PASC-SEIU Homecare Workers Health Care Plan Answers to Frequently Asked Questions
PASC and the United Long Term Care Workers Union (SEIU Local 6434) have successfully negotiated for a health benefits plan for IHSS providers who work 74 or more hours per month for at least two consecutive months. The PASC-SEIU Homecare Workers Health Care Plan is provided by L.A. Care and is administered by PASC.
- If I join the Homecare Workers Health Care Plan, where do I receive services?
- If I enroll in the PASC-SEIU Homecare Workers Health Care Plan what do I have to pay?
- What if I am already enrolled in Medi-Cal or eligible for Medi-Cal?
- What if I already have another health care plan?
- Where do I get information about the benefits provided by the PASC-SEIU Homecare Workers Health Care Plan?
- Who is eligible for the health plan?
- What if I choose not to enroll at this time?
- Can spouses or dependents enroll?
- How do I choose my primary doctor or make appointments once my Plan coverage begins?
- When will coverage be effective?
- When will I receive my L.A. Care New Member Welcome Packet?
- How do I apply?
- What if I don’t want to apply?
Medical services under this Plan are provided by L.A. Care Health Plan, which is a health maintenance organization (HMO) that only operates within Los Angeles County. You are required to receive health care services at a designated County health facility from a doctor who is on the County’s list of approved health care providers. You will receive a booklet listing doctors and other providers who take care of those enrolled in this Plan.
Once you have enrolled in the PASC-SEIU Homecare Workers Health Care Plan, $1 per month will be withheld from your IHSS paycheck to cover your share of the health care premium. In addition, you will be required to pay a co-payment at the time you receive care, usually $5 per service.
Primary Care Doctor Visit: $5
Prescription Drug: $5
Emergency Care: $35
This plan has been designed to provide coverage for eligible workers who do not currently have Medi-Cal, Medicare or other health insurance. Medi-Cal is comprehensive health care coverage available to qualified low-income persons, usually without monthly charges and without paying anything when you use a service. In addition, Medi-Cal covers a broad array of health services. If you are enrolled in Medi-Cal or are eligible for Medi-Cal, you should compare costs, co-payments and coverage and decide whether or not you want to join the Homecare Workers Health Care Plan.
If you have existing coverage through your spouse or because you have another job, you should compare the costs, coverage and services provided by that plan to the Homecare Workers Health Care Plan. Then, decide which is the best plan for you.
Where do I get information about the benefits provided by the PASC-SEIU Homecare Workers Health Care Plan?
Providers who are eligible for the plan will automatically be sent an enrollment packet that describes what the PASC- SEIU Homecare Workers Health Care Plan provides. If you are eligible for the health plan, you may contact the PASC Health Plan Call Center at 1-855-PASC-PLN, (1-855-727-2756), to request an enrollment form. If you are already enrolled in L.A. Care plan and have additional questions about specific benefits provided by the Plan, please call L.A. Care at 1-888-839-9909, or go to their website at www.lacare.org/members/ihss.
Who is eligible for the health plan?
In order to be eligible, data records must show that you have been authorized by the County to work 74 hours or more per month for two consecutive months, and that, as of the time of your actual enrollment, you have remained on the active payroll in a 74-hour assignment. To enroll in this plan, you must reside within Los Angeles County or within 15 miles of its border. You will continue to be eligible as long as you continue to be authorized to work at least 74 hours per month. If the number of hours you are authorized to work each month falls below 74 hours per month for two months in a row, your coverage will be terminated. If coverage is terminated, you are eligible to continue coverage at your own expense.
What if I choose not to enroll at this time?
You can enroll at any time as long as you continue to meet the eligibility criteria. Remember, to be eligible, data records must show that you have been authorized by the County to work 77 hours or more per month for the past two consecutive months and that, at the time of your actual enrollment, you have remained on the active payroll in a 77-hour assignment.
Within ten days after being enrolled in the L.A. Care plan, you will receive a new enrollee welcome packet with more information about the Plan and its benefits, your Plan insurance card, and a directory of participating pharmacies, physicians and other health care providers. You will also be given the name of the primary care physician who has been assigned to you; however, if you want to change, you may choose another primary care doctor from the list of physicians.
When will coverage be effective?
Applications received and processed by the fifth of the month will result in coverage becoming effective the first of the following month. Applications received and processed after the fifth of the month will result in coverage being deferred until the next month.
Your New Member Welcome Packet will be mailed to you when your coverage becomes effective. The packet will include a welcome letter, member I.D. card, Evidence of Coverage (member handbook), and provider/pharmacy directory. If you do not receive you New Member Welcome Packet within 10 days after your effective date of enrollment, or have questions regarding services, please call L.A. Care at 1-888-839-9909.
You will not be enrolled in the plan unless PASC receives your completed and signed application; therefore, providers who receive the enrollment packet, but do not wish to apply, should disregard their application.