What's the difference between HMO (Health Maintenance Organization) plans and PPO (Preferred Provider Organization) plans?

These videos explain each type of medical plan:

HMO plans

PPO plans
 

You must be enrolled in either the Kaiser Deductible medical plan or the Blue Shield Deductible medical plan to open the HSA account. The HSA is not available with the Kaiser HMO, Blue Shield HMO or Blue Shield PPO medical plans.

The district deposits $100.00/month into your HSA for single coverage or $150.00/month for double/family coverage and you can also put deposit money of your own into your account. You can use the money in the HSA to pay your Kaiser or Blue Shield medical plan deductible or copayments. Just be sure to keep all your receipts for your medical services and reimburse yourself from the HSA account for any medical expenses you accrue.

The Health Savings Account is through Optum Bank - FAQs and Guide. 

Here is a video about HSAs.

 

Dependents can be enrolled at your time of hire within 31 days; or within 31 days after experiencing a qualifying event; or during Open Enrollment.

The following documents must be provided for proof of dependent eligibility:

• Spouse - a copy of your marriage certificate and a copy of page 1 of your 1040 tax return from last year that shows your married status (block out all income).
• Domestic Partner - a certified copy of the State of California Certificate of Registration of Domestic Partnership and a copy of page 1 of each person's 1040 tax return from last year (block out all income).
• Children up to age 26 - a copy of their birth certificate. OR, if child is adopted: legal adoption documentation. OR, if you have legal guardianship or legal court documentation establishing guardianship the child can be covered up to age 18. 

 
If you are getting married/registering your domestic partnership and adding your new spouse/domestic partner and any children, here's what we'll need:

• Spouse - a copy of your marriage certificate. 
• Domestic Partner - a certified copy of the State of California Certificate of Registration of Domestic Partnership and a copy of page 1 of each person's 1040 tax return from last year (block out all income).
• Children up to age 26 - a copy of their birth certificate. OR, if child is adopted: legal adoption documentation. OR, if you have legal guardianship or legal court documentation establishing guardianship the child can be covered up to age 18.

 

These benefits are available through SRJC's membership in Self-Insured Schools of California (SISC).

Kaiser Member Services # is 800-464-4000.

Employee Assistance Program (EAP): employees and everyone in their household can access free resources
for help with personal concerns--emotional, marital, financial, interpersonal addiction and recovery, legal, stress, and more. Up to 6 free visits per topic.

EAP offers 24 hours, 7 day a week access to licensed mental health professionals. The EAP website also includes some wellness articles and resources for employees besides just access to providers.

And employees can also take a quick survey about emotional well-being that will provide resources and allow them to enroll in FREE programs like the Stress, Anxiety & Worry Program, The Depression Program, the Resilience Program, etc.

• Kaiser My Health Manager - your one-stop resource for managing your care online.

 

• Fitness memberships 

 

• Kaiser Mental Health and Well-being 
   
• Want a second opinion? All SISC members can consult with a Teladoc physician to obtain an expert medical opinion and an optimal treatment plan at no cost. Teladoc will collect all relevant medical records, retest pathology, engage leading experts, complete and review an expert report with the member, and answer any questions they may have.
   
• Learn to Live: Employees and everyone in their household can access free emotional well-being tools and resources online and via app. Members receive personalized, one-on-one coaching, live and on-demand webinars, and digital tools to effectively manage stress, depression, anxiety, substance use and sleep issues.
   
• You can also get a wellness coach with phone appointments.
   
• Here are some of the self-care apps free to Kaiser members:
  • Calm – app for sleep and meditation designed to help lower stress, anxiety and more. 
  • Headspace Care – 24/7 emotional support coach

 

If you have any questions or need assistance, please contact Human Resources at 707-527-4304.

 

This video showcases the Blue Shield SISC Plan Features and Member Benefits

These benefits are available through SRJC's membership in Self-Insured Schools of California (SISC).

Blue Shield Member Services # is 855-599-2657.

Employee Assistance Program (EAP): employees and everyone in their household can access free resources
for help with personal concerns--emotional, marital, financial, interpersonal addiction and recovery, legal, stress, and more. Up to 6 free visits per topic.

EAP offers 24 hours, 7 day a week access to licensed mental health professionals. 

And employees can also take a quick survey about emotional well-being that will provide resources and allow them to enroll in FREE programs like the Stress, Anxiety & Worry Program, The Depression Program, the Resilience Program, etc.

 

For ALL Blue Shield members:

• Fitness memberships

 

• Want a second opinion? All SISC members can consult with a Teladoc physician to obtain an expert medical opinion and an optimal treatment plan at no cost. Teladoc will collect all relevant medical records, retest pathology, engage leading experts, complete and review an expert report with the member, and answer any questions they may have. 

 

• Learn to Live: Employees and everyone in their household can access free emotional well-being tools and resources online and via app. Members receive personalized, one-on-one coaching, live and on-demand webinars, and digital tools to effectively manage stress, depression, anxiety, substance use and sleep issues.

 

• Access to your Blue Shield plan from your phone, tablet, or computer.

 

• MDLIVE - 24/7 virtual access to providers and therapists. 

 

• Vida Health - Sign up for the app or go online and you will be matched with a coach or therapist who will personalize a plan for you related to nutrition, weight loss, mental health or overall wellbeing. Free for PPO and HMO members. Not available for members on the HDHP/HSA plan.

 

• Solera4MeDiabetes Prevention Program: Free 16-week program to help Blue Shield members diagnosed with prediabetes reduce their risk of developing diabetes

 

For Blue Shield PPO members:

• Maven Maternity Care Benefit - free access to virtual care for pregnancy and postpartum support. Plus free 6-month diaper subscription if you meet certain criteria.

 

• Ambulatory Surgery Center - need to have surgery? Pay less by going to an Ambulatory Surgery Center versus paying more by going to an in-network outpatient hospital for certain surgeries.

 

• Hinge Health: Blue Shield PPO members have free* access to personalized, digital physical therapy using the latest technology. Members are empowered with tools to address back and joint pain whenever and wherever it works best for them. Not available for members on the HDHP/HSA plan.

 

• City of Hope - enhanced Cancer Benefit through the Oncology Center of Excellence Program.

 

• Carrum Health: Blue Shield PPO members receive a concierge surgery benefit that waives all cost-sharing* for expenses are covered in full for the patient and one companion. *Medical costs subject to deductible for members on an HDHP/HSA plan. * As of 1/1/2023 this benefit has been expanded to include Stanford Valley Care Hospital in Pleasanton, CA.

 

• Eden Health - customized virtual primary care through Eden Health's smart phone application. Not available for members on the HDHP/HSA plan.

 

Here are the steps for a non‐member to access formulary info for the Blue Shield plans:

• Call Navitus at 866‐333‐2757
• Identify yourself as a part of Self‐Insured Schools of California but note that you are not yet active Navitus members
• Give Navitus the RX plan offered by SRJC (For Blue Shield PPO & HMO it's 200D/10‐35 and for Blue Shield PPO Deductible/HSA it's 9X35HSA1700)
• Ask for the Navitus Book of Business Formulary, and that you would like information on XYZ drug. The medical carrier is (Anthem NVANT). This will help the agent provide the information when the member information/eligibility hasn’t been loaded yet.

 

Blue Shield Doctor Search

 

Blue Shield PPO: www.blueshieldca.com/networkppo

Blue Shield HMO: www.blueshieldca.com/networkhmo

 

IRS 1095-B Medical Coverage Statement for Tax Year 2024

 

It is not necessary to wait for forms 1095-B or 1095-C in order to file your taxes. You do not need to attach any of these forms to your tax return. These forms are typically ready by March 2025.

Some taxpayers may not receive these forms by the time they are ready to file their tax return. While the information on these forms may assist in preparing a return, they are not required. Individual taxpayers should not waive for these forms and should file their returns as they normally would. Taxpayers can prepare and file their returns using other information about their medical insurance.

 

KAISER MEMBERS

The form 1095-B that you can use to file your taxes is from Kaiser. This form doesn't come from SRJC.

Employees can call Kaiser Member Services for their form at 844-477-0450 or access their 1095-B form online in their online member portal once Kaiser completes it.

 

BLUE SHIELD PPO MEMBERS

The form 1095-B that you can use to file your taxes is from SISC PPO. This form doesn't come from SRJC.

 

BLUE SHIELD HMO MEMBERS

The form 1095-B that you can use to file your taxes is from Blue Shield HMO. This form doesn't come from SRJC.

 

IRS 1095-C INFORMATION

The deadline for employers to provide employees who are considered a full-time employee under the ACA guidelines with Form 1095-C is March 3, 2025. Part-time employees don't receive this form.

 

RETIREE INFORMATION ON 1095-B REPORTING

Anthem CompanionCare and Kaiser Senior Advantage members are excluded from this reporting. For more information on Medicare and the 1095-B reporting, you may visit the Medicare website Medicare and IRS Form 1095-B.