INDEPENDENT PROVIDER HEALTH BENEFITS SUMMARY
The IHSS Public Authority has contracted
with Kaiser Permanente to offer eligible IHSS individual
providers medical insurance. We also offer dental insurance
through Western Dental. There is no cost to join the dental
plan. However, there are a limited number of spaces available
under these programs. There is no dependent coverage available
for either plan at this time.
You
are eligible to receive medical benefits if you:
-
Are
authorized to work 80 hours or more per month
for three (3) consecutive months and continue to be authorized
to work 80 hours or more per month.
-
Agree
to pay the monthly premium for the medical insurance.
The monthly cost will be withheld from your
IHSS
paycheck. (However, if for whatever reason you are not deducted
from your IHSS paycheck or do not receive a monthly invoice
you are still required to remit payment to
out office by the 1st of the month). If you are an Advance
Pay Provider
the IHSS Public Authority will bill you directly
each month.
-
Submit
your enrollment form to the Public Authority by the deadline
indicated in your introduction
letter. (If you do not submit your enrollment form to the Public
Authority within the specified time you must wait until the next
open enrollment period.) Contact a Health
Benefits Specialist at 866-351-7722 to obtain an enrollment
form.
-
Do
not have any unpaid/past due premiums for previous medical
coverage with the Public Authority
Please contact a Health Benefits Specialist at 866-351-7722
for more information and enrollment forms.
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Medical
Benefits FAQ
(FAQ = Frequently Asked Questions)
- Where is my Member Card?
- What does my insurance cover?
- Do I have to pay for office visits?
- Do I have to pay for prescriptions?
- Can I change my Dr.?
- Do
I qualify for Health Benefits?
- Who do I make my check payable to?
- Why do I need to send a check to Public Authority?
- Will I be billed?
- When will the insurance premium be deducted?
- Where do I find the health benefit deduction on my check?
- Can I still be on health benefits if I am terminated or my status changes?
- How
long before I receive COBRA coverage?
- What is the U.D.W. phone number?
- How do I cancel/terminate my coverage?
- Can I enroll at anytime?
- Is this an H.M.O.?
- What is an H.M.O.?
- How does this affect my current insurance?
- What is a qualifying event?
- How are my benefits affected if I go on Vacation?
- Am
I covered if I go out of the service area? (Southern California
Region Service Area-Your Home Region)
- What's Urgent Care?
- Will my coverage be affected if I am on “leave” status?
- Who can I contact when I have questions regarding the benefits offered through Kaiser Permanente?
- Can I see a specialist directly, without a referral from my PCP?
- Where and when can I access Urgent Care Services?
- When should I expect a deduction from my paycheck for my Health Insurance Premium?
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1. Where is my Member Card?
Kaiser Permanente will send you a Member ID Card that shows
your Member record number, date of birth, and phone numbers
for Kaiser. If you lose your ID card or require medical services
prior to receiving your ID card, please call Kaiser Customer
Service Department at 1-800-464-4000.
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2. What does my insurance cover?
Kaiser Permanente is a comprehensive health care plan, which
offers a full spectrum of covered medical care. Covered services
vary depending upon the coverage your employer has selected
for you. However, these services always include coverage
for: hospital stays for medical conditions, surgery, outpatient
procedures, periodic immunizations, physical exams, physician
office visits, and much more, with varying levels of Co-payments
and/or co-insurance. If you have any questions consult your
Member Handbook or call Kaiser Permanente Customer Services
Department at 1-800-464-4000.
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3. Do I have to pay for office visits?
You are responsible to pay for Physician office visits.
Your co-payment is $20/visit.
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4. Do I have to pay for prescriptions?
Prescription Drugs
Generic items from a Plan Pharmacy - $15 for up to 30 day
supply, $30 for a 31-60 day supply, or $45 for a 61-100
day supply
Refills from mail order program - $30 for up to a 100 day
supply
Brand name items from a Plan Pharmacy - $35 for up to 30
day supply, $70 for a 31-60 day supply, or $105 for a 61-100
day supply
Refills from mail order program - $70 for up to a 100 day
supply
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5. Can I change my Doctor?
If you wish to change your Primary Care Physician (PCP)
or Primary Medical Group (PMG), please call Kaiser Customer
Service at 1-800-464-4000.
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6.
Do I qualify for Health Benefits?
If you have been authorized a total of 80 hours for three
consecutive months with San Diego IHSS Public Authority and
you maintain an authorization of a minimum of 80 hours per
month you may be eligible. Please call our Health Benefits
Department at 1-866-351-7722 to verify eligibility.
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7. Who do I make my check payable to?
Your check/money order should be made payable to “IHSS Public Authority”
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8. Why do I need to send a check to Public Authority?
As the employer of record the Public Authority is responsible for insuring your payments are made.
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9. Will I be billed?
Yes if:
-
You
are an Advance Pay provider.
-
You
did not submit your timesheet at the end of each pay
period.
-
We
were not able to deduct the premium from your payroll
check.
Otherwise your insurance premium will be deducted from
your payroll check.
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10. When will the insurance premium be deducted?
Your insurance premium is deducted once per month from either
the first or second paycheck of the month - whichever check
the State Controller can capture the premiums from.
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11. Where do I find the health benefit deduction on my check?
Your
deduction will show on your pay stub as “Health Ins”.
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12.
Can I still be on health benefits if I am terminated or my
status changes?
If your employment status has been terminated or if your
total authorized hours drop below 80, your health insurance
coverage will be cancelled. It is your responsibility to
report the change(s) immediately to the IHSS Public Authority
Health Benefits Department at 1-866-351-7722 during our normal
business hours (Monday-Friday 8:00am-5:00pm). You may be
eligible for COBRA continuation coverage. Please contact
a Health Benefits Specialist at the Public Authority for
more information.
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13.
How long before I receive COBRA coverage?
COBRA coverage should be received within two weeks from
the date that your coverage is terminated.
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14. What is the U.D.W. phone number?
To contact
your Union Representatives please call (619) 641-1190 or
(800)-244-2778.
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15.
How do I cancel/terminate my coverage?
All cancellation requests must be submitted in writing.
For more information please contact the Health Benefits Team
at 1-866-351-7722.
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16.
Can I enroll at anytime?
No, you
can only enroll for Kaiser/Western Dental benefits during
Open Enrollment. If you are a new provider with San
Diego IHSS Public Authority you can enroll for Kaiser/Western
Dental, provided you meet all of the eligibility requirements
set forth by IHSS Public Authority.
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17.
Is this an H.M.O.?
Yes, this is a High Co-pay HMO program.
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18.
What is an H.M.O.?
HMO stands
for Health Maintenance Organization. HMOs are a very effective
method of controlling health care costs.
Under an HMO program, the insurance company contracts with
specific doctors and medical groups who are “gatekeepers” to
your health care needs.
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19.
How does this affect my current insurance?
You need to contact Kaiser Permanente at 1-800-464-4000
for more information.
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20.
What is a qualifying event?
Any person who is an Eligible Employee who previously declined
coverage under the Plan and subsequently has a qualifying
event such as a loss of coverage may be able to enroll. Please
call the Health Benefits Team, immediately after losing your
coverage, for more information about qualifying events and
how to enroll.
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21.
How are my benefits affected if I go on Vacation?
If your
vacation will cause your authorized hours to drop below
80, then your coverage will be cancelled due to insufficient
hours. Please check eligibility requirements (Question
#6).
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22.
Am I covered if I go out of the service area? (Southern
California Region Service Area-Your Home Region)
If a member goes out of the service area they are covered
only for emergency services. Urgent conditions are
not emergencies.
If Urgent Care services are required while outside the service
area, you should still contact your Primary Physician first.
Your Primary Physician will authorize your visit to an
appropriate facility if treatment cannot be delayed until
you return
to the service area.
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23.
What's Urgent Care?
Urgent Care Services means those services that are medically
required within a short time frame, usually within twenty-four
hours, in order to prevent a serious deterioration of a member's
health due to an illness or injury.
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24.
Will my coverage be affected if I am on “leave” status?
Yes,
coverage will be cancelled, due to non-active status. Please
check eligibility requirements (Question
#6). It is
your responsibility to report the change immediately to the
IHSS Public Authority Health Benefits Department at 1-866-351-7722
during our normal business hours (Monday-Friday 8:00am-5:00pm).
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25.
Who can I contact when I have questions regarding the benefits
offered through Kaiser Permanente?
Kaiser Customer Service Representatives are available Monday
through Friday, from 7:00 a.m. to 7:00 p.m. (Weekends 7:00am-3:00pm),
at 1-800-464-4000. Information regarding the following (and
more) is available through Kaiser Customer Service:
-
General
information
-
ID
Card Requests
-
Physician
network updates and information
-
Claim
inquiries
-
Health
policies and procedures
-
Grievance
procedures
-
Primary
Care Physician (PCP) changes
-
Formulary
information
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26.
Can I see a specialist directly, without a referral from
my Primary Care Physician (PCP)?
You don’t
need a referral to receive primary care from Plan Physicians
in the following areas: internal medicine,
obstetrics/gynecology, family planning, family medicine,
and pediatrics.
Plan
Physicians who are specialists provide specialty care in
areas such as surgery, orthopedics, cardiology, oncology,
urology, and dermatology. A Plan Physician must refer you
before you can be seen by one of the specialists except
that
you don’t need a referral to receive care in the following
areas: optometry, psychiatry, and chemical dependency. Please
check Your Kaiser Guidebook to see if your facility has other
departments that don’t require a referral.
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27.
Where and when can I access Urgent Care Services?
Kaiser Permanente has Urgent Care Centers throughout San
Diego County. Look in your Provider Directory for Urgent
Care locations and access hours. Contact your Primary Care
Physician (PCP) or Kaiser 1-800-464-4000 for Authorization
before going to the Urgent Care Center, so they can coordinate
your care effectively.
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28.
When should I expect a deduction from my paycheck for
my Health Insurance Premium?
See Question #10. If for any reason a timesheet is not processed monthly, the Public Authority will invoice you separately for your health insurance premium(s).
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