Employees must elect medical coverage; dependent coverage is optional. Eligible dependents are: spouse, domestic partner, children to age 26.
If you choose to decline enrollment for your dependent(s) because of other health insurance coverage, you may in the future be able to enroll your dependent(s) in a health plan, provided that you request enrollment within 30 days after your other coverage ends. In addition, if you have a new dependent as a result of a qualifying event, such as marriage, Declaration of Domestic Partnership, birth, adoption, or placement for adoption, you may be able to enroll your dependent, provided you request enrollment within 30 days following the date of the qualifying event.
The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) requires employer-sponsored group health plans to permit benefit eligible employees and their dependents to enroll in a plan if they lose eligibility for Medicaid or CHIP or if they become eligible for premium assistance under Medicaid or CHIP. An individual who requests enrollment within 60 days of losing or becoming eligible for Medicaid or CHIP will be enrolled, even if there is otherwise no open enrollment period.
HEALTH PLAN OPTIONS
Kaiser HMO Plan Summary (PDF)
List of locations and other benefits: www.kaiserpermanente.org
Kaiser Behavioral Health Benefit (PDF)
Counseling Services: (877) 496-0450
Kaiser Chiropractic Benefit Summary (PDF)
Chiropractic services provided by: American Specialty Health (ASH)
ASH Provider Directory: www.ashcompanies.com/kp or (800) 678-9133
Kaiser Evidence of Coverage (PDF)
Kaiser Membership Services: (800) 464-4000
Group ID: 116461-0000
$10 Office co-pay
$10 Prescription co-pay
Mail Order Prescriptions: www.kaiserpermanente.org
Consortium Health Plan Summary - 2014 (PDF)
Consortium Health Plan Summary - 2013 (PDF)
Detailed Health Plan Summary (PDF)
PPO Provider Network: GWH-Cigna: www.cigna.com (Select "Find a Doctor"). You DO NOT need a user name & password to access the directory.
Consortium Health Plan Behavioral Health Benefit Summary (PDF)
Counseling services provided by: OptumHealth
OptumHealth Providers: (800) 999-9585
CHP Evidence of Coverage (PDF)
HIPAA Privacy Notices
Questions about eligibility, benefits or if you need help finding an in-network provider:
San Diego & Imperial County School Fringe Benefits Consortium
Group ID: JPAK-54
The Consortium Health Plan offers two levels of coverage based on doctor of choice:
PPO Provider Network:
Plan Pays 80%, Employee Pays 20%
$25 Office visit co-pay
Annual Deductible: $300 Individual / $900 Family
Effective January 1, 2014: Annual Out-of-Pocket Maximum: $3,000 per individual OR $6,000 per family (excludes prescription co-pays)
Non-member Provider Coverage:
Plan Pays: 60% UCR*, Employee Pays: 40%
Annual Deductible: $550 Individual / $1,650 Family
*Amounts in excess of UCR (usual/customary/reasonable) charges are members responsibility and do not apply to annual deductible or out-of-pocket maximums.
Effective January 1, 2014: Annual Out-of-Pocket Maximum: $6,000 per individual OR $12,000 per family (excludes prescription co-pays)
Prescriptions: (30-day supply)
$10 Prescription co-pay (generic meds)
$25 Prescription co-pay (preferred meds)
$40 Prescription co-pay (non-preferred meds)
Mail Order Prescriptions: Express Scripts or (877) 256-4684 (two co-pays/90-day supply)
(Mandatory Mail Order for Maintenance Medications)
PPO Claim Form (claim used to submit bills for out-of-network covered services)
This summary of benefits is informational only and is not a complete description of all applicable conditions. Coverage and plan offerings are subject to change in subsequent years pursuant to District policy.