SignatureValue HMO - Alliance 1200
Original Implementation Date: 05/01/2018 | Plan Effective Date: 01/01/2023Providers
Under the VEBA UnitedHealthcare HMO plans, members must choose a Primary Care Physician (PCP) from the medical group of providers available under the specified network. All covered services must be received or referred by the members' PCP.
Members can change their PCP/medical group at any time by contacting UnitedHealthcare, but the plan and network can only be changed during the annual Open Enrollment or within 30 days of a qualifying life event.
Alliance Network Medical Groups
Additional group information is available through the "Find a Doctor" button below.Mercy Physicians
Optum Care Network (formerly Primary Care Associates)
Optum Care Network Monarch
Rady Children's Health Network
Scripps Clinic
Scripps Coastal Medical Center
Scripps Physicians Medical Group
UCSD Medical Group
Network Diagram - UHC SVHMO A1200.pdf
How to Find a Doctor
Go to the UnitedHealthcare (UHC) website:
https://www.whyuhc.com/csveba/search-for-a-providerClick "Search the Network: CS VEBA Alliance HMO Network"
Click "Continue"
Type in a provider, service, or condition in the search bar or click on an icon to search by category
Click "Search"
Once you have selected your doctor, click on the “View Enrollment Information”
First-Time Enrollees
When submitting your enrollment online through Benefitfocus, enter the 10-digit ID number from the UHC website (listed under the Medical Group & IDs section) in the PCP Code Field
Select "Yes" or "No" from the drop-down menu options to indicate if you or your dependent are existing patients with that medical provider.
Continuing Members
Contact UHC or log onto www.myuhc.com to change the Primary Care Physician or medical group.
Out-of-Pocket Costs
The amounts that a member pays when utilizing services.
Deductible
Medical$2,000 / $2,000
Annually
Out-of-Pocket Max
Medical$3,000 / $6,000
Annually
Out-of-Pocket Max
Prescription$1,600 / $3,200
Annually
PCP Office Visit
$35 copay
Specialist Office Visit
Referral Required$50 copay
Preventive Care
Annually$0 copay
Urgent Care
$35 copay
(your medical group)20% coinsurance
(other medical group)(after deductible)
Emergency Care
Waived if admitted$300 copay
(after deductible)
Outpatient Surgery
20% coinsurance
(after deductible)
Hospitalization
In-Patient20% coinsurance
(after deductible)
Radiology
Standard Services:
$0 copay
Complex (MRI / PET):
20% coinsurance
Eye Health
No Referral RequiredAnnual Eye Exam:
$0 copay
Refraction: $25 copay
Additional Benefits
Prescriptions (Rx)
Prescription benefits are provided by Express Scripts. Subscribers will receive two prescription ID cards per family.
Chiropractic
Chiropractic benefits are provided by OptumHealth through the UHC medical plan. Services must be medically necessary and may be subject to prior authorization from OptumHealth.
Members use their medical ID card to access the chiropractic benefit.
Copay: $30 per visit
Network of Providers: California Schools VEBA
Health Reimbursement Arrangement
The limited purpose Health Reimbursement Arrangement (HRA) account is a VEBA-owned account, funded by VEBA, to use for qualified medical and prescription expenses.
Account Manager: OPTUM Bank
Debit Card Type: Mastercard
Portable: No
Rollover Funds: Up to $500 (maximum HRA amount = $1,700)
Eligibility Requirements: Enrollment in the UHC SignatureValue HMO - Alliance 1200
Funding Dates
Open Enrollment Election: 01/01
Qualifying Life Event Election: 1st of the month following date of event
Funding Amount
Employee Only or Employee + Dependent(s): $1,200
Eligible Expenses
Copays
Coinsurance
Deductibles
Prescriptions
Durable Medical Equipment
Behavioral Health
Behavioral/mental health services are provided by Optum Live and Work Well through the UHC medical plan and do not require a referral.
Members use their medical ID card to access the behavioral health benefit.
Copay: $40 per visit (outpatient) / 20% coinsurance after deductible (inpatient)
Network of Providers: California Schools VEBA
Out-of-Area Services
Subscribers
In or Out-of-State
Urgent Care
Emergency Care
Out-of-Country
Urgent Care*
Emergency Care
Dependent(s)
Dependent must be enrolled in the employee's UHC HMO plan to be eligible for the following:In-State: Full HMO Network Access
Dependent will have access to the full HMO network of providers to select as a PCP.
Action Required: Employee must update the dependent's address online through the Benefitfocus website. Member must contact UHC to change PCP.
Out-of-State: Nationwide PPO Plan
Dependent will be enrolled in a separate plan, UHC UMR PPO - Choice Plus, at no additional cost to the employee.
Action Required: Employee must update address online through Benefitfocus website. VEBA and/or UHC will notify member of plan change.
Out-of-Country
Urgent Care*
Emergency Care
ID Cards
Plan Documents
Summary Plan Description
Summary of Benefits & Coverage