Eligible Active Employees may choose among the different medical programs offered by the Plan, the current options available are:
1. Medical benefits paid directly by the Plan, or
2. Benefits provided by the Kaiser Foundation Health Plan. The Trustees of the Plan hope that these benefits will protect you and your family members if any of you suffer illness or injury.
You can select any dentist of your choice. To receive the plan’s highest level of benefits and pay the lowest out-of-pocket costs, use an Anthem PPO Dental 100/200/300 plan network dentist.
Your vision plan is provided by Vision Service Plan (VSP).
Hearing care, which is provided by or ordered by a physician or certified audiologist, is subject to the following limits:
- $30 for one hearing examination in a 24-month period.
- The first $500 for each hearing device paid in full and 50% of any additional up to a maximum of $1,000 Plan payment. 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:|
|Term Life Benefits|
|Active Employees with 5 or more years of service||additional $28,000|
|Accidental Death Benefit|
|In the event of Loss of:|
|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|
Short-Term Disability Benefit
Accident & Sickness (Weekly Benefit)
- 1st 13 weeks: $100
- 2nd 13 weeks: $150
Benefits begin on the first day of 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 (800) 828-3939.
Pre-admission/pre-treatment approval is mandatory.
All calls and information are confidential.
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 healthcare 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.
- Actives Kaiser HMO Enrollment/Change Form
- Application for Short Term Disability
- Claim For HRA Premium Payment Form
- Dental Claim Form
- MaxorPlus Rx Claim Reimbursement Form
- Self-Funded PPO Enrollment Form
- Dental PPO Plan Summary of Benefits
- UAS HRA Mobile App
- Medical Plan Options
- Summary Plan Description
- Vision Benefits Summary
- VSP at your fingertips
- VSP Grievance Process Notice
- Wex HRA Information