HEALTH BENEFITS FOR INDIVIDUAL PROVIDERS

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 make payment to our 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 or a qualifying event). 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.

Medical Benefits FAQ

(FAQ = Frequently Asked Questions)

1. Where is my Member Card?
2. What does my insurance cover?
3. Do I have to pay for office visits?
4. Do I have to pay for prescriptions?
5. Can I change my Dr.?
6. Do I qualify for Health Benefits?
7. Who do I make my check payable to?
8. Why do I need to send a check to Public Authority?
9. Will I be billed?
10. When will the insurance premium be deducted?
11. Where do I find the health benefit deduction on my pay stub?
12. Can I still be on health benefits if I am terminated or my status changes?
13. How long before I receive COBRA coverage?
14. What is the U.D.W. phone number?
15. How do I cancel/terminate my coverage?
16. Can I enroll at anytime?
17. What type of medical plans are offered?
18. What is an H.M.O.?
19. How does this affect my current insurance?
20. What is a qualifying event?
21. How are my benefits affected if I go on vacation?
22. Am I covered if I go out of the service area? (Southern California Region Service Area-Your Home Region)
23. What's Urgent Care?
24. Will my coverage be affected if I am on "leave" status?
25. Who can I contact when I have questions regarding the benefits offered through Kaiser Permanente?
26. Can I see a specialist directly, without a referral from my PCP?
27. Where and when can I access Urgent Care Services?
28. 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?

Yes. Co-payments vary depending on the Plan selected.

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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 to work a total of 80 hours for three consecutive months with an IHSS Consumer(s) 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 your 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 Health Benefits Adminstrator, the Public Authority is responsible for insuring your payments are made.

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9. Will I be billed?

Yes if:

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 - from 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 offer 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 and/or Western Dental benefits during Open Enrollment or a Qualifying Event. If you are a new Provider with IHSS, you can enroll for Kaiser and/or Western Dental provided you meet all of the eligibility requirements, although there may be a waiting period before such benefits will be available to you.

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17. What type of medical plans are offered?

• High Co-Pay HMO Plan
• Deductible HMO Plan

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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 7:00 a.m. to 3:00 p.m.), at 1-800-464-4000. Information regarding the following (and more) is available through Kaiser Customer Service:

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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). It is your responsibility to pay your monthly premium.

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