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Medical Plans

 

CUSD OFFERS 9 MEDICAL PLANS:

 

Need virtual access to your carrier ID cards? Click HERE!

 

 
UHC/ UMR Plan Names:
  • UHC Harmony $10 HMO
  • UHCCS VEBA Alliance HMO $10
  • UHC Harmony HMO Journey w/ HRA 
  • UHC CS VEBA Alliance HMO Journey w/ HRA 
  • UMR Select Plus PPO
 
Express Scripts (All UHC Plans):
 
Journey Harmony and Journey Alliance Health Reimbursement Account (HRA)
Chiropractic Services - Optum Health
 
Mental Health Service for UHC Plans
  • Get pre-authorization from Optum Behavioral Health
  • Call Optum Customer Service for pre-authorization and for emergencies, 24/7, at (888) 625-4809 
  • Costs:
 
Fitness
 
Substance Abuse Services
  • No need for pre-authorization for inpatient or outpatient services
  • Coverage through Optum
  • Contact UMR for cost information: (800) 826-9781
  • In-network vs. out-of-network costs are different
  • Find an in-network UMR provider
  • UMR Mobile App
 
Carrum Health (Surgery Benefit)
  • Customer Service: (888) 855-7806
  • 2019 Carrum Health Letter
  • ***Important 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 or Carrum Health directly.
 
Rally Marketplace

 
 
Kaiser Plan Names:
  • Kaiser HMO $15
  • Kaiser HMO $25
 
Chiropractic Services - Optum Health
 
Fitness
 
Mental Health Services
  • To schedule a mental health appointment, call: Orange County: (714) 644-6480
    • Members do not need a referral.   
  • Behavioral Health Line & Mental Health Crisis Line: (800) 900-3277
    • Available 24/7
    • Resolution specialists to help members resolve concerns about mental health care appointments: (800) 390-3503
 


Plan Name: Cigna Select HMO - Southern California
 
Fitness
 
Chiropractic Services - Optum Health
 
Mental Health Services for Cigna Select HMO

 

 
Out of Area Dependents 
  • Urgent Care and Emergency Services (Applicable to ALL Medical Plans)
  • UHC Surest PPO Summary of Benefits (Applicable to UHC and Cigna Medical Plans ONLY)
  • UHC Surest PPO Mobile App Information (Applicable to UHC and Cigna Medical Plans ONLY)
  • If I am enrolled in a UHC HMO or the Cigna HMO plan, how do I get my out of area dependent onto UHC Surest PPO while they're living out of the area?
 
 
Disabled Adult Dependents
  • 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.
    • UHC Disabled Adult Dependent Application
      • Once the member receives approval, they can submit a copy to our insurance department so we can provide the approval to VEBA (the trust that administers our insurance). 
  • Kaiser Members: Contact Kaiser directly at (800) 731-4661 or (858) 614-3584.
    • Once the member receives approval, they can submit a copy to our insurance department so we can provide the approval to VEBA (the trust that administers our insurance). 
  • Cigna Select HMO: Contact Cigna directly at (800) 244-6224.
  • Delta Dental and VSP Members: Delta Dental and VSP rely on the status approval granted by the medical carriers. 
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 UHC/ UMR 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.