HEALTH PLAN

The CUSD Health Plan is a self-insured Preferred Provider Organization (PPO) Plan, administered by HealthNow Administrative Services. Within California the plan utilizes the highly regarded medical providers of the Blue Shield network. Outside of California members can choose from the providers in Blue Shield’s Blue Card network. Members receive the maximum allowance of benefits available for covered services when they are received from contracted providers. For a detailed explanation of covered services under the plan please refer to the Health Plan Summary Plan Document.

For questions about covered items under the CUSD Health Plan, please contact HealthNow Administrative Services (HNAS) at (855) 323-1124 or at www.hnas.com

Claims

For questions or assistance with medical claims filed after 09-01-2013 please contact HealthNow Administrative Services (HNAS) at (855) 323-1124 or at www.hnas.com

For questions or assistance with medical claims filed prior to 09-01-2013 please contact Capitol Administrators at (877) 916-2525.

Co-Pays

Office Visit Co-Pay – The CUSD Health Plan has a $25 co-pay for all office visits including physical therapy, mental health, lab work and chiropractic office visits when services are rendered by a contracted provider.

Urgent Care Co-Pay – The CUSD Health Plan has a $35 co-pay for all urgent care visits.

Emergency Room Co-pay – The CUSD Health Plan has a $150 emergency room co-pay for all visits to contracted providers. If you are admitted to the hospital through the emergency room, the copay will be waived.

Co-pay Cap – The CUSD Health Plan has a copay maximum of 50 co-pays per person per calendar year. Once the copay maximum is reached, no additional co-pays will be applied for the remainder of that calendar year.

Deductibles – The CUSD Health Plan has a $300 Individual Deductible and a $600 Family Deductible.  Charge from Inpatient and Outpatient Hospital charges as well as those from Ambulatory Surgical Centers will be applied accordingly towards the Deductibles.

Out of Pocket Maximums – The CUSD Health Plan has a $1,550 in network Individual Out of Pocket Maximum and a $3,100 in network Family Out of Pocket Maximum.  The CUSD Prescription Plan has a $5,300 Individual Out of Pocket Maximum and a $10,600 Out of Pocket Maximum.