Special Video Message from the District Superintendent and the JHMB
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PPO Plan Options A & B
Ever since the Families First Coronavirus Response Act (the “Families First Act”) was signed into law on March 18, 2020, the Joint Health Management Board (JHMB) has been working diligently behind-the-scenes to review the law and make the appropriate Plan adjustments to support our plan participants and their families during this pandemic.
Effective March 18, 2020, and continuing until the COVID-19 national emergency is declared over, the JHMB will provide the following coverage for its PPO Plan A & B participants:
COVID-19 Testing and Related Items/Services
The Plan will cover at 100% of the Plan’s allowable expense:
- FDA-approved COVID-19 diagnostic tests and the administration of the diagnostic tests.
- Items and services furnished to an individual during health care provider office visits (in-person visits and telehealth) that result in an order for or the administration of a COVID-19 diagnostic test.
Telehealth Visits
- PlushCare: The Plan has waived the existing $5 copayment all PlushCare telehealth visits (whether related to COVID-19 or not).
- Non-PlushCare: The Plan will cover telehealth visits related to the furnishing or administration of the a COVID-19 diagnostic tests, including the evaluation to determine if such a test is needed. In addition, the Plan will cover all telehealth visits by non-PlushCare providers (as an “Office Visit”), so as to limit participants exposure to the virus if in need of medical and/or mental health and substance abuse services. The plan’s usual deductible, copayment, or coinsurance for in-network and out-of-network providers will apply for non-PlushCare telehealth visits.
NOTE: All mental health and substance use disorder telehealth services must be obtained through a Halcyon Behavioral network provider.
The information highlighted above is a brief summary of the plan amendment recently approved by the JHMB. Please review the full plan amendment online for more details and clarification.
Plan Option C (Kaiser) Members
Prior to passage of the federal “Families First” Act, the California Department of Managed Healthcare, which regulates fully insured HMOs such as Kaiser Permanente, required that HMO plans immediately waive cost‐sharing for all medically necessary screening and testing for COVID‐19.
Therefore, cost sharing (deductibles, copayments and coinsurance) will be reduced to zero dollars ($0.00) for medically necessary screening and testing for COVID‐19 including the visit, associated lab testing, and radiology services in a plan hospital, emergency or urgent care setting, or medical office.
If a member is diagnosed with COVID‐19, all treatment including but not limited to hospital, transportation and pharmacy services will be covered in accordance with the Plan document.
For more details, call the advice number on your Kaiser Permanente membership card to speak with a licensed care provider or to schedule a telephone or video appointment with your doctor. If you don’t have your membership card with you, visit kp.org/getcare and click on “24/7 advice.”