Note: Effective 2023 Aetna replaced Blue Shield

 

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

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 Aetna are defined below:

HMO Plans

Aetna HMO

All medical services are coordinated through a Primary Care Physician (PCP) in the Aetna HMO network. Any specialty care you need must be coordinated through your PCP and will require pre-authorization from Aetna. Most services and medicines are covered with a small co-payment.

Aetna AVN HMO
  • Same benefits as the Aetna Full HMO plan
  • Access to a select network of local doctors and hospitals, including Mills Peninsula
  • A lower premium than you pay for Aetna Full HMO

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

Aetna PPO ($200 deductible)
  • (In-Network) Medical services are provided through the Aetna PPO Network. You are responsible for paying an annual deductible and a percentage of the cost of the services (generally 20% of Aetna'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 Aetna's allowable amount)

HDHP Plans

Aetna HDHP PPO

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 HMO

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.

 

 

Transparency in Coverage - Machine Readable Files

The information available through the below link is provided in good faith to comply with the Machine-Readable Files (MRF) provision of the Transparency in Coverage Final Rule (TCFR). These files are extensive collections of data to be ingested and read by machines and are not intended for consumer/member use.  When the Access files link below is selected the company EIN/tax ID number with no hyphen will be required.

To learn more about the TCFR and the MRF provision, refer to this Centers for Medicare & Medicaid Services page.