Redondo Beach Unified School District offers the following health care benefits to all eligible employees. In order to be enrolled in these benefits, an enrollment form is needed.

Blue Shield of California – Access+ HMO

Blue Shield Access+ is an HMO plan that gives you the flexibility to receive services from a specialist within your medical group without a referral.  If you are diagnosed, the Specialist will contact your primary care physician to obtain a referral authorization for any further treatment or surgery. Self referral to a specialist is a $30 co-payment. 

Please Note:  Seeing a specialist outside your medical group, without a referral, is no longer a covered benefit.

In-patient hospital deductibles and co-pays remain the same. The member pays a $250.00 per admission plus a 20% co-insurance, not to exceed $1000.00 combined out of pocket expenses per calendar year.

For out-patient services performed, the member will either pay a $125.00 co-pay plus a 20% co-insurance, not to exceed $1000.00 combined out of pocket expenses per calendar year; or it will be covered at 100% depending on the type of out-patient facility. 

For complete details about this plan, please refer to the Blue Shield Evidence of Coverage.

Blue Shield PPO

Like most PPO plans, Blue Shield PPO offers two different ways to access care:

–         In-network, meaning you choose a doctor (or hospital) contracted with Blue Shield’s PPO; or

–         Out-of-network, meaning you choose a doctor (or hospital) not contracted with Blue Shield’s PPO.  

Benefits are greater when using in-network PPO providers.  That is, the deductible and co-insurance is lower and your out-of-pocket expense will be lower. So, to maximize your benefits under this plan, use in-network PPO doctors and hospitals.

In-Network

$500 calendar year deductible per Individual, 20% co-insurance, $2000 out of pocket maximum per individual.                 

Out-of-Network

$750 calendar year deductible per individual, 40% co-insurance, $6,000 out of pocket maximum per individual.

Please refer to the Summary of Benefits for family deductible and maximums.

For complete details about this plan, please refer to the Blue Shield Evidence of Coverage  (for both HMO and PPO)

For escalated issues please contact:

Elizabeth (Betsy) Gepford – Service Coordinator (909) 974-5206

Enrique Schneider – Client Executive (909) 974-5215

Jan Correa – Field Service Representative (909) 974-5205

Prescription Drug Plan

The following is a brief summary:

HMO Co-Payments:

–         $15 co-pay for Generic

–         $30 co-pay for Name Brand on the Formulary (approved) List

–         $50 co-pay for Non-Formulary 

There is a one-time $100 deductible per calendar year for Name Brand and/or Formulary prescriptions.

Mail Order Pharmacy Program: $30 co-pay for Generic, $60 co-pay for Brand Name, $100 for Non-Formulary.  Mail orders receive a 90 day supply.

PPO Co-Payments:

–         $10 co-pay for Generic

–         $20 co-pay for Name Brand on the Formulary (approved) List

–         $35 co-pay for Non-Formulary 

Mail Order Pharmacy Program: $20 co-pay for Generic, $40 co-pay for Brand Name, $70 for Non-Formulary.  Mail orders receive a 90 day supply.

NOTE:  All carriers make different decisions regarding drugs that are identified as formulary vs. non-formulary and those that need prior authorization and those that do not.  Please refer to Blue Shield’s Drug Formulary list located on their website as some drugs may not be covered, the level of coverage may be changed, or prior authorization may be needed.

For complete details about this plan, please refer to the Blue Shield Evidence of Coverage.

Kaiser

With the Kaiser traditional HMO plan, there are no deductibles or percentages to figure out. You can choose to receive care at any of their medical facilities or from their affiliated physicians, depending on where you live. “My Health Manager” is a one-stop online resource that makes managing your health easier and more convenient. Use it 24 hours, seven days a week. My Health Manager allows you to e-mail your doctor’s office, view most test results, make appointments and much more.

For escalated issues, please contact: Juan Martinez  (562) 777-2626

• $15 office co-pay

Prescription Drug Plan

Delta Dental – PPO

The Delta Dental PPO program allows you the freedom to visit any licensed dentist, including a dentist from our Delta Dental Premier indemnity network. However, there are advantages to visiting a Delta Dental PPO network dentist instead of a Premier or non-Delta Dental dentist. Plan details are listed in their Summary of Benefits.

Delta Care USA – HMO

Delta Care USA – HMO provides you and your family with quality dental benefits at an affordable cost. There are no deductibles and out-of-pocket costs are clearly defined in their Summary of Benefits.

Vision Service Plan  - Choice Plan

 VSP allows you to have an annual eye exam with a $5 co-pay. Lenses are allowed every 12 months, and frames are allowed every 24 months.  Contact benefits are also available.

 ING Life Insurance

ING Life Insurance is provided for actively working eligible employees in a group term life policy. Coverage is $25,000.00 and supplemental life insurance is available.

ING (LTD) Income Protection

ING offers group long term disability to eligible employees who qualify for this benefit. Monthly benefit is 66.67% of your average salary. Refer to ING’s Income Protection Plan Summary for more details.