Medical and Dental Coverage
Selecting a medical and dental plan is an important and personal matter. Among the many factors which need to be considered are type of plan, out-of-pocket expenses, level of coverage, convenience, service area, and the quality and number of physicians, dentists, and other providers.
>
See the 2011 Medical Plan Options
For calendar year 2011, the district offers five medical and three dental plan options to eligible employees and their eligible dependents as follows:
Medical Coverage
PacifiCare and Kaiser Health Maintenance Organization (HMO)
Members must live within specified service areas. There are no deductibles to meet before benefits are payable. In most cases, claim forms are not required. Services must be obtained from specific doctors and facilities. When you enroll in these plans, you will select a Primary Care Physician (PCP) who will direct all your medical care, including referrals to specialists and other participating providers for laboratory tests, x-rays, hospitalization and medications. Many services are provided at no cost; some services require a co-pay that the member must pay. Note: PacifiCare will change names to UHC of California in June.
PacifiCare (PPO)
The PacifiCare PPO plan is a health care organization composed of physicians, hospitals, or other providers which provides health care services at a reduced fee. A PPO is similar to an HMO, but care is paid for as it is received instead of in advance in the form of a scheduled fee. PPOs may also offer more flexibility by allowing for visits to out-of-network professionals at a greater expense to the policy holder. Visits within the network require only the payment of a small fee. There is a shared cost and a deductible for out-of-network expenses. Note: PacifiCare will change names to UHC of California in June.
Dental Coverage
Delta Dental PPO
This plan contracts with dentists provided by Delta Dental of California however, your choice is not limited to these providers. You may go to a Delta Dental PPO provider or any other licensed provider. Delta Dental contracts with specific dentists in San Diego County for discounted fees. If you go to a Delta PPO dentist, most services will be provided at no cost. If you choose to go to a non-Delta Dental PPO dentist, you will be responsible for a percentage of the bill. There is a deductible before the plan will pay any benefits. The maximum amount payable by the plan per person, per calendar year, is $1,500.
Delta Dental PPO Summary of Plan Benefits 
DeltaCare and Western Dental Prepaid Plans
Prepaid dental plans operate much like the medical HMOs. Under these plans you select a primary dentist or facility from a list of participating dentists or facilities. The dentist/facility will generally provide all your dental care, or if necessary, will refer you to a participating specialist. Most services are provided at no cost. No claim forms are required.
Contact Information
Medical
Kaiser
Dental
Delta Dental PPO
(866) 499-3001
DeltaCare USA Dental
Western Dental
Chiropractic Benefits
American Specialty Health Plans (ASHP)
Pharmacy Benefits
