Medical
Plan Administrator
California Schools Voluntary Employee Benefits Association (VEBA) is a voluntary joint labor management benefits organization located in San Diego, California Under the umbrella of VEBA, Kaiser and UnitedHealthcare medical plans are available to District employees.
Free Services for Members
The VEBA Advocacy Department is available to provide needed assistance to employees and their covered dependents who are enrolled in any of the District-sponsored medical plans.
Advocacy can assist with:
Referrals
2nd Opinions
Quality of Care Issues
Doctor / Insurance Issues
Transition of Care:
Pending Surgeries
Ongoing Treatment
Prescription Refills
Pregnancy
Get medical advice from leading medical experts: medical questions answered, a diagnosis double-checked, help deciding on a treatment plan or guidance about a surgery. All services are 100% confidential and completely FREE.
The Employee Assistance Program (EAP) through OptumHealth provides five free visits per condition, per household member (only one person in the household has to be a VEBA member) for services such as:
Budgeting
Child Care Support
Counseling
Legal Advice
Resource Center
Enrollment Costs
Active Employees
Contribution Processing
Any required contributions are processed:
Through the employee's paycheck
One month in advance of the month of coverage
On a pretax basis
Contact the Insurance Department within 30 days of a qualifying life event or during the annual Open Enrollment to request the deduction be processed post-tax.On the 10-month schedule
No deductions in July or August.
Monthly adjustments may be charged to account for mid-year qualifying life event changes.
Certificated 100% FTE | Classified 4+ Hour | Management
Employee may elect to enroll in the District-sponsored Kaiser 15 HMO medical plan at no cost.
Employees enrolled in one of the District-sponsored UnitedHealthcare medical plans will be required to pay a "buy-up" (the difference in the premium cost between the UnitedHealthcare medical plan and Kaiser 15 HMO medical plan according to the tier-level).
Certificated 50 - 99.99% FTE
Employees enrolled in one of the District-sponsored medical plans will be required to pay the difference in their FTE percentage based on the Kaiser plan's tier-level premium.
Employees enrolled in a District-sponsored UnitedHealthcare plan are required to pay an additional "buy-up" (the difference in the premium cost between the UnitedHealthcare medical plan and Kaiser 15 HMO medical plan according to the tier-level), if applicable.
Retirees & COBRA Members
2024 Medical Plan Options
Hybrid HMOs
HMOs with HRAs are defined as having a set employee-paid contribution each month, copays for standard services, deductibles and coinsurance for non-standard services. These plans include a free Health Reimbursement Arrangement (HRA) account, funded by VEBA, to help offset out-of-pocket costs.
Journey HMO
Alliance 25
Alliance 25
Buy-Up Cost / Month
All classesEmployee Only: $0
Employee + Spouse / Dom Part: $60
Employee + Child(ren): $0
Employee + Family: $0
Service Costs
Primary Care Provider: $25 copay
Specialist Office: $40 copay
Emergency Care: 20% after deductible
Prescriptions: $10 / $30 / 50%
Annual HRA Contribution
Employee-Owned$350 / $700 / $1,100
Journey HMO
Harmony 25
Harmony 25
Buy-Up Cost / Month
All classesEmployee Only: $0
Employee + Spouse / Dom Part: $0
Employee + Child(ren): $0
Employee + Family: $0
Service Costs
Primary Care Provider: $25 copay
Specialist Office: $40 copay
Emergency Care: 20% after deductible
Prescriptions: $10 / $30 / 50%
Annual HRA Contribution
Employee-Owned$1,000 / $1,600 / $2,200
Classic HMOs
Classic HMO medical plans are defined as having a set employee-paid contribution each month and standard copays at time of service. There are no deductibles, coinsurance, or Health Reimbursement Arrangements (HRA).
SignatureValue HMO
Harmony 20
Harmony 20
Buy-Up Cost / Month
All classesEmployee Only: $0
Employee + Spouse / Dom Part: $117
Employee + Child(ren): $0
Employee + Family: $0
Service Costs
Primary Care Provider: $20 copay
Specialist Office: $20 copay
Emergency Care: $150 copay
Prescriptions: $10 / $20 / $60
Annual HRA Contribution
None
Performance HMO Plan D
Network 1
Network 1
Buy-Up Cost / Month
All ClassesEmployee Only: $0
Employee + Spouse / Dom Part: $277
Employee + Child(ren): $0
Employee + Family: $8
Service Costs
Primary Care Provider: $20 copay
Specialist Office: $20 copay
Emergency Care: $150 copay
Prescriptions: $5 / $10 / $30
Annual HRA Contribution
None
Kaiser 15 HMO
Buy-Up Cost / Month
Employee Only: $0
Employee + Spouse / Dom Part: $0
Employee + Child(ren): $0
Employee + Family: $0
Service Costs
Primary Care Provider: $15 copay
Specialist Office: $15 copay
Emergency Care: $100 copay
Prescriptions: $10 / $20
Annual HRA Contribution
None
PPOs
UMR PPO Nexus ACO
CA SelectPlus 80/50 SD
CA SelectPlus 80/50 SD
Buy-Up Cost / Month
All classesEmployee Only: $443
Employee + Spouse / Dom Part: $1,326
Employee + Child(ren): $692
Employee + Family: $1,345
Service Costs
Primary Care Provider (Tier 1): $30 copay
Specialist Office (Tier 1): $50 copay
Emergency Care: $100 copay
Prescriptions: $5 / $10 / $30
Annual HRA Contribution
None
Medical Plan Comparison
2024 Plan Year
Scroll to the right to view additional plans or expand the document to view it in a larger view.
Vendor Codes 2024 eff. 2024.01.pdfEmergency Care
If a member believes that they are experiencing an emergency medical condition, they should call 911 or go directly to the nearest hospital emergency room or other facility for treatment. They do not need to obtain preauthorization to seek treatment for an emergency medical condition, even if outside the coverage area.
Non-emergency care received in an emergency room is not covered.
If a member has received emergency care, they, or someone else on their behalf, should notify their Primary Care Physician's office or the insurance carrier within 24 hours, or as soon as reasonably possible to receive guidance on future care and claim processing.
