I have the PPO and I received a letter that Anthem no longer has an agreement with Dignity Health. How does that affect my care?
Anthem Blue Cross announced Monday August 16, 2021 that the health insurance provider has reached a new multi-year contract agreement with Dignity Health.... Anthem says the new agreement is retroactive to July 15, 2021, and will remain in place through April 30, 2025.
I have Kaiser, can I go to a private lab for Covid 19 testing?
Yes, members will be reimbursed for COVID-19 tests that are performed by a 3rd party lab, as long as the test is FDA approved and performed by a licensed vendor. To be reimbursed for a COVID-19 test taken at a lab outside Kaiser Permanente, members should go to kp.org/coverageandcosts and follow these steps:
1. Below “Helpful resources,” click “Submit a claim.”
2. Below “Claim forms,” click the PDF to download. (If you’re redirected to our Claim Services website, select “Documents and Forms” from the Resources menu and then download the medical claim form.)
3. Fill out the form and then mail it to the address listed on the form.
How do I verify eligibility, file a claim, reach customer service, or file an appeal?
PPO Participants should call (800) 556-5918 or go to www.deltahealthsystems.com
Kaiser participants should go to KP.org or reference their ID card.
Do we have a telemedicine option?
Yes, PPO participants can call PlushCare at (866) 460-6205 or visit plushcare.com, to save time and money.
Kaiser participants can get after hour nurse advice at (888) 576-6625 or for telemedicine call (800) 464-4000
My family is in crisis, we need help. Does our insurance cover therapy? Through the Employee Assistance Program (EAP) Our district pays for 5 free visits. EAP is benefit for both members and their dependents. The resources available range from being affected by a tragedy or natural disaster to planning a move, divorce, handling legal and financial matters or finding child, elder and pet care. If you need behavioral health services, EAP can help. The program is to help advise, answer questions and provide a listening ear during times of stress or uncertainty. EAP services are completely confidential. Please call Anthem Blue Cross at 1-800-999-7222 or www.anthemeap.com and enter Gold Coast Joint Benefits Trust to log in.
Are regular cleanings part of my $1500 benefit? No, just this year, our newly negotiated contract with Delta, excludes regular cleanings from the $1500 per year benefit. This includes the x-rays needs for this exam.
What are the requirements to receive retiree health benefits?
Employees must be at least fifty-five (55), have taught in the California public system for at least fifteen (15) years, and have taught in the Oxnard School District for eight (8) years. For eligible members, the District will contribute the full amount of the employee and dependent coverage for group health, vision, and dental insurance until the employee reaches age sixty-nine (69). The coverage will become secondary coverage when the employee reaches Medicare eligibility currently at sixty-five (65)
I am actively working and turning sixty-five (65) soon, do I need to enroll in Medicare?
If you are actively working, you are not required to enroll in Medicare coverage or A or B. This applies to the participant, spouse, and dependents.
Once I am retired, when do I need to apply for Medicare?
Participant, spouse, and dependents must each apply for Medicare Parts A and B when eligible at age 65. KAISER participants must assign Parts A and B to Kaiser and enroll in the Kaiser Senior Advantage Plan, as soon as eligible for Medicare. When you receive your Medicare card, you must forward a copy of your Medicare card, along with your completed Senior Advantage Card (if you are enrolled in Kaiser) to the plan administrator, Delta Heath Systems, PO Box 1147, Stockton, CA 95201, no later than the 15th of the month, before the month of your 65th birthday, in order to maintain your plan enrollment.