Health Plans

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

The County offers five (5) medical plan options designed to provide choices for retirees. 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: Retiree and all family members must be eligible for, and enrolled in, the same plan option. 

"REMEMBER 30 DAYS"

You must come to 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 Annual 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

Medicare Advantage Plans

The enrolled member assigns his/her Medicare benefits to the HMO.  In this case, the HMO acts like Medicare, and no Medicare benefit is available outside of the HMO network.  The member chooses a Primary Care Physician (PCP).  All medical care except for emergency services must be provided or referred by the member’s PCP.  These plans are designed for retirees who have enrolled in Medicare Parts A and B.  Participants in this plan must also enroll in Part D through this plan.  Participants may not enroll in any other Part D plan though any other carrier.  This type of plan typically has the lowest premium.

• Health Net Seniority Plus

• Kaiser Permanente Senior Advantage

Medicare Coordinated Plans

The enrolled member chooses an HMO plan, and claims are billed directly by the HMO to Medicare.  In this case, the enrolled member still has Medicare benefits available to them outside of the HMO network.  Any covered balances are the responsibility of the HMO.  The member must follow the HMO and Medicare guidelines and is only responsible for applicable co-payments.  These plans are designed for retirees who have enrolled in Medicare Parts A and B.  Participants in this plan must also enroll in Part D through this plan.  Participants may not enroll in any other Part D plan though any other carrier. 

• Blue Shield HMO Coordinated

• Health Net HMO Coordinated

• Kaiser Permanente Cost Plan (the Kaiser Cost Plan is for current enrollees only.  No new enrollments are permitted by Kaiser due to Medicare regulations.)

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.  There are two types of PPOs offered this year. 

• Blue Shield PPO for Medicare Participants

• Blue Shield High Deductible PPO for non-Medicare participants

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

You may decline enrollment at the time of retirement or any time after your initial coverage eligibility period.  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 with proof of continuous, comparable group coverage will be required in accordance with the Retiree Health Insurance Program Administrative Policy.

Summaries

• Quick summary-major benefits for County Retirees (2008)

• Retiree Medical and Dental Insurance Program for Calendar Year 2008

• Retiree Medical and Dental Insurance Program for Calendar Year 2007

Inquire about the availability of documents in alternate formats.