Westminster School District

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Medical Plans

 

 

Medical and Prescription Drugs

 

Kaiser Permanente HMO Medical Plan:

With the Kaiser Health Maintenance Organization (HMO) plan, services must be obtained at a Kaiser facility. Kaiser integrates all elements of healthcare such as physicians, medical centers, pharmacy and administration in one convenient facility.
Kaiser Permanente HMO Plan Highlights:
  •  To be eligible for this plan, you must reside in the Kaiser Southern California service area.
  •  There is no deductible and no claim forms to file.
  • Services are only covered when you use Kaiser providers and facilities, except in the case of emergency.
  • Kaiser offers the convenience of doctors, pharmacies and labs under one roof.
  • Kaiser does not require that you choose a primary care physician until after you enroll in the plan.
  • Kaiser offers online tools, so you can email your doctor’s office, make appointments, refill prescriptions, and more.

 

 

Blue Shield HMO Medical Plans:

 
With the Blue Shield Health Maintenance Organization (HMO) plans, you must choose a Primary Care Physician (PCP) or medical group. All of your care must be directed through your PCP or medical group. Any specialty care you need will be coordinated through your PCP and will generally require a referral or authorization. You will receive benefits only if you use the doctors, clinics and hospitals that belong to the medical group in which you are enrolled, except in the case of an emergency.
HMO Plan Highlights:
  •  To be eligible for these plans, you must reside in the Blue Shield of California HMO service area.
  • There are no deductibles and no claim forms to file.
  • You must select a PCP from Blue Shield’s pre-approved list of healthcare providers.
  • If you need specialist care, you’ll need a referral from your PCP.
  •  Each family member may choose his or her own Blue Shield HMO network PCP.
  • Non-network benefits are not covered.
  • Prescription drug coverage is provided through Navitus.

 

Blue Shield PPO Plans:

 
You have the option of choosing the Blue Shield Standard PPO (80%) or Blue Shield Optional PPO (90%) plan. With the Blue Shield Preferred Provider Organization (PPO) plans, you have the freedom to choose your doctor without using a Primary Care Physician (PCP) and you may self‐refer to specialists. You may use a PPO provider whose negotiated rates provide richer levels of benefits with claim forms filed by the providers. You may also obtain services using a non‐network provider; however, you will be responsible for the difference between the covered amount and the actual charges and you may be responsible for filing claims.
PPO Plan Highlights:
  •  You are not required to select a PCP.
  •  As a PPO member, you may use a PPO provider outside of the PPO plan network, but you will pay more out-of-pocket and may be responsible for filing claims. If you visit a non-network provider or health care facility, the plan will pay benefits only up to the “allowed amount,” which is based on a limited fee schedule. You will have to pay any charges above the allowed amount (in addition to your regular co-insurance).
  • Prescription drug coverage is provided through Navitus.

Preventative Services

 
As a result of Health Care Reform, effective 10/1/10, preventive care benefits are covered at 100% under the Kaiser and Blue Shield medical plans (this does not apply to out-of-network services under the PPO plans). To access a list of preventive care benefits covered under the plans, please refer to the district website. You may also contact your insurance carrier for specific questions.
Kaiser: 800-464-4000
Blue Shield: 800-642-6155