2025 BENEFITS eGUIDE

Medical Plans

The County’s medical plans are designed to help maintain wellness and protect you and your family from major financial hardship in the event of illness or injury. All County medical plans comply with the standards provided by the Patient Protection and Affordable Care Act (federal health care reform). Follow these steps for selecting the medical plan that best meets your needs.

STEP 1: Understanding Your Location and Network Providers

Your access to in-network medical health care providers and facilities will depend on where you live.

• If you live in the local service area, you will be automatically enrolled in the Health Partners of Northern California (HPNC) network. (For more information, refer to the map on page 6.)

• If you live outside the local service area, you will be automatically enrolled in the UnitedHealthcare (UHC) network and will only have access to those health providers and facilities.

Both health networks offer a comprehensive list of providers and access to local, regional and national medical centers that offer the best possible care for both routine and complex medical care issues. The table provides some general information on each network.

To search for providers in the HPNC network, visit www.healthpartnersnca.org.
To search for providers in the UHC network, visit www.myUHC.com.

*If you live in the local service area and have a covered dependent that lives out of the area (or if you and/ or an eligible participant are traveling), the National Out of Area Network (NOoAN) is available. These claims are paid at the in-network level. Please call for pre-authorization of any service in the NOoAN.

Note: In the event of an emergency, we encourage you to seek immediate care at the nearest facility. Services will be paid at the in-network level for a true emergency.

HPNC Local Service Area Zip Code Map

HPNC Local Service Area Zip Code List

• If you live in one of the zip code areas listed below, you will automatically be enrolled in the HPNC network.

• If you do NOT live in one of the zip code areas listed below, you will automatically be enrolled in the UHC network.

  95221	95250	95320	95351	95372
  95222	95251	95321	95352	95373
  95223	95252	95323	95353	95375
  95224	95254	95324	95354	95379
  95225	95255	95326	95355	95380
  95226	95257	95327	95356	95381
  95228	95305	95328	95357	95382
  95229	95307	95329	95358	95383
  95230	95309	95330	95360	95385
  95232	95310	95334	95361	95386
  95233	95311	95335	95363	95387
  95245	95313	95336	95364	95389
  95246	95314	95337	95366	95390
  95247	95315	95346	95367	95397
  95248	95316	95347	95368
  95249	95319	95350	95370

It is important for you to report your address changes to Employee Benefits in a timely manner

STEP 2: Select Your Medical Plan

The County offers you a choice between two different medical plans that provide comprehensive medical and prescription drug coverage. The plans also offer many resources and tools to help you maintain a healthy lifestyle. Following is a brief description of each plan.

High Deductible Health Plan (HDHP) with Health Savings Account (HSA)

The HDHP HSA plan comes at a lower premium cost and includes an annual deductible. The highlight of the plan is that it comes with a health savings account (HSA) through Optum Bank that is partially funded by the County. An HSA is a personal savings account that allows you to save and pay for qualified health care expenses with federally tax-free dollars*—now or in the future.                                    
See page 12 for more information about the HSA.

Here’s how the HDHP HSA plan works:

• Annual Deductible: You must meet the entire annual deductible before the plan starts to pay for medical and prescription drug expenses.

• Preventive Care: Routine preventive care services, such as annual physicals, are covered at 100% and the deductible does not

• Copays: Once you meet the plan’s annual deductible, you will pay a fixed dollar amount (copay), which is the amount you will pay out-of-pocket for each office visit, service or prescription drug.

• Out-of-Pocket Maximum: Once you reach the out-of-pocket maximum, the plan will pay 100 percent of all eligible covered services and prescription drugs for the rest of the plan year.

• Health Savings Account: You may use your HSA funds to pay for qualified health care expenses, including your deductible and copays.

Exclusive Provider Organization Plan (EPO)

The EPO plan initially offers a higher level of benefits than the HDHP with HSA; however, the premiums are higher as well. There is no annual deductible. All benefits are based on a fixed dollar amount (copay), which is the amount you will pay out-of-pocket for each office visit, service or prescription drug. The EPO plan functions like a traditional HMO plan and may offer additional convenience for employees who are willing to pay a higher monthly premium or who are otherwise unable to participate in the HDHP with HSA option due to having other coverage including Medicare.

It is important to remember, medical providers who are not in-network or contracted with Health Partners of Northern California or UnitedHealthcare will not be covered under the EPO plan.

Medical Plan Highlights

Following is an overview of the medical plan benefits. For more information, including the out-of-network HDHP benefits, refer to the Summary Plan Documents on the Employee Benefits website.

Copay amounts shown in the above chart represent what the member is responsible for paying.
*Benefits with an asterisk ( * ) require that the deductible be met before the plan begins to pay.

Telemedicine & Health Bridges

Telemedicine - Amwell

To provide more convenient and timely access to medical care for County plan participants, the County is happy to offer Amwell, our telemedicine partner. This benefit is available for all HPNC and UHC health plan participants.

The County’s telemedicine services allow you to be seen by board-certified practitioners, 24/7/365, from anywhere, using a smartphone, tablet or standard telephone. Telemedicine physicians can treat a variety of less-complex conditions such as colds, flu, allergies and infections as well as prescribe medications for the treatment of these conditions (limitations apply). Additional services include Behavioral Health (therapy and psychiatry), nutritional counseling and smoking cessation.

The cost varies by services obtained but is comparable to an in-office visit. Charges for telemedicine visits (and related prescriptions) will be applied to HDHP members’ deductibles. Pharmacy charges will be treated as if you went to your usual physician.

Health Bridges of Northern California

Health Bridges of Northern California’s primary mission is to provide health plan members a health BRIDGE to better health. Staff assists members navigate the health care maze with compassion and clarity so they can return to a place of better health. They are ready to assist you with:

• Chronic care management services for members experiencing chronic conditions such as diabetes, high blood pressure and high cholesterol

• Hospital post discharge care management to assist members in understanding discharge orders and coordinate follow-up care visits

• Nurse care managers to answer questions about diagnosis and treatment plans

• Member liaison services to:

  • - Secure member appointments with in-network providers

  • - Assist with finding specialty providers and obtain specialty referrals

  • - Obtain prior authorizations for surgeries and durable medical equipment

  • - Arrange second opinion or transfer to a level 1 facility, such as UCSF

For more information, visit www.healthbridgesofnorcal.com or call 209-996-1296.

Dental Plans

The County offers you a choice between two dental plans through Delta Dental. Both plans allow you to visit the dentist of your choice; however, you will maximize your benefits and reduce your out-of-pocket costs when you visit a provider in the plan's contracted network.

• The Core plan offers discounted dental services provided through the Delta Dental PPO network.

• The Buy-Up plan offers discounted dental services provided through the Delta Dental PPO and Premier networks; however, costs are usually lower when you visit a PPO dentist. The plan also offers a higher calendar year benefit maximum and orthodontia coverage for children. Once enrolled in the Buy-Up plan, coverage must be retained for at least three years.

• For more information on Delta Dental or to review a list of network providers, visit www.deltadentalins.com or call 800-765-6003.

  Dental Incentive Program

  For your first year on the dental plan, Delta Dental will pay 70% of the cost for covered services. The amount Delta Dental pays will increase by 10% each year (to a maximum of 100%) for each individual enrolled in the plan, as long as that person visits the dentist at least once during the plan year. Below is an example of the Incentive Program:

  1st year on the plan (with dental visit):  Coverage is 70%

  2nd year on the plan (with dental visit):  Coverage is 80%

  3rd year on the plan (with dental visit): Coverage is 90%

  4th year on the plan* (with dental visit): Coverage is 100%

  5th year on the plan – no dental visit: Coverage drops to 90%

  Note: The coverage percentage paid by Delta Dental will continue to drop 10% per year if there is no dental visit.

  *After the fourth year, your coverage will remain at 100% as long as you continue your annual dental visit.

  Following is an overview of the dental plan benefits. For more information, refer to the Summary Plan Documents on the Employee Benefits website.

  Key Dental Benefits	Core Plan	Buy-Up Plan1
  Contracted Network	PPO2	PPO and Premier3
  Calendar Year Deductible
  In-Network / Out-of-Network	$0 /$10 per person	$0 /$10 per person
  Calendar Year Benefit Maximum (preventive, basic and major services combined)
  Per Individua	$1,500	$2,000
  Covered Services
  Preventive Services	70% - 100%	70% - 100%
  Basic Services	70% - 100%	70% - 100%
  Major Services	70% - 100%	70% - 100%
  Orthodontia	Not covered	50% ($2,000 lifetime benefit per eligible child)

  Coinsurance percentages shown in the above table represent what the plan pays.

  1. Buy-Up coverage must be retained for at least three years.

  2. Claims are paid based on PPO contracted fees for PPO dentists, PPO contracted fees for Premier dentists and PPO contracted fees for non-Delta Dental dentists.

  3. Claims are paid based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and program allowance for non-Delta Dental dentists.

  Vision Plan

  The County offers you a vision plan through VSP.

  The VSP vision plan gives you access to one of the largest networks of eye care specialists. You will receive the highest level of benefits and greatest cost savings when you see a VSP Choice network provider. If you receive services from an out-of-network provider, you will pay all expenses at the time of service and submit a claim for reimbursement up to the amount allowed by the plan.

  For more information on VSP or to review a list of network providers, visit www.vsp.com or call 800-877-7195.

  Following is an overview of the vision plan benefits. For more information, refer to the Summary Plan Documents on the Employee Benefits website.

  Key Vision Benefits	In-Network	Out-of-Network Reimbursement
  Exam (once every 12 months)	$10 copay	up to $45
  Lenses (once every 12 months) Single / Bifocal / Trifocal	No charge after exam copay	up to $30 / $50 / $65
  Frames (once every 24 months)	$150 allowance for a wide selection of frames $170 allowance for featured frame brands 20% savings on the amount over your allowance $80 Costco frame allowance	up to $70
  Contact Lenses (once every 12 months; instead of glasses)	$150 allowance for contacts Up to $60 copay for contact lens exam (fitting and evaluation)	up to $105

  Optical Diabetic Eyecare Plus Program — VSP members with Type 1 diabetes have access to the Diabetic Eyecare Program. This program provides coverage for additional eyecare services to help diabetic participants manage their condition better.

  Special Discounts — VSP offers discounts on a number of non-covered services, such as additional pairs of glasses, special lens options and LASIK surgery.