Health and Welfare Summary Plan Description
9.1 General Rules.
As an alternative to the Self-Funded PPO, a Participant may elect coverage under one of following two HMOs offered under the Plan:
Blue Shield of California
Headquarters
601 12th Street
Oakland, CA 94607
Tel: (800) 642-6155Kaiser Foundation Health Plan, Inc.
1950 Franklin Street
Oakland, CA 94612
(800) 464-4000
(800) 777-1238 (Senior Advantage)
The HMOs consist of networks of health care providers that have contracted with an organization (specifically, either Kaiser Foundation Health Plan, Inc. or Blue Shield of California) to provide medical services to Participants for a fixed payment. Both HMOs have separate written informational material that explain the services and benefits provided, as well as each HMO's limitations and exclusions. The HMO you select will provide you with complete written disclosures after you enroll, including an identification card. The medical facilities you must use are listed in the HMO packet you receive. Importantly, you must use the Physicians and Hospitals associated with the HMO you select. A Covered Individual who is covered under an HMO is ineligible for the benefits described in Article VIII.
Substance abuse related conditions. The only exception in which a Covered Individual under an HMO may use benefits described in Article VIII ar for substance or alcohol abuse issues provided through Beat It! Employee Assistance Programs. Pre-authorization by Beat It! is required for full coverage of non-emergency in-patient substance abuse treatment. To access the confidential national 24-hour/7 day a week client hotline please call (800) 828-3939. See Section 8.9(32) for Covered Charges.