HomeMy WebLinkAbout1982-12-21; City Council; Resolution 7095L
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RESOLUTION NO. 7095
health maintenance organization plan for city employees,
and
WHEREAS, city staff and representatives of the employees'
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A RESOLUTION OF THE CITY COUNCIL OF THE CITY
OF CARLSBAD, CALIFORNIA, APPROVING AN AGREE- MENT WITH KAISER FOUNDATION HEALTH PLAN.
WHEREAS, the City of Carlsbad desires to provide a
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association have reviewed various alternative ways to provide
a health maintenance organization plan for city employees, and
WHEREAS, city staff and representatives of employees'
association recommend implementation of the Kaiser Foundation
Health Plan,
NOW, THEREFORE, BE IT RESOLVED by the City Council of the
1511 City of Carlsbad as follows:
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1. That the above recitations are true and correct.
2. That the health plan proposal submitted by Kaiser
18 // Foundation Health Plan, Incorporated attached hereto as
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Exhibit A is hereby approved in concept.
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PASSED, APPROVED AND ADOPTED at a regular meeting of the
3.ty Council of the City of Carlsbad held the 21st day of
ecaiker 1982, by the following vote to wit:
AYES: Council PWhers Casler, -is, Kulchin, Chick and Prescott
NOES: None
ABSENT: None vi d f5L-L
MARY H. ASLER, Mayor
ATTEST :
( SEAL)
BENEFITS AND RATES INFORMATION
Coverage for employee, spouse,
dependents to 19, and students to 24 -.
Single
A Coverage*
$ 67.09
Two-party $134.18
Three or More $191.10
Each member (up to 3 per Family Unit) entitled to benefits under both
Parts A and B of Medicare who has assigned Part B benefits to Health
Plan :
SUBTRACT ............. $ 32.21
For each member age 65 or older who is (1) not entitled to benefits
under Part B of Medicare, or (2) entitled to benefits under Part B
of Medicare but has not assigned such benefits to Health Plzn:
ADD ............. $ 14.58
*The proposed coverage includes all HMO required benefits including
Mental Health and Alcoholism and Drug Dependency benefits.
prepaid Maternity coverage isi included to comply with Public Law
95-555. Since coverage would be effective after July 1, 1980, the
coverage includes the State of California required Post-Mastectomy
benefit. Prepaid Injectables and Prescription Drug 3 are also in-
cluded in the coverage.
Fully
1 I I The rates included here are 1983 rates and apply only to contracts which
will be effective during the first quarter of the 1983 calendar year.
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CARE IN MEDICAL OFFICES A-COVERAGE
Medical office visits for diagnosis and treatment,
including visits for vision and hearing examinations, family planning, infertility and well-baby care; emergency room visits - .
No Charge
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Diagnostic test and procedures: laboratory tests
including cytology examinations and venereal disease tests, X-rays, nuclear medicing
procedures ipcluding radioisotopes, sonograms,
cardiovascular studies, audiologic function
studies, EEG, EKG. EMG, and other diagnostic
studies using electrostimulation or electronic
equipment or producing recordings, tracings.
images or similar readings
No Charge
Nuclear medicine procedures (including
radioisotopes used therewith) for the treatment of cancer; radiotherapy
No Charge
Nuclear medicine procedures (including
radioisotopes used therewith) for the treatment
of conditions other than cancer; dermatological
black light treatment
No Charge
Inhalation therapy, short-term physical therapy and occupational therapy, and orthoptics
NO Charge
Intravenous fluids and’medications, additives
and nutrients administered through intravenous fluids; generally available immunizations except mass immunizations, allergy test materials;
chemotherapy medications generally available
in the Service Area when prescribed by a
Permanente physician for the treatment of
cancer; dressings, casts
No Charge
Unexpected mass immunizations The lesser of Health Plan’s cost or 50% of non-member rates
Allergy treatment materials I NoCharge
Injected medication No Charge for most
injectables; reasonable rates for certain newly developed injectables
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CARE WHILE HOSPITALIZED
Physician's services in the hospital, including
operations
A-COVERAGE
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No Charge
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Room and board, general nursing, special duty
nurse when prescribed; iniensive care; use of operating room
Drugs and medicines; dressings, casts,
anesthesia
Diagnostic tests and procedures: laboratory tests including cytology examinations and venereal disease tests, X-rays, nuclear medicine
procedures including radioisotopes. sonograms.
pulmonary function studies, cardiovascular
studies, audiologic function studies, EEG, EKG, EMG, and other diagnostic studies using
electrostimulation or electronic equipment or
producing recordings, tracings, images or similar
readings
Therapeutic procedures: inhalation therapy,
short-term physical therapy and occupational
:herapy. nuclear medicine procedures (including radioisotopes used therewith), radiotherapy
Blood for transfusions
There is no charge for the transfusion procedure. Laboratory services associated with transfusions are covered as indicated under "diagnostic tests and procedures"
No Charge
No Charge
No Charge
No charge if replaced per blood bank rules; if covered by Medicare; if a
family unit member has given blood in the preceding 12 months; or if no
member of the family unit meets the medical criteria for bld donors
ALCOHOLISM AND DRUG DEPENDENCY
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Treatment, including counseling for dependency and medical management of withdrawal symptoms, is provided in medical offices in group and individual sessions without charge.
When prescribed, hospitalization for medical management of withdrawal symptoms is provided on the same
basis as hospitalization for any other - condition.
Home visits and methadone maintenance are not provided.
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AMBULANCE SERVICE
Approved necessary ambutance sewice within Service Area 1 NoCharge
CHRONIC KIDNEY CONDITIONS CARE
I- - -. - Ubn direction by a Permanente physician, Health Plan will arrange for hemodialysis for chronic kidney conditions or for kidney transplants at no charge, provided that the member’s condition meets the criteria of
the facility to which referral is made
EXTENDED CARE
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Physician’s services 1 NoCharge
100 days of skilled Nursing Facility level of care per calendar year at designated facilities when prescribed by Permanente physicians; includes room and board, general nursing, drugs and biologicals
For Part A and Medicare members the covered days of extended care services will be reduced and offset by all days covered in whole or in part by Medicare which were not prexribed or
directed by a Permanente physician or which were received in
facilities not designated by the Health Plan
No Charge
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HEALTH EDUCATION
Health education services for specific conditions, such as diabetic counseling. post-coronary counseling and
nutritional counselina
No charge
When available. general health education se-rvices not
addressed to a specific condition, such as weight control
classes and anti-smoking classes
Reasonable rates
Self-administered medications: Intravenous fluids and medications, nutrients and additives administered through intravenous fluids, and amino acid-modified dietary products used for treatment of inborn errors of amino acid metabolism obtained at a Kaiser-Permenante pharmacy are provided at no charge.
Education in appropriate use if Plan services and
printed health education publications with instructions
on achieving and maintaining health
Members not entitled to Medicare benefits: Home health services; prescribed part-time, intermittent services
of registered nurses, home health aides and medical social workers are provided without charge. Prescribed
inhalation therapy and short-term physical therapy and occupational therapy are provided without charge.
Members entitled to Medicare benefits: Home health services; prescribed visiting nurse service; physical,
occupational and speech therapy; part-time services of home health aides, social services and durable medical
equipment when covered in whole or in part by Medicare are provided without charge.
Physician's home visits for supervision of home health services are provided without charge.
No charge
MATERNITY CARE
Interrupted pregnancy (spontaneous or induced termination of
pregnancy) -.
Full care for mother after confirmation of pregnancy. This
includes physician's services, hospitalization. X-ray and
laboratory services. and, if necessary. cesarean section. Full care of child during mother's confinement. Thereafter coverage for the newborn continues only if the parent applies for enrollment
of the newborn (and pays prepayment fees, if any) within 30 days of birth.
No charge 1
No charge
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MEDICAL SOCIAL SERVICES
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Includes hospital discharge planning. counseling I Nocharge
OUT-OF-PIAN EMERGENCY CARE
Emergency ;are is medically necessary health service that is generally available and customarily provided in Southern California and which is immediately required because of unforeseen illness or injury.
This benefit applies ody to care required before a member's condition permits transfer to the nearest Kaiser-Permanente facility: continuing or follow-up care is not covered.
Medically necessary special transportation to such facility will be covered with prior Kaiser-Permanente approval.
Payment will be made for Emergency Care Within the Service Area obtained from physicians and hospitals
not associated with Kaiser-Permanente provided that:
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Kaiser-Permanente facilities were not used because to have done so would have entailed a delay which
would have resulted in death, serious disability or significant jeopardy to the member's condition, or
because the choice of provider was beyond the control of the member or the member's immediate family.
For members residing within the Service Area provided that:
Payment will be made for Emergency Care Outside the Service Area in the following circumstances:
Emergency services were received outside the Service Area because the member became ill or was
injured while outside the Service Area.
Emergency services were received outside the Service Area because the member became ill or was
injured while outside the Service Area and:
A. The member became ill or was injured and received emergency service while more than 30
miles from home or; B. The member was less than 30 miles from home and emergency services were needed to prevent death. serious disability. or significant jeopardy to the memberj condition. and it would have been unreasonable to expect the member to obtain emergency services from
Kaiser-Permanente facilities; or if the choice of the provider was beyond the member's control
and that of the memberi immediate family.
For members residing outside the Service Area provided that:
Newborn deliveries occurring outside the Service Area are considered emergencies in situations of
unexpected premature deliveries. Normal deliveries (after 8 months of gestation) are not considered emergencies unless Health Plan determines that the member was outside the Service Area because of circumstances beyond her control or because of extreme personal emergency.
MEMBER PAYS
Copa yments The member must pay the amounts which would have been paid as supplemental charges at Kaiser-
Permanente facilities for the emergency care. Health Plan's payment will be reduced by such amounts.
If care is obtained within the Service Area or within 30 miles of the home of a member who resides outside
the Service Area. the member must pay 50% of the first $100 in excess of the supplemental charges.
Health Plan will pay only the reasonable cost of emergency care obtained from physicians or hospitals not
associated with Kaiser-Permanente. The member is responsible for payment of that portion of any charges
deemed not reasonable. Such payments, if out of pocket to the member. are copayments under the
Supplemental Charges Maximum provision.
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. OUT-OF-PLAN EMERGENCY CARE'(continued)
Reductions
Payment will be reduced by any Other Benefits. which means all amounts paid or payable (or which would
be paid or payable if there were no Health Plan benefits) under Medicare. any insurance policy or contract or any government programs except Medicaid (Medi-Cal). However. if a member notifies Health Plan that
Other Benefits have not been paid within a reasonable time. Health Plan will make payment for the emergency care provided that the member (or the family member entitled to do SO) assigns all Other
Benefits to Health Plan and agrees to fully cooperate with Health Plan in obtaining such Other Benefits and allows Health Plan to obtain confirmation from the source of Other Benefits that they have not been paid. Any person claiming out-of-plan emergency care benefits shall furnish Health Plan with such information as may be tiecessary to implement these provisions.
Any overpayment by-Health Plan may be recovered from the person to whom made or from any insurance
company or organization that is obligated to pay for the care received.
Payment under this benefit for emergency services required as the result of illness or injury caused by a
third party is made if the member agrees in writing to reimburse Health Plan for any amount paid up to the
amount of any settlement or judgment received and directs his or her attorney to pay such amount directly
to Health Plan. This paragraph does not apply to Medicare members.
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POST MASTECTOMY
If all or part of a breast is removed for medically necessary reasons on or after July 1.1980. reconstructive
surgery when medically feasible and prosthetic devices incident to that mastectomy are provided without charge. External prosthetic devices will be provided by designated sources. Replacement will be made when prosthesis is no longer functional. Custom made prostheses will be provided when necessary.
SPEECH THERAPY
Prescribed speech therapy. while hospitalized. in a medical office or as a home health service is provided on
a group or individual basis at a charge of $5 per visit for the first 30 visits for each condition. Additional
prescribed visits are at non-member rates except that further treatment of articulation disorders associated
with congenital abnormalities of the palate are provided at $5 per visit. Prescribed visits covered in whole
or in part by Medicare are provided at no charge. An appointment which is broken will count as a visit unless properly canceled.
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. MENTAL HEALTH 3
WHAT IS COVERED
Mental health care specified below will be provided
for acute psychiatric conditions which in the
judgment of the Permanente physician are subject to significant Improvement through relatively short-
term therapy.
7he calendar year maximums for office visits, days of
hospitalization and day care/night care sessions indude services provided during the calendar year under this and any other enrollment in Health Plan.
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MENTAL HEALTH SERVICES
IN MEDICAL OFFICES Diagnostic evaluation and individual and group
therapy. Copa yments Medicare Member pays: Nothing for first 20 visits
each calendar year, $5 each visit thereafter.
Other Members pay: $10 per visit for first 20 visits
each calendar year, non-Member rates thereafter.
MENTAL HEALTH HOSPITALLEATION AND DAY OR MGHT CARE
Up to 45 days each calendar year of psychiatric
hospttalization, including professwnal services. Two sess~ons of day care or night care may be provided in
lieu of one day of psychiatric hospitalization.
Copayments
Member pays: Nothing for first 14 days, 25% of non- member rates for each of the next 31 days, except
that Member pays nothing for days covered in whole
or in part by Medicare.
EXCLUSIONS R Care for chronic psychosis, organic psychosis and other conditions which a Permanente physician considers would not be responsive to
therapeutic management
E4 Care for the mentally retarded a Care as a condition of parole or probation E Court-ordered testing E Testing for intelligence, aptitude or interest - -
Prescribed psychological testing is provided
without charge.
If you do not keep an appointment or do not give 24 hours' notice of cancellation by calling the
appointment desk when you schedule the
appointment you will be charged any copayment
which would have applied to the visit and the
number of covered visits will be reduced by one visit.
- STUDENTS/OVER AGE COVERAGE
Coverage will be extended to age24 for the
unmarried dependent child of the subscriber
or the subscriber's spouse provided that th.e
child is attending an accredited school on a
full time basis.
Under these benefits, group coverage ceases
at the end of the month in which the stated
age is artained.
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Exclusions, Limitations, Reductions on Benefits
The following are excluded from coverage under this plan:
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Financial responsibility for conditions covered by Workers' Compensation or for
which Care or reimbursement is available from a govemment agency or program
other than Medicaid. -
Military serviceconnected conditions, as defined by the Veterans Administration,
for which care is reasonably available to the member from the Veterans Adminiiation.
Physical examinations and related services for insurance, employment, licensing.
Dental care and dental X-rays (including injury to teeth).
Service to reverse voluntary infertility.
Podiatry.
Chiropractic.
Experimental procedures and procedures not generally and customarily available
in Southem California.
Plastic surgery or other services primarily for cosmetic purposes (except for
reconstructive surgery as described under Post-Mastectomy Benefit).
Custodial, domiciliary, convalescent and intermediate care.
Corrective appliances and artificial aids (except for prosthesis as described under
Post-Mastectomy Benefit).
Durable equipment (except for members entitled to Medicare benefits as
described under Home Care).
Blood unless the conditions specified in chart for blood at no charge are satisfied.
Organ transplants, except kidney transplants.
Services related to sex changes.
Limitations in Services
Health Plan is not responsible for the following:
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Delay or failure to render services due to a major disaster or epidemic affecting
Kaiser-Permanente facilities or personnel.
Unusual circumstances, such as complete or partial destruction of facilities, war,
riot, labor disputes not involving Plan organization, disability of a significant number
of personnel, or similar events which result in delay in providing services or inability
to provide services; non-emergency care may be postponed in the event of labor
disputes involving Plan organizations.
Conditions for which member has refused recommended treatment for personal
reasons, when Permanente physicians believe no professionally acceptable
alternative treatment exists.
Rehabilitative treatment is limited to conditions (including acute phases of chronic
conditions) subject to significant improvement through relatively short-term therapy.
Mental Health services are limited as described under the Mental Health Benefit.
Services for Alcohol and Drug Dependency are limited as described under the
Alcoholism and Drug Dependency J3enefit.
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Reductions
- Services will be provided if you are injured through the fault of someone else, such
as in an auto accident. However, tf you collect any amount from the other person
or his or her insurance company, you must pay Health Plan non-member rates for
all hospital and medical sewices paid for by Health Plan or provided by Kaiser-
Pennanente to care for your injuries. The amount collected from you will never
exceed either the lower of non-member rates or the amount you collect from the
other person or his or her insurance company. Payment of Out-of-Plan emergency
benefits is made for the services of physicians, hospitals, and other providers not-
contracting with Health Plan but only if the member executes an agreement (1) to
reimburse Health Plan for any amount it pays up to the amount of any settlement
or judgment the member received, and (2) directing his or her attomey to disburse
such amounts directly to Health Plan. (Ths reduction does not apply to
Medicare members.)
Members will be charged non-member rates for servicesfor which they are entitled
. to payment under Medicare and for which they have not made assignment.
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Effective 1/1/81
Supplemental Charges laximum
Registration charges, if any, for medical office, hospital emergency room or home
visits and supplemental charges,-if any, for matemity care, inhalation therapy,
physical therapy, orthoptics, for services listed under diagnostic tests and procedures,
nuclear medicine treatments and isotopes, dermatological black light treatments, and
charges, if any, for the first 20 mental health visits each calendar year, if a covered
benefit, and out-of-plan emergency care claims copayments for these services, paid by
the member, are subject to calendar year maximums. Please note that other
payments, such as those for speech therapy and drugs and, if applicable, for
occupational therapy and those made for services provided if you are injured through
the fault of someone else, are excluded from this provision, as are out-of-plan
emergency care payment reductions made because of other benefits.
There is a maximum for these supplemental charges paid by each member and a
maximum for the total supplemental charges paid by all the members of a family unit.
Each year the supplemental charges maximum for a member and for family units will
be announced for the following calendar year.
When a member or a family unit has incurred the appropriate supplemental charges
maximum, the member or family unit will be exempt from such supplemental charges
for the remainder of the calendar year.
It is the member's responsibility to obtain and keep receipts for such charges and to
present them as proof that the copayment limitation has been reached. Identification
will be provided to exempt members. Any exemption from supplemental charges will
be effective only for the date proof of eligibility for the exemption is presented.
Information regarding current supplemental charges maximums and procedures may
be obtained from the Membership Service Department at each medical center.
TenlJCbrary Identification Card F@gram
Groups contracting with Kaiser Foundation Health Plan are now encouraged to take advantage of the Temporary Identification Card Program. The Temporary Identification Cards are issued by the
group's representative and are designed to identify new members seeking care in our facilities prior
to receiving the plastic Identification Cards. Temporary Identification Cards contain information
which will assist the new member in registration, appointment making or admission to the hospital at one of our facilities.
When issuing the Temporary Identification Card, we request that the group's representative
(Benefits or Personnel officer) complete the following steps -
on the Temporary Identification Card, indicate the effective date of coverage and list all new members for the account - including birth dates for each new member
explain use of the Temporary Identification Card to the subscriber
request signature of subscriber
Temporary Identification Cards will be provided to the Group by the Kaiser Foundation Health
Plan Representative. The Group name, Group number and information concerning benefits will be
preprinted on the Temporary Identification Card by Kaiser Foundation Health Plan.
Temporary Identification Cards are effective for three months following the effective date of
coverage. When a new member receives his permanent plastic Identification card, he should discontinue use of the Temporary Identification Card.
Your Kaiser Foundation Health Plan Representative will supply detailed instructions on the use of
the Temporary Identification Card.
TEMPORARY IDEN'ITFICATION
FOR NEW MUreERS
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FACILITIES
KAISER-PERMANENTE MEDICAL CENTER (Hospital and Medical Offices) 24-hour emergency services
KAISER-PERMANENTE MEDICAL OFFICES
KAISER-PERMANENT€ MENTAL HEALTH
FACILITIES
OTHER KAISER-PERMANENTE FACILITIES
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BELLFLOWER AREA
‘ and Medical Offices
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1 BELLFLOWER Hospital
9400 E Rosecrans Ave , Bellflower 9333 E Rosecrans Ave ,
Bellflower
‘ Medical Offices
10251 Artesia, Bellflower
’ 3 CERRITOS Medical Offices ; 10929-10945 South St, Cerritos ; 4 HUNTINGTONPARK Medical Offices ! 2680 Saturn Ave ,
Huntington Park
5 NORWALK Medical Offices
12500 S Hoxie Ave , Norwalk
2 BELLFLOWER
.‘ METROPOLITAN
’ LOS ANGELES AREA
LOS ANGELES
Kaiser Foundation Hospital
4867 Sunset Blvd., Los Angeles
LOS ANGELES
Medical Offices
1505 N. Edgemont St.,
Los Angeles 1510 N. Edgemont St.,
Los Angeles 1526 N. Edgemont St., Los Angeles
4900 Sunset Blvd., Los Angeles
4733 Sunser Blvd., Los Angeles
1515 N. Vermont Ave., Los Angeles
LOS ANGELES Health Evaluation Center
1530 Hillhurst Ave., Los Angeles
DOWNTOWN Medical Offices
1000 W. 8th PI., Los Angeles
DOWNTOWN
Mental Health Center
765 W. College St., Los Angeles
EAST LOS ANGELES
Medical Offices
5220 Telford St., Los Angeles
12 ANAHEIM Medical Offices
1184 N. Euclid Ave., Anaheim
1188 N. Euclid Ave., Anaheim
Medical Offices
11900 Gilbert St., Garden Grove
Medical Offices
18081 Beach Blvd.,
Huntington Beach
200 N. Lewis Ave., Orange
13 GARDEN GROVE
14 HUNTINGTON BEACH
15 ORANGE Medical Offices
riv.ww COUNTIES AREA
16 FONTANA Hospital and Medical Offices
9961 Sierra Ave., Fontana
17 INDIAN HILL Medical Offices
250 W. San Jose St., Claremont
18 ONTARIO Medical Offices
1025 W. “I” St., Ontario
19 RIVERSIDE Medical Offices
3951 Van Buren Blvd., Riverside
20 SAN BERXARDINO Medical Offices
1717 Date PI., San Bernardino
Mental Health Offices
222 Mountain Ave., Upland
21 UPLAND
SAN DIEGO AREA
22 SAN DIEGO Hospital and Medical Offices
4647 Zion Ave., San Diego
23 BONITA Medical Offices
3955 Bonita Rd., Bonita
24 CLAIREMONT MESA
Medical Offices
7060 Clairemont Mesa Blvd.,
San Diego
Kaiser Foundation Hospital
203 Travelodge Dr., El Cajon
26 LA MESA Medical Offices
8010 Fletcher Parkway Dr.,
La Mesa
25 ELCAJON
ORANGE COUNTY AREA
11 ANAHEIM Hospital
and Medical Offices
Canyon General Hospital 441 N Lakeview Ave , Anaheim 41 1 N Lakeview Ave., Anaheim
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27 MAPLE STREET
Psychosocial Services
328 Maple St., San Diego
Medical Offices
3033 Bunker Hill St., San Diego
29 POINT LOMA Medical Offices
3420 Kenyon St., San Diego
SAN FERNANDO VALLEY AREA
30 PANORAMA CITY Hospital
28 MISSION BAY
and Medical Offices
I3652 Cantara St., Panorama City
14600 Roscoe Blvd., Panorama City
9134 Woodman Ave., Arleta
Medical Offices 10401 Balboa Blvd.,
Granada Hills
16800 Devonshire Blvd.,
Granada Hills
33 LANCASTER Medical Offices
43112 N. 15th St. W., Lancaster
34 PANORAMA CITY Medical Offices
8001 Ventura Canyon Ave., Panorama City
Medical Offices
13746 Victory Blvd., Van Nuys
36 WOODLAND HILLS Medical Offices
21263 Erwin St., Woodland Hills
5855 De Soto Ave., Woodland Hills
31 ARLETA Medical Offices
32 GRANADA HILLS
35 VANKUYS
SAN GABRIEL VALLEY AREA
37 PASADENA Medical Offices
450 N. Lake Ave., Pasadena
38 WEST COVINA
Medical Offices
1249 Sunset Ave., West Covina
39 WEST COVINA
Mental Health Offices
1539 Garvey Ave.. West Covina
SOUTH BAY AREA
40 HARBOR CITY Hospital and Medical Offices
25825 S. Vermont Ave.,
Harbor City
41 HARBOR CITY Medical Offices
25975 S. Normandie Ave.,
Harbor City
Psychosocial Services
2075 Palos Verdes Drive N.,
Ste. 2081, Lomita
43 LONG BEACH Medical Offices
3820 Cherry Ave., Long Beach
44 CARSON Medical Offices
23701 S. Main St., Carson
WEST LOS ANGELES AREA
45 WEST LOS ANGELES Hospital
and Medical Offices
6041 Cadillac Ave., Los Angela
5971 Venice Blvd., Los Angeles
5981 Venice Blvd., Los Angeles
46 INGLEWOOD Medical Offices
110 N. La Brea Ave., Inglewood
47 INGLEWOOD
Skilled Nursing Facility
3425 W. Manchester Blvd.,
Inglewood
48 WEST LOS ANGELES Medical Offices
2310 S. La Cienega Blvd., Los Angeles
49 WEST LOS ANGELES
Medical Offices
130 N. La Cienega BIvd., Los Angeles
42 LOMITA
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Kaiser Care Outside the
Southern California Service Area
Southem Califomia members of Health Plan who are temporarily visiting the areas
listed below may obtain medical and hospital services for accidents or unforeseen
illnesses requiring immediate attention at Kaiser-Permanente or Kaiser/hudential
facilities. Benefits and supplementd charges may vary, but the coverage for care you
receive in these facilities will approximate your Southem California coverage.
Kaiser-Permanente:
Northem California:
Colorado:
District of Columbia:
Hawaii:
Maryland:
Ohio:
Oregon:
Virginia:
Washington:
Antioch, Hayward, Martinez, Napa, Oakland, Redwood City,
Richmond, Sacramento, San Francisco, San Jose, San Rafael,
Santa Clara, South San Francisco, Sunnyvale, Vallejo,
Walnut Creek
Denver, Lakewood, Westminster
Washington
(Maui) Lahaina, Wailuku, (Oahu) Honolulu, Kaneohe, Maili,
Niu Valley, Waipahu
Gaithersburg, Kensington
Cleveland, Parma
Beaverton, Clackamas, Portland, Salem
Reston Springfield
Vancouver
Kaiser/Prudential Health Plan:
Texas: Dallas-Fort Worth
Members who move to another Health Plan region or to thegeographic area served
by KaiserPrudential Health Plan must promptly apply to a Health Plan office in that
region to transfer membership.
The right to out-of-plan emergency benefits and to services in the service area of
another Health Plan region or in the geographic area served by Kaiser/F’rudential
ends after a member has lived in the other area for 90 days, unless the member
receives prior written authorization for continuation of these benefits and
services from Heafth Plan.
a 5’
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Kaiser Foundation Health Plan
Southern California Region
All new Membership in Kaiser Foundation Health Plan is limited to those individuals who reside within the zip codes listed below.
90000 through 90099
90101 through 90199 -
90200 through 90299
90300 through 90399
90400 through 90499
90500 through 90599
90600 through 90699
90700 through 90703 (Avalon excluded)
90705 through 90799
90800 through 90899
91OOO through 91099
91 100 through 91 199
91200 through 91299
91300 through 91399
91400 through 91499
91500 through 91599
91600 through 91699
91700 through 91799
91800 through 91899
92100 through 92199
92400 through 92499
92500 through 92599
92600 through 92671 (San Clemente excluded)
92673 through 92699
92700 through 92799
92800 through 92899
In zip codes beginning with 920,922,923.930 and 935, only the specific zip codes listed below are within the Enrollment Area.
92001
92002
92007
92008
920 10
9201 1
92012
92014
92016
92017
92020
92021
92022
92024
92025
92026
92027
9203 1
92032
92035
92037
92038
92040
9204 1
92045
92047
92048
92050
92053
92054
92062
92063
92064
92065
92067
92069
92070
9207 1
92073
92075
92077
92078
92080
92082
92083
92220
92223
92305
92307
92314
92315
92316
92317
92318
92320
9232 1
92322
92324
92325
92326
92329
92330
92333
92335
92339
92340
9234 1
92343
92345
92346
92348
92352
92353
92354
92356
92358
92359
92360
92362
92367
92369
92370
9237 1
92372
92373
92376
92378
92380
92381
92382
92385
92386
92388
92391
92392
92395
92396
92397
92399
93010
930 15
9302 1
93040
93060
93063
93064
93065
935 10
93532
93534
93543
93544
93550
93553
93563
26
.,;. . . .~ .. .- . .. . ,- .. .. . - . . .. .. . .. - .. . . . .. . .. . .-