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PLAN SUMMARIES 2023

PLAN SUMMARIES 2023

United HealthCare

Kaiser Permanente

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:

 
 
Scroll down for plan details...
 
  • Need virtual access to your carrier ID cards? Click HERE!
 

UNITED HEALTHCARE PLANS

 
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
 
Journey Harmony - Health Reimbursement Account (HRA)
 
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
  • To find an in-network provider, call UMR or go here
  • UMR Mobile App
 
Carrum Health - (for all UHC PPO plans)
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.   
NEW!  HEALTHCARE MANAGEMENT THROUGH RALLY FOR UHC MEMBERS!
 
Rally is an interactive website and phone app that helps you manage your health. You can also earn Rally coins for use in the Rally Marketplace. Go HERE for more information. 
 
Learn more about Rally Marketplace HERE.
KAISER PERMANENTE PLAN
 
  • Customer Service: (800) 464-4000
  • Website
  • Kaiser Fact Sheet (PDF)
  • Gym Membership Discounts
  • Coverage While Traveling
    • Urgent Care and Emergency Services
    • 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. 
 
Plan Names:
  • Kaiser $15
  • Kaiser $25
 
American Specialty Health (ASH) - Chiropractic Services (for Kaiser HMO plan)
 
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
 

CIGNA HMO PLAN

Plan Name: Cigna Select HMO - Southern California:
 
American Specialty Health (ASH) - Chiropractic Services (for Cigna Select  HMO plan):
 
Mental Health Services for Cigna Select HMO
  • See primary care physician (PCP) for referral
 

OUT OF AREA DEPENDENTS - ALL PLANS

 

HEARING AID COVERAGE

 

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

*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.