What’s New in 2019

UnitedHealthcare Medicare Advantage PPO Prescription Drug Formulary Change
In support of the San Francisco Health Service System (SFHSS) mission to preserve and improve sustainable, quality health benefits for Retirees, the UnitedHealthcare Medicare Advantage PPO plan will be changing its Prescription Drug Formulary effective January 1, 2019. If you are currently enrolled in the UnitedHealthcare Medicare Advantage PPO plan, you will receive a letter notifying you that the Prescription Drug Formulary will be changing and if you are taking any prescription medications which may no longer be covered. Please take the time to review the letter, and if applicable, work with your doctor to select covered formulary medications.

Delta Dental PPO New SmileWay Program and Dental Accident Benefits
Delta Dental PPO enrollees who have certain chronic conditions (diabetes, heart disease, HIV/AIDS, rheumatoid arthritis and/or stroke), will be able to receive an annual periodontal scaling and root planing procedure (deep cleaning of gums) as well as more frequent annual teeth cleaning or periodontal maintenance services. Dental Accident Benefits have been added to provide additional dental service coverage for conditions caused directly or independently of all other causes by external, violent, and accidental means.

VSP Vision Offers 100% Coverage for Standard Progressive Lenses
VSP Basic and Premier Plans are now offering 100% coverage (no co-pay) for standard progressive lenses. Additionally, if you are enrolled in the VSP Premier Plan, your co-pay for premium progressive lenses and custom progressive lenses will be $25. Basic Plan co-pays for premium and custom progressive lenses will not change

Medicare Issuing New Medicare Beneficiary Identifier Numbers (MBIs)
Starting in April 2018, Medicare began issuing Medicare Beneficiary Identifier numbers to all Medicare members, to replace existing Medicare cards with Social Security numbers. All new cards should be received by April 2019. MBIs are 11-digits long and are randomly generated by Medicare. If you or your dependent are asked or required to submit proof of Medicare-coverage to SFHSS, please be sure to write your DSW number on your new Medicare card or Proof of Medicare Letter, otherwise, we will not be able to identify your corresponding record. Contact Member Services at (415) 554-1750

 

Medical Plans at a Glance: Retirees With Medicare

HMO
 

An HMO (Health Maintentance Organization) offers benefits through a network of participating physicians, hospitals and providers. For non-emergency care, you access service through your Primary Care Physician or an urgent care center.

KAISER PERMANENTE HMO

KAISER PERMANENTE SENIOR ADVANTAGE

 
  • Must be enrolled in Medicare Part B
  • Must live in Kaiser service area: CA, HI, WA and the Northwest
  • In-network service only
  • Out-of-pocket, fixed co-pays
  • No deductible
  • One ID card for all your covered services and prescription drugs.
 

Your Medicare dependents who live in Kaiser service areas will be enrolled in Kaiser Permanente Senior Advantage.
Your non-Medicare dependents will be enrolled in Kaiser Permanente's Traditional HMO Plan.


KAISER PERMANENTE PLANS
RETIREES WITH MEDICARE
PPO
 

A PPO (Preferred Provider Organization) offers a wider choice of physicians because you can access service in-network or out-of-network. You are not assigned a Primary Care Physician so you have more responsibility for coordinating your care.

UNITED HEALTHCARE PPO

UNITEDHEALTHCARE (MEDICARE ADVANTAGE PPO)

 
  • Must be enrolled in Medicare
  • Live anywhere in the USA
  • One ID card for all your covered services and prescription drugs from a network of 67,000 pharmacies nationwide
  • Out-of-pocket; fixed co-pay
  • No deductible
  • Obtain service from any willing Medicare provider in the USA
 

Your non-Medicare dependents will be enrolled in the City Plan PPO. Blue Shield Plans are not available to members living outside of California.


UNITEDHEALTHCARE BENEFITS AT
A GLANCE: RETIREES WITH MEDICARE
 

Medical Plans at a Glance: Retirees Without Medicare

HMO
 

An HMO (Health Maintentance Organization) offers benefits through a network of participating physicians, hospitals and providers. For non-emergency care, you access service through your Primary Care Physician or an urgent care center.

KAISER PERMANENTE HMO

TRADITIONAL PLAN (NON MEDICARE HMO)

 
  • Must not be eligible for Medicare
  • Must live in Kaiser service area: CA, HI, WA and the Northwest
  • In-network service only
  • Out-of-pocket, fixed co-pays
  • No deductible
 

Your Medicare dependents will be in
Kaiser Permanente Senior Advantage.




KAISER PERMANENTE BENEFITS AT A
GLANCE: RETIREES WITHOUT MEDICARE
PPO
 

A PPO (Preferred Provider Organization) offers a wider choice of physicians because you can access service in-network or out-of-network. You are not assigned a Primary Care Physician so you have more responsibility for coordinating your care.

CITY PLAN

UNITEDHEALTHCARE (NON MEDICARE PPO)

 
  • Must not be eligible for Medicare
  • Live anywhere in the world
  • Access covered services worldwide
  • Annual deductible must be reached before coverage begins
  • Out-of-pocket coinsurance %
  • Lower rate of employer coinsurance for out-of-network providers
  • Reasonable and customary fee reimbursement limits
 

Your non-Medicare dependents will be enrolled in the City Plan PPO. Blue Shield Plans are not available to members living outside of California.

UNITEDHEALTHCARE BENEFITS AT
A GLANCE: RETIREES WITHOUT MEDICARE
HMO
 

An HMO (Health Maintentance Organization) offers benefits through a network of participating physicians, hospitals and providers. For non-emergency care, you access service through your Primary Care Physician or an urgent care center.

BLUE SHIELD TRIO HMO

BLUE SHIELD (NON MEDICARE HMO)

 
  • Must not be eligible for Medicare
  • Must live in Blue Shield service area
  • In-network service only
  • Out-of-pocket, fixed co-pays
  • No deductible
  • Lower premium contributions
 

Your Medicare dependents will be enrolled in UnitedHealthcare MAPD PPO. Blue Shield Plans are not available to members living outside of California.

BLUE SHIELD TRIO BENEFITS AT A
GLANCE: RETIREES WITHOUT MEDICARE
HMO
 

An HMO (Health Maintentance Organization) offers benefits through a network of participating physicians, hospitals and providers. For non-emergency care, you access service through your Primary Care Physician or an urgent care center.

BLUE SHIELD ACCESS+ HMO

BLUE SHIELD (NON MEDICARE HMO)

 
  • Must not be eligible for Medicare
  • Must live in Blue Shield service area
  • In-network service only
  • Out-of-pocket, fixed co-pays
  • No deductible

  •  

    Your Medicare dependents will be enrolled in Unitedhealthcare MAPD PPO. Blue Shield Plans are not available to members living outside of California.

BLUE SHIELD ACCESS+ BENEFITS AT
A GLANCE: RETIREES WITHOUT MEDICARE