Medical
Your benefit plan may vary according to your classification and/or bargaining unit. Refer to your Memorandum of Understanding (MOU) or the Salary Ordinance to determine which plan eligibility. Within the plan design offered to you, you may elect to participate in one of several medical programs:
- Kaiser HMO Plans
- UnitedHealthcare HMO Plans
- UnitedHealthcare PPO Plan
About the HMO Plans
Under a Health Management Organization (HMO) plan, you need to use doctors, hospitals, facilities, and other plan providers affiliated with the HMO. Your out-of-pocket costs are typically limited to copays for the services you receive; the plan pays the balance. Services are not subject to a deductible.
If you enroll in the UnitedHealthcare (UHC) HMO plan, you need to designate a Primary Care Physician (PCP) for yourself and each of your covered dependents. (The County of Alameda’s (County) medical plans allow you to choose a different PCP for each person.) Provider directories are available through each plan’s Website. You can also call each plan’s customer service number for assistance in locating a PCP.
If you do not choose a PCP, one will be designated for you by the plan. You may change your PCP at any time.
About the UnitedHealthcare PPO Plan
Under the Preferred Provider Organization (PPO) plan, you may visit any provider without the need for a referral. The UHC Select Plus Plan offers you a national network and out-of-network coverage.
However, when you use a UHC PPO network doctor, hospital, or laboratory, you pay less out-of-pocket because the provider charges are capped, and the plan covers a higher percentage of covered services. It’s important to be aware that staying in the County’s plan network and using network doctors can help you save money.
When you use providers outside the UHC PPO network, the plan pays a percentage of provider’s fees and charges up to the plan’s “Reasonable and Customary” (R&C) payment limits. Provider charges that are higher than the UHC PPO R&C limits are your responsibility.
You do not need to choose a PCP or obtain referrals to see a specialist. However, we recommend that you select a PCP to help you manage your care. A PCP can also help you avoid unnecessary or duplicate tests and services, and can connect you to a network specialist, if needed.
Plan Highlight Sheets
For details on each medical plan’s design refer to the highlight sheets below for the 2024 Benefit Summaries:
- Kaiser $15 Plan
- Kaiser $40 Plan
- UHC Signature Value $15 Plan
- UHC Signature Value $40 Plan
- UHC Advantage $15 Plan
- UHC Advantage $40 Plan
- UHC Chiropractic & Acupuncture $15 Plans
- UHC Chiropractic & Acupuncture $40 Plans
- UHC Select Plus PPO Plan
In reviewing the above information, please know that these documents provide a summary of the plans only. You should carefully review each plan’s Evidence of Coverage Booklet for more details. Contact the plan carriers directly if you have questions regarding the benefits covered.
Refer to the following rate sheet for the costs that are effective as of February 1, 2025
Prescription Drug Coverage
The County’s medical plans cover prescription drugs under three (3) categories. Your share of the cost is based on the category you and your doctor choose, as follows:
- Generic. You will pay the lowest copay for generic drug, whose active ingredients and dosage are identical to that of their brand-name counterparts.
- Brand-name. You will pay a higher copay for brand-name drugs. These are medications with no generic equivalent.
- Non-formulary. You will pay the highest copay for non-formulary drugs. These are medications that have an effective and less costly equivalent to brand-name options.
A list of drugs found within each category is available through our carriers’ websites or by request through their customer service numbers.
Refer to the medical plan highlights sheets for more information on the coverage levels offered under each plan.
Mail Order Prescription Drugs
Enrollees in the UHC or Kaiser plans can save money on prescription drugs through the plans’ mail-order prescription drug programs. You will pay two (2) copayments for up to a 90-day supply of covered drugs. You can order your prescriptions online or by phone, and they are delivered directly to your home.