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New Participant Portal
You can enroll for the new Participant Portal experience. Click here for instructions on how to access the new Participant Portal.
Register for New Participant PortalActive Health Plan Benefit Tabs™
This is a summary of benefits and not a substitute for the Southern California IBEW-NECA Health Plan Summary Plan Description, and to the extent it differs from the SPD, the terms of the SPD will govern.
- Eligibility
- Choice of Plans
- Blue Shield
- Kaiser
- UnitedHealthcare
- Dental
- Vision
- Life Insurance
- Cont. Coverage
- Member Assistance Program (MAP)
- Health Reimbursement Arrangement
Overview
Kaiser is a staff model Health Maintenance Organization (HMO). Doctors belong to the Kaiser Permanente Medical Group which is affiliated with the Kaiser Foundation Health Plan of Southern California. You choose a primary care physician (PCP). Your PCP will be responsible for all of your healthcare needs, and will refer you to a specialist when necessary. Note that certain providers allow for annual enrollments only.
Lifetime Maximum
No plan maximum
Annual Copayment Maximums
$1,500 Individual
$3,000 Family
Inpatient Hospital Charges
$250 copayment per admission
Outpatient Office Visits and Most Outpatient Services
Your copayment is $20 per visit for almost all covered outpatient services and $25 per visit for most physician specialist visits, including infertility visits.
Chiropractic
Chiropractic benefits are offered through American Specialty Health Plans of California. The co-payment for each visit is $5 for up to 30 visits per year.
Prescriptions
See the Prescription BenefitTab.
You must use a generic drug substitute whenever it is available. If you or your doctor requests a brand-name drug instead of a generic equivalent, you will be charged the difference in cost between the brand-name drug and the generic, in addition to the co-payment applicable to the quantity and type of drug prescribed. The co-payments, which vary depending on the type of drug prescribed and the quantity dispensed, are detailed below:
| Retail Pharmacy; Tier 1 (except Kaiser, Tier 1 represents mostly generic drugs and some brand name drugs) | $10 up to a 30-day supply | $10* up to a 30-day supply 1 | $10 up to a 30-day supply for generic drugs | $10 up to a 31-day supply |
|---|---|---|---|---|
| Retail Pharmacy; Tier 2 (except Kaiser, Tier 2 represents mostly brand drugs and some generic name drugs) | $20 up to a 30-day supply | $20* up to a 30-day supply 1 | $30 up to a 30-day supply for brand name drugs | $30 up to a 31-day supply |
| Mail Order; Tier 1 (except Kaiser, mostly generic drugs and some brand name drugs) | $20 up to a 90-day supply | N/A | $20 up to a 100-day supply for generic drugs | $20 up to a 90-day supply |
| Mail Order; Tier 2 (except Kaiser, mostly brand drugs and some generic name drugs) | $40 up to a 90-day supply | N/A | $60 up to a 100-day supply for brand name drugs | $60 up to a 90-day supply |
Early retirees please refer to the prescription benefits described under the Retiree Benefit tabs.
Dependent Coverage
Kaiser has its own definition of covered dependents.
Important: If you have a baby, the newborn must be enrolled within 30 days. Kaiser does not automatically enroll newborns as dependents, even if they are born at a Kaiser facility.
Additional Info
Phone: 1-800-464-4000
Web Site: www.kp.org
Summary Schedule of Benefits
Kaiser Group #:
Active - 101155-00
Retiree - 101155-01
More care options while you're away from home
Support your health with complementary care
What to expect when you get your COVID-19 vaccine
Kaiser Permanente Mobile App
Kaiser Permanente – Medical Care While Traveling
Digital Medical Card: Information on how to access your Digital Medical Card
TeleHealth - English and Spanish
Evidence of Coverage - 45% & 50% Sound Apprentice
Evidence of Coverage - Active
Evidence of Coverage - Retiree
Summary of Benefits and Coverage (SBC) - Active
Summary of Benefits and Coverage (SBC) - 45% & 50% Sound Apprentice
Reimbursement
Use the form to seek reimbursement for urgent or emergency use of services while traveling international. Please contact Kaiser Permanente for more information on restrictions and limitations.
Member Reimbursement Form
Formulario de Reembolso para Miembros