Medical – Kaiser Permanente Health Maintenance Organization (HMO)
You and your family can count on quality care and coverage under the County's
Kaiser Permanente HMO.
Kaiser Information and additional resources:
Please click on any of the following for details on your coverage
To be eligible for this benefit, you must be an employee in a regular position scheduled
to work a minimum of 40 hours per pay period and have received pay for at least
one half plus one hour of your scheduled hours.
If you are eligible to participate in County-sponsored medical and dental plans, your eligible
dependents may also participate. Your eligible dependents are:
- Your qualifying children
- Your qualifying children include children up to age 26 that are born to you, your stepchildren,
children legally adopted by you (including those children during any waiting period before the finalization
of their adoption), children for whom you are the permanent legal guardian, and children you support
as a result of a valid court order.
Qualifying children over the age of 26 that are supported primarily by you and incapable of self-sustaining
employment by reason of total and permanent mental or physical disability are also eligible for coverage.
- Your qualifying relative
- Qualifying relatives who are eligible for medical and dental coverage are limited to your spouse,
your domestic partner's children, and your grandchildren (for Kaiser Permanente members only). Kaiser
Permanente allows coverage for grandchildren if the dependent child was enrolled in Kaiser Permanente
prior to the birth of the grandchild. Coverage for the grandchild may continue as long as the dependent child
is covered. Other benefit plans do not allow for coverage of grandchildren. Please consult
with the applicable Evidence of Coverage or contact the benefit plan directly for clarification
before you submit your enrollment.
Parents, grandparents, grandchildren, common-law spouses, divorced spouses, roommates, and relatives
other than those listed above are not eligible for County-sponsored medical and dental plans.
- Your state registered domestic partner
The Kaiser Permanente HMO is available only to employees and their eligible dependents
living within the Kaiser Permanente zip code service areas of the following counties:
- Los Angeles
- San Bernardino
- San Diego
Certain outlying zip codes within the County are not eligible for coverage through
Kaiser Permanente. Please contact Kaiser Permanente at 1-800-464-4000 to verify
that you are in an eligible service area.
Medical Membership Cards
Within a month of the effective date of your coverage, you should receive your medical
membership (ID) cards. You may, however, begin using your medical benefits before
receiving your ID cards.
If you do not receive your ID cards, or if you need replacement cards, call your
plan's member services department. You can request a replacement card at
www.kp.org and the card will be mailed to you.
If you have a problem accessing care, call EBSD at 1-909-387-5787.
How the Plan Works
Kaiser Permanente providers (e.g., physicians, hospitals, etc.) work exclusively
with Kaiser Permanente facilities around the country. You have access to virtually
full-service, unlimited medical care at little or no additional cost.
You have no deductible to pay.
The most you will pay out of your pocket each year for eligible expenses is $1,500
per person, or $3,000 per family. This means the plan will pay all eligible expenses
for the remainder of the year once you reach this out-of-pocket limit.
Other Important Facts
Kaiser Permanente Providers
You must use Kaiser Permanente's physicians, hospitals and other approved health
care providers. Otherwise, you will not be eligible for benefits under the plan,
except in a life-threatening situation, such as an out-of-area urgent or emergency
Kaiser Permanente will coordinate all non-emergency admissions.
If you think you have an emergency medical condition and cannot safely go to a Kaiser
Permanente hospital, call 911 or go to the nearest hospital. Please see your Evidence
of Coverage for more details on your coverage and benefits. If you cannot get to
a Kaiser Permanente facility, call the 800 number on the back of your ID card for
This is a general summary of Kaiser Permanente benefits. A more complete description
of benefits and the terms under which they are provided, including limitations and
exclusions, are contained in the Evidence of Coverage. If there are any discrepancies
between the information contained in this summary and the provisions of the Evidence
of Coverage, the Evidence of Coverage is the controlling document. Remember, the
Kaiser Permanente contract determines the exact terms and conditions of coverage.
The plan covers:
- Eye exams
- Health education to help keep you and your family healthy
- Hearing exams
- Pediatric checkups
- Routine checkups
Under the Mental Health Parity Law (AB88), the plan must also cover the diagnosis
of and medically necessary treatment for severe mental illness, regardless of your age.
In this case, co-payments and limits are the same as for other medical conditions
covered under the plan.
Please view the Summary of Benefits and Coverage
for a summary of covered expenses.
- Benefits are reduced by any benefits you are entitled to under Medicare,
except when Medicare is the secondary payer by law.
- If you become ill or injured through the fault of a third party
and you collect money from the third party or from his or her insurance company,
you must reimburse Kaiser Permanente for any services and supplies Kaiser Permanente
covers for that injury or illness; alternatively, Kaiser Permanente may file a claim
against the third party on its own behalf for the value of the services and supplies
Kaiser Permanente covers for that injury or illness.
- Kaiser Permanente will seek reimbursement under the medical expense
provisions of any motor vehicle insurance covering you, and any liability insurance
that provides payment to you as a result of your injury or illness; you must provide
Kaiser Permanente with all consents, releases, and other documents necessary for
Kaiser Permanente to obtain payment.
Making a Claim
You do not have to file claim forms except for out-of-area urgent or emergency care.
Contact Kaiser Permanente Customer Service for more information.
When Coverage Ends
Coverage under the plan will terminate on the earliest of the following conditions:
- Your employment terminates
- The Group Agreement terminates
- You are no longer eligible for County benefits
- You become covered under another health plan or under any other
plan offered in connection with the County
Termination will be effective on the date indicated in the official plan document.
If a Dependent Is No Longer Eligible
A covered dependent loses eligibility on the last day of the pay period during which:
- You become ineligible to receive County benefits
- Your child attains age 26; an exception is a disabled child
- The final decree of divorce is granted or Domestic Partnership termination
with the State
You are responsible for notifying the County, within 60 days, when a dependent loses
eligibility for coverage. It is your responsibility to complete a Benefits Election
Agreement and submit it to your Payroll Specialist within 60 days of the date a
dependent loses eligibility. If you fail to notify the County within 60 days, you
might be liable for any claims paid or services rendered on behalf of an ineligible
Your notification within 60 days is very important. At the time the County learns
that a dependent is no longer eligible for coverage, the termination effective date
will be retroactive to the last day of the pay period in which eligibility was lost.
The County's agreements, plan documents and administrative policies require the
County to notify the plans within specified time frames. Employees who fail to notify
the County within 60 days might experience a loss of premiums and/or ability to
Also note that your former spouse/domestic partner must be removed from your medical
and/or dental plan coverage even if the divorce settlement requires you to provide
coverage. Your ex-spouse will be eligible for COBRA if you provide notice of your divorce
within 60 days of the event date.
Coverage at Retirement
When you retire, your County medical and dental insurance coverage will continue
for one pay period following your retirement. You might be eligible to continue
your medical and dental insurance through COBRA. A COBRA notice will be mailed to
your home approximately two weeks after your retirement to remind you of this option.
For retirement, COBRA allows you to continue your current medical and dental plans
for up to 18 months. You will be responsible for the full premium plus a 2% administrative
fee. All premium payments are made directly to the County of San Bernardino and
are mailed to Employee Benefits and Services, Human Resources Department. Retiree
warrant deductions are available.
When you retire from the County of San Bernardino, you are eligible to participate
in the County-sponsored Retiree medical and dental plans. However, as a retiree,
you are responsible for paying 100% of the cost of premiums. Subsequent changes
to enrollment can only be made during Retiree Open Enrollment, which is held annually
during the month of November. The exception to this would be if you experienced
a mid-year qualifying event. At the time you meet with a Retirement Specialist at
the SBCERA, you will be instructed to contact EBSD for an appointment to discuss
your medical and dental enrollment options. To obtain retiree medical and dental
plan information and premium costs, contact EBSD directly at 1-909-387-5787. Premium
payments may be deducted directly from your retiree warrant.
Employees and/or dependents who are over the age of 65 or are disabled may choose
either a County-sponsored medical plan or Medicare. If you and/or your dependents
are eligible for Medicare, yet choose to stay in a County plan, Medicare will pay
benefits after the County's plan has paid.
To help you decide, call the Social Security office to discuss Medicare Parts A
and B coverage and premiums. You will need to provide the Social Security office
with your planned retirement date, the date you (and your dependents, if applicable)
will attain age 65, and (if applicable) any information from Medicare notifying
you of eligibility based on your disability.
If You Have Questions
Call Kaiser Permanente's Member Services at 1-800-464-4000 if you:
- Have a question about benefits, claims, or eligibility
- Need a member identification (ID) card
- Want to file a grievance
Lines are open 24 hours, seven days a week, except holidays. You can also
visit Kaiser Permanente's web site at
www.kp.org for more information.