MEDICAL, DENTAL, & VISION
The County of Monterey offers a cafeteria style benefits package for its employees including health, dental, and vision insurance. Employees have 30 days from their date of hire to enroll into insurance or to make a change to their plan based on a qualifying event. Employee deductions are taken once a month on a pre-tax basis.
Permanent employees working at least 40 hours per pay period (0.5 full-time equivalent) are eligible for health, dental, and vision insurance and the Flexible Spending Account (FSA) provided through the County. Permanent employees, regardless of hours worked, may apply for the Dependent Care Assistance Program (DCAP).
REQUIRED DOCUMENTS FOR ENROLLED DEPENDENTS
Employees are required to provide supporting documents to verify the identity and relationship of their enrolled dependent(s).
- Spouse – Marriage Certificate and Social Security Card.
- Domestic Partner – Certificate of Domestic Partnership and Social Security Card.
- Child - Birth Certificate and Social Security Card.
- Step Child - Birth Certificate, Marriage Certificate (to establish the relationship between the employee and the child’s parent), and Social Security Card.
- Other- Please see the CalPERS Affidavit of Parent Child Relationship for more details. Note: parents of an employee are ineligible for insurance.
The County of Monterey contracts with CalPERS to provide health insurance for eligible employees and their eligible dependents. Employees have the option to enroll into health insurance within 30 days of hire, during open enrollment, or upon becoming eligible for benefits. Other qualifying events are outlined below in the Qualifying Events section.
Plan eligibility is based on the employee’s residential zip code. Employees can use the Health Plan Search by Zip Code to find which plans they are eligible for. Employees may also use their employer’s address to establish plan eligibility.
LiveHealth Online is a new way of seeing a board-certified doctor or therapist through a private video visit using your smartphone, tablet or computer. You can be at home or even on vacation. And, online visits using LiveHealth Online are a covered benefit under your Anthem health plan. All you have to do is sign up at livehealthonline.com to use it. By using LiveHealth online, you can have 24/7 access to doctors in about 10 minutes or less. Doctors can assess your condition and send prescriptions to your pharmacy, if needed. This is a great option when your doctor isn’t available for things like pinkeye, the flu, a cold, a sinus infection and more. Plus, with your Anthem health plan, all you pay is your normal office visit co-pay just as if you had been seen by your own health care provider.
For staff who do not have Anthem, please see the following information on ways to access care from home from Kaiser and Blue Shield:
Employee health deductions are determined by their bargaining unit and FTE level and are outlined in the 2020 Employee Health Contributions. Employees in all bargaining units except H and S will receive half the County contribution towards their insurance if their FTE falls between .5-.79. Part-time employee costs for health insurance can be found HERE.
Use the 2020 Health Benefits Summary to compare plan coverage.
Gives you access to a network of health care providers (doctors, hospitals, labs, pharmacies, etc.) known as preferred providers. Does not require you to select a Primary Care Physician. Allows you access to many types of services without receiving a referral or advance approval.Encourages you to seek services from preferred providers to ensure your coinsurance and co-payments are counted toward your calendar year out-of-pocket maximums. Allows you the option of seeing non-preferred providers, but requires you to pay a higher percentage of the bill. Limits the amount preferred providers can charge you for services.
Contracts with providers (doctors, medical groups, hospitals, labs, pharmacies, etc.) to provide you services at a fixed price. Most HMOs require you to select a Primary Care Physician who will work with you to manage your health care needs. Requires advance approval from the medical group or health plan for some services, such as treatment by a specialist or certain types of tests. Generally requires you to obtain care from providers who are a part of the plan network. Requires you to pay the total cost of services if you obtain care outside the HMO’s provider network without a referral from the health plan (except for emergency and urgent care services).
- Anthem Traditional HMO
- Anthem Select HMO
- Blue Shield Access+
- United Healthcare HMO
- Kaiser Permanente
ANTHEM HEALTH PLANS AVAILABLE IN MONTEREY COUNTY
|Benefit|| PERS Care
|| PERS Choice
|| PERS Select
|| HMO Select
Member / Family
| $500 / $1,000
||$500 / $1,000||$1,000 / $2,0001||None|
| Out-of-pocket maximum
Member / Family
|$2,000 / $4,000||$3,000 / $6,000||$3,000 / $6,000||$1,500 / $3,000|
|Primary care physician (PCP)||$20 copay||$20 copay||$10 copay2||$15 copay|
|Specialist||$35 copay||$35 copay||$35 copay||$15 copay|
| Urgent Care
||$35 copay||$35 copay||$35 copay||$15 copay|
|Emergency Room||$50 copay; 10% coinsurance after deductible is met3||$50 copay; 20% coinsurance after deductible is met3||$50 copay; 20% coinsurance after deductible is met3||$50 copay3|
|Outpatient hospitalization||10% coinsurance||20% coinsurance||20% coinsurance||No charge|
|Impatient hospitalization||$250 deductible per admission; then 10% coinsurance||20% coinsurance||20% coinsurance4||No charge|
- Member can earn deductible credits up to $500 for individual or $1,000 for family
- $10 copay when member sees the assigned PCP; $35 for all other primary care doctors in the plan
- Copay is waived if patient is admitted
- Waived for inpatient maternity stays for members who complete the Future Moms program
Monterey County contracts with Pacific Health Alliance (PHA) to administer their employee dental insurance plan. Employees whose spouse is also employed by the County of Monterey cannot have double coverage. Dependent children whose parents are both employed by the County of Monterey cannot have double coverage and all eligible children must be enrolled under one parent. The Monterey County Dental Plan eligibility, coverage, and administration procedures can be found in the Monterey County Dental Plan Document.
A summary of dental coverage can be found HERE.
Dental Plan Administrator:
Pacific Health Alliance
1350 Old Bayshore Blvd., Suite 560 Burlingame, CA 94010-1814
Monterey County contract with Vision Service Provider (VSP) to administer their employee vision insurance plan. Employees and their dependents should give the employee’s employee ID number with four 0s in front of it instead of their SSN to look up their profile with VSP, example: 000-03-1000. Employees whose spouse is also employed by the County of Monterey cannot have double coverage. Dependent children whose parents are both employed by the County of Monterey cannot have double coverage and all eligible children must be enrolled under one parent.
A summary of vision coverage can be found HERE.
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives employees and their families who lose their insurance benefits the right to continue group health benefits. Employees have the option to enroll into insurance with COBRA if the loss of coverage was due to voluntary or involuntary job loss, cancellation of insurance due to FTE reduction below a 0.5 FTE, death, divorce, retirement, or when an enrolled child turns 26 years of old. In most circumstances COBRA can last up to 18 months and can be terminated upon subscriber request. The cost for COBRA is 102% of the premium and employees and their dependents have 60 days from the notification of loss of coverage or last day of coverage to enroll.
Employees are only able to make changes to their insurance due to a qualifying event. Most employees will make changes during open enrollment, but there are additional circumstances that allow employees to make specific changes to their coverage. Employees only have 30 days to notify their department HR office of their qualifying event and to complete the enrollment forms.
- New Hire – The employee is able to enrollment into health, dental, vision insurance, FSA, and/or DCAP for themselves and their eligible dependents
- Separation – Termination of all benefits
- Physical Address Change – An employee may switch their insurance plan if they moved from one insurance region to another. Example: Moving from Santa Cruz to Marina. If an employee moves they should update their address on ESS and contact their department HR to see if the move constitutes a region change.
- Birth/Adoption – An employee may add the new child to insurance and/or increase FSA election or enroll/increase their DCAP election.
- Death – An employee must notify their department HR that their dependent is no longer eligible for insurance.
- Marriage – An employee may add the new spouse to insurance and/or increase FSA election.
- Divorce – An employee is required to notify their department HR office of the divorce within 30 days of the divorce being finalized. The spouse will be removed from insurance.
- Gain other Coverage – An employee and/or their eligible depends may cancel insurance from the County.
- Loss of Coverage – An employee and/or their eligible depends may enroll into insurance through the County
- FTE Change – An employee is eligible to enroll into insurance if their FTE changes from .49 or below to an FTE of .5 and above. Insurance will be terminated if an employee’s FTE reduces below a 0.5.
INSURANCE WHILE ON A LEAVE OF ABSENCE
While an employee is in a working, paid leave, or protected leave status the County will apply County contribution toward their insurance premium. If an employee moves into an unpaid protected leave status (such as Family Medical Leave Act) they will need to pay their monthly insurance contributions to Employee Benefits. If the employee moves into an unpaid unprotected status they have 30 days to elect to cancel coverage for themselves or their dependents, or may continue coverage by paying the full premium cost of their insurance.
For more information, employees should contact their HR office directly.