The County of Santa Clara offers you three medical plan options. You can choose from two Health Maintenance Organization (HMO) plans and a Point of Service (POS) Plan. Refer to the comparison chart in your Benefits Guide (PDF) to see key plan features and benefits.
About the HMO Plans
With an HMO plan, you choose a Primary Care Physician (PCP) from a network of local healthcare professionals who will refer you to in-network specialists or hospitals when necessary. All of your healthcare is coordinated through that PCP.
You may choose the Kaiser Permanente Health Plan or Valley Health Plan. With Kaiser, you must live or work within a 30-mile radius of a Kaiser hospital. With Valley Health Plan, you must live or work in Santa Clara County.
Most services are covered at 100% with minimal or no office visit copayments. Out of network services are not covered except under life threatening emergency conditions.
About the Health Net POS Plan
The Health Net Point of Service plan is a type of managed care health insurance plan that offers you a choice of different types of providers, separated into three “Tiers.” The benefits paid by the plan - and what you’ll pay out of your own pocket - will vary, based on your Tier choice when you receive your care. Here’s how it works:
Tier One: HMO Providers - You may pay the lowest share of the cost.
- Receive care from Health Net HMO providers located within a 30-mile radius of where you live or work.
- You select a Primary Care Physician (PCP) who coordinates your care and refers you to specialists and hospitals if needed.
- You pay a $15 office visit copayment and the plan pays covered services at 100%.
Tier Two: Preferred Provider Organization (PPO) Providers - You may pay more out-of-pocket.
- Receive care from a provider in a selected network of Health Net medical doctors, hospitals, and other health care professionals (called a “PPO” network).
- Referrals for specialized care are not required.
- You pay a $20 office visit copay. Also, the plan pays 90% for many covered services; you pay the remaining 10%.
Tier Three: Out of Network - You pay the most out-of-pocket.
- You may seek care out of network from any licensed provider.
- You need to meet a deductible for out of network care before the plan begins paying benefits.
- Then, the plan pays 70% of the charges it considers “usual, customary, and reasonable” for the services you receive. (This is also known as the plan’s “maximum allowable amount.“ You are responsible for the remaining balance.
For more information, or to ask questions, contact your Department’s Service Center or the plans directly. You can find contact information here.
2021 Kaiser Group Agreement Summary of Changes and Clarifications Notice