Benefits for Actives

Summary Plan Description

Medical Benefits

Please note: Same sex or opposite sex domestic partners are not covered.
2018 Medical Plan Options (side-by-side-comparison)

Self-Funded PPO Medical Plan
Kaiser HMO Plan

Dental Benefits

Other Benefits

Vision Plan

Your vision plan is provided by Vision Service Plan (VSP).

Hearing Care

Hearing care, which is provided by or ordered by a physician or certified audiologist, is subject to the following limits:

  1. $30 for one hearing examination in a 24-month period.
  2. The first $500 for each hearing device paid in full and 50% of any additional up to a maximum of $1,000 Plan payment.
  3. Limit of two hearing devices in a two-year period.
Life and AD&D

(For Active and Category 2 Employees)

LIFE INSURANCE REDUCTION BENEFIT LEVEL FOR NON-BARGAINING UNIT EMPLOYEES OVER AGE 65:
65-69
50%
70-74
25%
75-79
15%
80-84
10%
84+
5%
TERM LIFE BENEFITS
Active Employees $22,000
Active Employees with 5 or more years of service additional $28,000
ACCIDENTAL DEATH BENEFIT
Full Amount $22,000
In the event of Loss of:
Life Full Amount
Both Hands or Both Feet Full Amount
Sight of Both Eyes Full Amount
One Hand and One Foot Full Amount
One Hand and Sight of One Eye Full Amount
One Foot and Sight of One Eye Full Amount
One Hand One-Half the Full Amount
One Foot One-Half the Full Amount
Sight of One Eye One-Half the Full Amount
Thumb and Index Finger of Either Hand One-Half the Full Amount

 

Short-Term Disability Benefit

(For Active Employees Only)

Application for Short Term Disability

ACCIDENT & SICKNESS (Weekly Benefit)
1st 13 weeks: $100
2nd 13 weeks: $150

Benefits begin on the first day for an accident or hospital confinement and on the eighth day in case of non-hospital illness. The benefit covers both occupational and non-occupational accidents or illnesses.

Chemical Dependency Services

Beat It! is a specialty program for the treatment of problems with alcohol and drug abuse. This program is available to all qualified participants and their eligible Dependents, including members who have chosen the Kaiser, Health Net or PacifiCare plan for medical coverage.

The benefits include 28-day inpatient treatment in a pre-approved facility or an outpatient counseling program with a pre-approved counselor. These benefits are paid at 100% for first- time use of the program, inpatient or outpatient. Second-time use of the program will be paid at 80%. Alcohol and drug treatment benefits are subject to a lifetime maximum of $25,000.

Inpatient modalities are flexible and depend on the need of the client. These facilities may not be the same as the contract facilities for the medical inpatient program. All inpatient programs include six months to one year of aftercare and family involvement.

Outpatient counseling with approved counselors includes 40 hours of one-on-one therapy sessions.

The phone number should be used for direct connection to the alcohol and drug abuse treatment counselors. They will assist you with pre-treatment counseling and making arrangements for care. Please call (408) 436-2392 or 1-800-828-3939.

Pre-admission/pre-treatment approval is mandatory.
All calls and information are confidential.

Smoking Cessation

Effective August 1, 2014, the Plan will cover 100% of the costs for in-network smoking cessation benefits associated with screening for tobacco use, and two (2) cessation attempts per calendar year. For each smoking cessation attempt the Plan will cover four (4) counseling sessions, and a 9O-day supply of Food and Drug Administration (FDA)-approved cessation medications when prescribed by your health care provider. The Plan will cover 60% of out-of-network smoking cessation benefits, with the same calendar year limits on counseling sessions and prescription medications.

Contact Information for All Providers

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