER 30 DAYS"

You must contact the Employee Benefits Office within 30 days of the date of a qualifying status change event to make a change to your medical, dental and life insurance.  Failure to do so within the 30-day time frame will result in your inability to make the change until the next Open Enrollment period.

Health Maintenance Organization (HMO)

One of the medical plan options available to employees is called a Health Maintenance Organization or HMO.  Under an HMO plan, a Primary Care Physician (PCP) generally directs all medical care and specialty referrals for members.

• Blue Shield

•  Health Net

• Kaiser Permanente

Preferred Provider Organization (PPO)

The County also offers employees a medical plan called a Preferred Provider Organization (PPO).  A PPO plan allows you freedom of choice because you may choose your doctor without using a Primary Care Physician (PCP) and you may self-refer to specialists.  You may also choose to see a doctor who is out of network and still receive a benefit.  PPO plans have a calendar-year deductible, which is the amount that must be paid before benefits will be paid. After the deductible is satisfied, you must pay the coinsurance or co-payments, plus the cost of any non-covered services to the provider.

• Blue Shield High Deductible PPO

 High Deductible Health Plan (HDHP)

A High Deductible Health Plan (HDHP) is defined by Internal Revenue Code 223(c)(2). To qualify as an HDHP, both medical (except for certain types of preventative care) and prescription expenses must apply to the deductible.

For 2008, the County offers two HDHP options to choose from; Kaiser High Deductible HMO, and Blue Shield High Deductible PPO.

If you choose to enroll in one of the HDHP medical plans, you may also be eligible to establish a Health Savings Account (HSA).

• Kaiser Permanente High Deductible HMO

• Kaiser Permanente Sample Fee Schedule (Sample of fees Kaiser will use for the High Deductible plan.  This list shows estimated member charges for some commonly used medical services.  These charges are valid as of January 2007 and are subject to change without notice.  This is not a complete list.  For more information, call Kaiser Deductible Products Service Team at 1-800-390-3507.)
  
  Kaiser Permanente FAQ about cost estimates for cost-sharing (High Deductible) plans.
   

•  Blue Shield High Deductible PPO

Waivers

If you have other group health coverage, you may wish to waive the County provided medical benefit.

You may waive coverage during your initial eligibility period, or within 30 days of a “change of status” event of gaining other group coverage. If you choose to waive coverage, you will be allowed to enroll in a County sponsored medical plan only if you enroll within 30 days of a mid year “change of status” event of the loss of other group coverage. Documentation of the loss of other group coverage will be required to enroll in the County provided medical benefit.

Summaries

• Quick summary-major benefits for Active Employees (2009)

• Quick summary-major benefits for Active Employees (2008)

• Quick summary-major benefits for Special District Employees (2009)

• Quick summary-major benefits for Special District Employees (2008)

Inquire about the availability of documents in alternate formats.