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The County of San Mateo offers employees choices in Health coverage under two primary carriers. We offer plans with Kaiser and Blue Shield.

All of your medical plan options provide access to quality care and cover a similar list of procedures. It’s the details of how you share the cost of care – your bi-weekly contribution amount, and your co-payments and coinsurance – that differ. For more information, please log on to your benefits online account via Workday, where you will find the Kaiser and Blue Shield Fact Sheets, Benefits Summary, Evidence of Coverage, and Claim Forms.

County Employees With Blue Shield Medical Insurance:

You can choose San Mateo Medical Center (SMMC) as your provider for some or all of your healthcare needs. All co-pays and deductibles for inpatient hospital stays and emergency room visits at San Mateo Medical Center will be waived for employees with Blue Shield and their covered dependents.  (Note: outpatient co-pays will still apply.) You can choose Blue Shield plans during the Open Enrollment period if you wish to get care at SMMC.

Open Enrollment Information

Once a year in October, employees may change from one plan to another or add dependents. During the year new dependents may be added within 31 days of marriage, birth, adoption or formation of domestic partnership, and children of domestic partners. After 31 days, the dependent cannot be added until the next open enrollment.

The different plans that we currently offer for both Kaiser and Blue Shield are defined below:

HMO PLANS
Blue Shield HMO

All medical services are coordinated through a Primary Care Physician (PCP) in the Blue Shield HMO network. Any specialty care you need must be coordinated through your PCP and will require pre-authorization from Blue Shield. Most services and medicines are covered with a small co-payment.

Blue Shield HMO Trio
  • Same benefits as the Blue Shield Access+ HMO plan
  • Access to a select network of local doctors and hospitals
  • A lower premium than you pay for Access+ HMO
  • Access to Shield Concierge, a team of experts that includes pharmacists, registered nurses, service representatives, and others
Kaiser HMO
  • All medical services are rendered in the plan’s own Kaiser facilities. Most services and medicines are covered with a small co-payment.
  • Services outside of Kaiser are not covered except if it is a life-threatening emergency.
PPO PLANS
Blue Shield PPO
  • (In-Network) Medical services are provided through the Blue Shield PPO Network. You are responsible for paying an annual deductible and a percentage of the cost of the services (generally 20% of Blue Shield’s allowable amount)
  • (Out-of-Network) This allows you to access services through any licensed doctor or hospital. You are responsible for paying a deductible and a higher annual percentage of the cost of care (generally 40% of Blue Shield’s allowable amount
HDHP PLANS
Blue Shield HDHP

Works in conjunction with a Health Savings Plan (HSA). You use the same PPO Network that you would under the standard PPO plan. All your preventative services are covered in full. You pay for the entire cost of non-preventative services until you satisfy your annual deductible after which, you pay 10% of the cost for non- preventative services until you reach your Calendar Year Maximum.

KAISER HDHP

Works in conjunction with an HSA. You use the same Kaiser facilities that you would under the standard Kaiser plan. All your preventative services are covered in full. You pay for the entire cost of non-preventative services until you satisfy your annual deductible after which, you pay 10% of the cost for non-preventative services until you reach your Calendar Year Maximum.