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Medical Plans

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You have your choice among three medical plans: Aetna, Kaiser and Blue Shield. Eligible Employees All regular and probationary employees who work 20 or more hours a week. Eligible dependents are your lawful spouse, dependent unmarried children to age 19, or young adult dependents to age 30 (if you provide more than 50% of his/her livelihood), domestic partners and children of domestic partners - (the County's contribution for domestic partners and children of domestic partners are considered taxable income). Open Enrollment Once a year in October, employees may change from one plan to another or add dependents. During the year new dependents may be added within 31 days of marriage, birth, adoption or formation of domestic partnership, and children of domestic partners. After 31 days, the dependent cannot be added until the next open enrollment. Aetna and Kaiser are Health Maintenance Organizations - HMO's. Open Enrollment Form (PDF) Please read the Comparison Chart (PDF) for medical plans carefully. Then make your selection for coverage. It is important to note that these are summary comparisons only. More complete information is available in the certificates of coverage available through the Employee and Public Services Department. Your contribution towards the cost of your plan is determined by your represented union group as shown on the rate schedule. Health Plans Costs Table County Employees With Blue Shield Or Aetna Medical Insurance: You can choose San Mateo Medical Center (SMMC) as your provider for some or all of your healthcare needs. All co-pays and deductibles for inpatient hospital stays and emergency room visits at San Mateo Medical Center will be waived for employees with Blue Shield or Aetna and their covered dependants.  (Note: outpatient co-pays will still apply.) You can choose these plans during the Open Enrollment period if you wish to get care at SMMC. Policies and Procedures If you join: Aetna You must choose a primary care physician from the Aetna network of member-doctors. That primary care physician is responsible for all of your medical care and will refer you to a specialist, if necessary and make arrangements for any required hospitalization. Contract and Evidence of Coverage - Active Employees NOTE: Members may access benefit information by registering for and using Aetna Navigator. Your use of the documents in this medium shall signify your agreement not to alter or change their content in any way without the express consent of Aetna, and your agreement to indemnify and hold Aetna harmless for all loss, liability, damage, expense, cost, or other obligation which Aetna may incur or be required to pay as a result of any claim, demand, or lawsuit brought by any party (including yourself) arising from or in connection with any unauthorized changes. http://www.aetna.com/index.htm This is Aetna's Home page that can be used as a launching pad to investigate any number of options within Aetna's Internet site including DocFind, Aetna Navigator, RX Formulary, and more. http://www.aetna.com/docfind/ Find a Primary Care Physician (PCP) or specialist, hospital, drug store, and other Aetna providers close to home or in any area of the country with Aetna's DocFind. http://www.intelihealth.com InteliHealth is a great site to learn about medical conditions and their treatment. Search for medical conditions, medications, and even shop for health-related items on InteliHealth. http://www.aetna.com/formulary/ Look up the copayment for a prescription drug or to learn if a specific drug is covered in the Pharmacy Coverage Policies. http://www.aetna.com/cpb/index.html Unsure if a particular treatment is covered, take a look at the Coverage Policy Determinations that identify and discuss Aetna's Coverage Issues. http://www.aetna.com/Member_Public/index.jsp Aetna Navigator is a one-stop web page containing a self-service center to change your PCP, replace an ID card, and find health-related information. http://www.intelihealth.com Questions about particular health conditions can be answered by investigating this link. http://www.intelihealth.com New prescriptions can be confusing, but information is available by using Aetna's drug resource center. http://www.intelihealth.com If a medical term is confusing, look it up on Aetna's link to an online medical dictionary. Kaiser You select your physician from the staff at a local Kaiser facility. Your medical care will be provided by that physician, or other Kaiser physicians, within a Kaiser facility, or in another facility to which you are referred by your Kaiser doctor. Blue Shield The Blue Shield Point of Service Plan is a three tier Plan with HMO, PPO (Preferred Provider Org.) and indemnity (Non-Preferred Providers) comprehensive medical plan. Participants may select which tier they use each time they seek services. Some basic medical services are covered in full, without a deductible under the HMO provision; other major services may require a co-payment and a deductible under the PPO provision. You must select an HMO doctor but may use any doctor and any facility anywhere; your expenses will be reimbursed according to the plan tier you select. Evidence of Coverage and Disclosure, Point-Of-Service (POS) Plan (PDF) Evidence of Coverage and Disclosure, Preferred Provider Plan (PPO) Plan (PDF) Evidence of Coverage Amendment for POS and PPO plans "NOTICE: This copy of the Blue Shield Combined Evidence of Coverage and Disclosure Form is being provided for your convenience. Blue Shield of California takes no responsibility for the information contained in this document on the Internet. Please note that the Combined Evidence of Coverage and Disclosure Form will be, or has been, provided to you in a printed copy format by Blue Shield of California and such printed copy is the official disclosure form required by the California Health and Safety Code." Blue Shield of California's Contract for POS plan    Blue Shield of California's Health and Wellness information on the web: LifePath Advisors available 24/7 Alternative Care Discounts (massage therapy, acupuncture, etc.) Healthy Living Programs Health Library Subscribe to Blue Shield's Health and Wellness e-mail newsletter and stay current with the latest trends. Hospital Comparison Tool Contact Customer Service: Order ID Cards Order Forms Listing of Blue Shield of California's participating medical providers Pharmacy Benefits Blue Shield of California's on-line drugstore Claims Look-Up to determine status of outstanding claim Blue Shield Subscriber Statement of Claim Form  Blue Cross Blue Shield Association website for care outside CA   Remember that your medical enrollment form must be completed and returned to your payroll clerk within the first three days of your employment.