Benefits for Retirees

Application for Coverage as a Retiree for Health & Welfare Benefits

Medical

Health Net
Kaiser Permanente
United Healthcare
Hartford

Dental

Other Benefits

Vision Plan

Vision benefits are 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.
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.

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