IHSS Provider Health Benefits - Coverage Information

IHSS Provider Health Benefits

WHO QUALIFIES? Any IHSS Providers who are paid 80 or more hours per month may qualify

for medical, dental and vision coverage (it is all 3 coverages together, and there is no dependent

coverage available). To qualify, you must first complete and return an Enrollment Application.

An Application may be requested by calling 510-577-3551, or by completing and returning a

request postcard. All Applications must be received by the 10

of the month to be considered

for coverage in that same month.

COVERAGE BEGINS: Eligibility is dependent upon being issued 160 paid hours over two

consecutive months, with at least one paid hour in each month. Once you complete and return

an Application, it may take up to ninety (90) days for your coverage to begin. Once you have

successfully met the eligibility requirements for paid hours, we will mail you a confirmation letter

with your effective start date. Premium deductions are automatically withdrawn for the first

paycheck issued each month. If no deduction is taken, you will be invoiced directly. Failure to

pay premiums in a timely manner may result in termination of your health benefits coverage and

removal of your enrollment.

MAINTAINING COVERAGE: Once your coverage has started, you must continue to be paid 80

or more hours monthly for your coverage to continue. We refer to the date your check is issued,

which you may locate at the top of your paystub near the Recipient’s name, to determine which

month your paid hours will be credited. Those paid hours must show in the State’s payroll

database for you to get credit for those hours. Coverage is NOT based on hours “worked”, only

on hours PAID as shown in the State payrolling database.

LOSS OF COVERAGE: If you are paid fewer than 80 hours in one month, you will receive a Low

Hours Warning Letter, letting you know that you are at risk of losing your health benefits

coverage. This is a courtesy, allowing you the opportunity to manage any potential payroll issues

you may be having. If you are paid fewer than 80 hours for a second consecutive month,

however, you will be terminated from the health benefits. If you are terminated due to a change

in your hours, or a payroll error, your enrollment stays active in our database and you will be

covered again once you re-meet the initial coverage criteria of 160 paid hours over a two-month

period with at least one paid hour in each month.

If you feel you are having payroll issues, you must manage this directly with IHSS Payroll by calling

510-577-1877 or coming to the IHSS Lobby at 6955 Foothill Blvd, Suite 143 Oakland, CA 94605.

The Public Authority is unable to manage payroll issues.

HOW TO CANCEL: You may cancel your benefits at any time, however you must notify the

Public Authority by calling 510-577-3551 or provide written notification by the 10

of the month

to cancel by the last day of the current month, or your termination will take place on the last

day of the following month.

IHSS Provider Health Benefits - Coverage Information

COST: Your monthly premiums are automatically deducted from the first paycheck issued to

you each month. If you select the HMO dental plan, the monthly premium for all three coverages

is $20/month. If you select the PPO dental plan, the monthly premium for all three coverages is

$45/month. During the first five (5) months of coverage, you may elect to change your dental

plan choice. After the first five months, you will have to wait until annual dental open enrollment

which is effective May 1

annually. You will be invoiced directly if you are an Advanced Pay

Provider or any Provider who misses a premium deduction. Two or more months failure to pay

premiums will result in termination of coverage.

COVERAGE:

MEDICAL: The medical insurance is provided by Alameda Alliance for Health: 510-747-4567 in

an HMO Group Plan. This plan is for the IHSS Provider only, there is no dependent

coverage available.

Examples of Benefits and Co-Pays*:

o A primary care provider & preventative care visit: $10 co-pay for office visits

o Preventative health services: No co-pay

o X-rays & other diagnostic tests: No co-pay

o Inpatient Care: $100 per admission

o Family Planning: No co-pay

o Prescription Medications: $10 co-pay for generic or $15 for name brand

o Emergency Care: $35 co-pay, however co-pay is waived if admitted to hospital

o Specialty Care: $10 co-pay for Outpatient/Office visits/Physician Services

o Mental Health Services: $10 co-pay for Outpatient, $100 co-pay for Inpatient

Further details can be found at: www.alamedaalliance.org

DENTAL: Two dental plans are offered through Delta Dental and your selection determines

your overall monthly premium:

DeltaCare USA HMO 800-422-4234, wherein you may only visit dentists in the provider

network.

Delta Dental PPO 800-765-6003, wherein you may visit any dentist who takes your

coverage.

Further details can be found at: www.deltadental.com

VISION: The EyeMed Vision Plan 866-723-0514 includes:

o A regular eye exam, prescription eyewear lenses and frames

o Is easy to use, no card is needed, no claim forms, no hassles

o No application required. Your coverage will begin automatically when your medical

and dental coverages begin.

Further details can be found at: www.eyemedvisioncare.com