Medical Plans

Note: Effective 2023 Aetna will be replacing Blue Shield

The County of San Mateo offers employees choices in Health coverage under two primary carriers. We offer plans with Kaiser and Blue Shield.

Kaiser HMO and Kaiser HDHP
Blue Shield HMO, Blue Shield HMO Trio, Blue Shield PPO and Blue Shield HDHP (not available after 2022)
Aetna (effective 2023)

All of your medical plan options provide access to quality care and cover a similar list of procedures. It’s the details of how you share the cost of care – your bi-weekly contribution amount, and your co-payments and coinsurance – that differ.

Open Enrollment Information

Once a year in October, employees may change from one plan to another or add dependents. During the year new dependents may be added within 31 days of marriage, birth, adoption or formation of domestic partnership, and children of domestic partners. After 31 days, the dependent cannot be added until the next open enrollment.

The different plans that we currently offer for both Kaiser and Blue Shield are defined below:

HMO Plans
Blue Shield HMO	All medical services are coordinated through a Primary Care Physician (PCP) in the Blue Shield HMO network. Any specialty care you need must be coordinated through your PCP and will require pre-authorization from Blue Shield. Most services and medicines are covered with a small co-payment.
Blue Shield HMO Trio	Same benefits as the Blue Shield Access+ HMO plan Access to a select network of local doctors and hospitals A lower premium than you pay for Access+ HMO Access to Shield Concierge, a team of experts that includes pharmacists, registered nurses, service representatives, and others
Kaiser HMO	All medical services are rendered in the plan’s own Kaiser facilities. Most services and medicines are covered with a small co-payment. Services outside of Kaiser are not covered except if it is a life-threatening emergency.
PPO Plans
Blue Shield PPO	(In-Network) Medical services are provided through the Blue Shield PPO Network. You are responsible for paying an annual deductible and a percentage of the cost of the services (generally 20% of Blue Shield’s allowable amount) (Out-of-Network) This allows you to access services through any licensed doctor or hospital. You are responsible for paying a deductible and a higher annual percentage of the cost of care (generally 40% of Blue Shield’s allowable amount
HDHP Plans
Blue Shield HDHP	Works in conjunction with a Health Savings Plan (HSA). You use the same PPO Network that you would under the standard PPO plan. All your preventative services are covered in full. You pay for the entire cost of non-preventative services until you satisfy your annual deductible after which, you pay 10% of the cost for non- preventative services until you reach your Calendar Year Maximum.
KAISER HDHP	Works in conjunction with an HSA. You use the same Kaiser facilities that you would under the standard Kaiser plan. All your preventative services are covered in full. You pay for the entire cost of non-preventative services until you satisfy your annual deductible after which, you pay 10% of the cost for non-preventative services until you reach your Calendar Year Maximum.