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. The HMO is available only to employees and their eligible dependents living within the Kaiser Permanente zip code service areas.
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.
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.
Enrolling in the plan is easy. Ask your payroll specialist for an enrollment packet. As a new employee, you have 60 days from your date of employment to enroll in a medical plan. EBSD must receive your enrollment forms and supporting documentation within that 60-day period.
Current employees can add or change coverage only during the annual open enrollment period or if you experience a qualifying event.
Refer to the Employee Benefits Guide for more details.
If You Have Other Group Coverage/If Your Spouse Works for the County
All County employees are required to enroll in a County-sponsored medical plan. However, if you have other employer-sponsor group medical coverage comparable to a County sponsored plan (i.e. through your spouse or domestic partner), that enrollment satisfies this requirement and you may opt-out of the County's coverage.
The following waiver exceptions apply to a County employee who is married to or who has a registered domestic partnership with another County employee:
- At the time of enrollment, you or your spouse/domestic partner may elect to waive individual coverage; however, the spouse who waives coverage must be enrolled under the other spouse's medical plan.
- If you are married to another County employee and you and your spouse are covered under separate County medical plans, you or your spouse may waive coverage and enroll as a dependent on your spouse's medical plan during the County's Open Enrollment.
- If you marry another County employee or enter into a domestic partnership with another County employee during the year, you may waive your coverage and enroll as a dependent on your spouse/domestic partner's medical plan within 60 days of your marriage/domestic partnership.
See your Payroll Specialist for more information and to obtain the required opt-out or waiver forms.
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 situation.
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 guidance.
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 [Medical Plans Comparison Chart] 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 family member.
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 delete dependents.
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 twenty four hours, seven days a week, except holidays. You can also visit Kaiser Permanente's web site at www.kp.org for more information.