PLAN SUMMARIES 2023
PLAN SUMMARIES 2023![]()
United HealthCare
2023 UHC PLAN SUMMARIES:
- Harmony HMO $10
- Signature Value Alliance HMO $10
- Journey Harmony w/ HRA
- Signature Value Alliance (Low Option)
- Performance HMO Network 2
- UMR CA Select Plus PPO
- Hawaii PPO - Plan Summary
- UHC Evidence of Coverage
- Express Scripts - Select Plus PPO
- Express Scripts - Choice Plus PPO
COST-SAVINGS:
IMPORTANT INFORMATION:
Kaiser Permanente
2023 KAISER PLAN SUMMARIES:
ADDITIONAL KAISER INFORMATION:
- Kaiser $15 Evidence of Coverage
- Kaise $25 Evidence of Coverage
- Kaiser Chiropractic Services
- Kaiser Telephone Appointments
- Emergency Services
- Guidebook to Kaiser Permanente Services
- Visiting Member Services
- Orange County: Facility Guide
- Orange County: 4 Steps to Getting Started
- Orange County Map: Understanding where to go for different types of care
- Traveling as a Kaiser Permanente Member
- Urgent Care (PDF)
For additional Kaiser Permanente information, find a chiropractor, find a specialist, special discounts, wellness programs visit their website at www.kp.org
Cigna
2023 CIGNA PLAN SUMMARIES:
ADDITIONAL CIGNA INFORMATION:
For additional Cigna information, find a chiropractor, find a specialist, special discounts, wellness programs visit their website at www.cigna.com.
CUSD OFFERS 9 MEDICAL PLANS:
- 2023 Medical Side-by-Side Comparison Sheet
- 5 - United Healthcare (UHC) HMO Plans
- 1 - United Healthcare (UHC) PPO Plan
- 2 - Kaiser HMO Plans
- 1 - Cigna HMO Plan
Scroll down for plan details...
Need virtual access to your carrier ID cards? Click HERE!
UNITED HEALTHCARE PLANS
- Customer Service: (888) 586-6365 (All HMO Plans)
- Customer Service: (800) 826-9781
- (This is for UMR, the 3rd Party Administrator for all UHC PPO Plans)
- Website
- How to Find UHC HMO Primary Care Physician
- Go Here for a UHC PPO Doctor - Choose Select Plus on the Search Page
- Memorial Care Members Enrolled in UHC Harmony $10 HMO or UHC Journey Harmony w/ HRA: Free Virual Exam Kit (effective January 2023)
- Welcome to UHC Signature Value Harmony HMO Members to Memorial Care
Plan Names:
- Harmony $10 HMO
- Alliance $10 HMO
- Alliance HMO - Low Option
- Journey Harmony w/ HRA
- Performance Network 2
- Select Plus PPO
Prescription Drug Coverage (All UHC Plans):
Plan Name: Express Scripts
- Customer Service: (800) 918-8011
- 2023 Update Regarding Kroger Pharmacies
- Website
- Go Here for Informational Flyer
Journey Harmony - Health Reimbursement Account (HRA)
- BrainShark Videos
Optum Health - Chiropractic Services (for all UHC HMO plans)
- Customer Service: (800) 428-6337
- Website
Mental Health Service for UHC Plans
For All UHC HMO Plans:
- Get pre-authorization from Optum Behavioral Health
- Call Optum Customer Service for pre-authorization and for emergencies, 24/7, at (800) 999-9585
- Costs:
- Outpatient services are the same as medical outpatient office co-pays/costs
- Substance abuse services 100% covered for inpatient and outpatient
UHC/UMR PPO Plans:
- No need for pre-authorization for inpatient, outpatient or substance abuse services
- Coverage through Optum
- Contact UMR for cost information: (800) 826-9781
- In-network vs. out-of-network costs are different
- Click Here to find an in-network UMR provider
- UMR Mobile App
Carrum Health - (for all UHC PPO plans)
- Customer Service: (888) 855-7806
- Carrum Health Sample Letter from VEBA
Carrum Health is a surgery benefit for those members needing either a spine procedure, hip and knee replacement or Coronary Artery Bypass Graft (CABG). Through Carrum, members will have access to the highest quality surgeons who have proven to have the best outcomes for the covered procedures. The benefit will be added to PPO plans beginning on January 1, 2020.
Please note: The member will be required to call Carrum Health prior to scheduling their surgery.
- If the member contacts Carrum and uses a Carrum recommended facility for their surgery they will have the procedure coinsurance or deductible waived.
- If the member contacts Carrum but chooses not to use a Carrum recommended facility- they may use a facility of their choice and pay the standard plan coinsurance and deductible.
- If the member does not contact Carrum Health prior to scheduling their surgery they will be required to pay a $1,000 pre-certification penalty in addition to their plan deductible and coinsurance.
For questions please contact VEBA Advocacy at (888) 276-0250 or Carrum Health directly at (888) 855-7806. When an employee newly enrolls in any UHC PPO plan, a follow up information packet, including links to a dedicated website and registration, will be mailed directly to the member's home.
KAISER PERMANENTE PLAN
- Customer Service: (800) 464-4000
- Website
- Kaiser Fact Sheet (PDF)
- Gym Membership Discounts
- Coverage While Traveling
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- Beginning in August 2022, Kaiser Permanente HMO members will have access to Cigna's national network of physicians and providers, should they need emergency or urgent care during their travels away from home. This care provides 24/7 access by Kaiser Permanente health care professionals by phone or video. Members will have even more ways to get care how and when they need it - virtually and in person. Following this link will allow you to learn more about our new collaboration with Cigna.
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Plan Names:
- Kaiser HMO $15
- Kaiser HMO $25
American Specialty Health (ASH) - Chiropractic Services (for Kaiser HMO plan)
- Customer Service: (800) 678-9133
- Website
- ASH Informational Flyer
Mental Health Services
To schedule a mental health appointment, call: Orange County: (714) 644-6480. To make a mental health appointment KP members do not need a referral.
Behavioral Health Line & Mental Health Crisis Line for Kaiser Southern California: 1 (800) 900-3277
- Available 24/7
- The Mental Health Crisis Line for Kaiser Southern California is 1 (800) 900-3277. With this number, members can get help 24 hours a day, 7 days a week. This number will help with access to mental health, crisis intervention, guidance, and more.
Phone Line For Members’ Mental Health, Substance Use Appointment Concerns (Escalations): 1 (800) 900-3277
- Available Monday through Friday from 8 a.m. to 5 p.m.
- After-hours calls will be routed to a closed recording that advises members to contact 911 if they are having a medical or psychiatric emergency.
Resolution specialists will help members resolve concerns about mental health care appointments: 1 (800) 390-3503
Other Mental Health Resources
- PowerPoint on Mental Health Escalation Line
- PowerPoint on Digital Wellness Tools
- Calm App Info
- Digital Tools Info
- myStrength App Info
CIGNA HMO PLAN
Plan Name: Cigna Select HMO - Southern California:
- Customer Service: (800) 244-6224
- Website
- Cigna and St. Joseph HOAG Health Select
- Cigna Medical Select HMO Find a Doctor (PDF)
- Cigna Medical HMO Guest Flyer (PDF)
- Cigna Select Know Before You Go (PDF)
- Cigna Select So Cal Network (PDF)
- After Hours Care (PDF)
American Specialty Health (ASH) - Chiropractic Services (for Cigna Select HMO plan):
- Customer Service: (800) 678-9133
- Go to MyCigna page here to search for chiropractors
- Use these instruction here to search for chiropractors on Cigna.com
- Chiropractic Journey - Medical Necessity Review (MNR)
Mental Health Services for Cigna Select HMO
- See primary care physician (PCP) for referral
DISABLED ADULT DEPENDENTS
For UHC members: Please have the treating physician complete the below form and return it directly to UHC per the instructions on the application. UHC will notify the member of approval or denial.
For Kaiser members: Contact Kaiser directly at (800) 464-4000, and they will send the member the form and submittal instructions. Kaiser will notify the member of approval or denial.
For Cigna Select HMO and Delta Dental members: Obtain a copy of a letter from the treating physician determining the dependent's disability and submit this with a letter requesting enrollment or continuation of coverage for the dependent to the Insurance Department. The Insurance Department will submit the letter to our Health Benefit Trust (VEBA) for approval and notify the member of approval or denial.
GENERAL NOTES REGARDING HEALTH COVERAGE
GENERAL NOTES REGARDING HEALTH COVERAGE![]()
GENERAL NOTES REGARDING HEALTH COVERAGE
*Employees electing one of the United Healthcare HMO Networks will select a physician from a list of Primary Care providers, that physician then directs the medical care. Benefits accessed are covered at 100% except for office visit co-payments and prescription medications.
*Employees electing the Cigna Select HMO will select a physician from a list of Primary Care providers in the St. Joseph Hoag Health Network. Benefits accessed are covered at 100% except for office visit co-payments and prescription medications.
*Employees electing Kaiser Permanente HMO will access care from any Kaiser Permanente facility. Benefits accessed are covered at 100% except for office visit-co-payments and prescription medication.
*Employees electing the United Healthcare PPO can access physicians and specialist at any time without referrals. The employee has a co-payment for primary care and specialists. For most other services, an annual deductible does apply, then the plan pays a percentage.