Alameda County IHSS Provider Health Benefits

Am I eligible for benefits?

Providers who are paid 80 or more hours per month are eligible for medical, dental and vision benefits. The plan offers all three coverages together as one package, they are not available individually. Spouses and dependents are not eligible.

Enrollment & Wait Period

• Don’t wait, enroll today! There is up to a 90-day waiting period that begins once we have received your enrollment form. Call our Health Benefits Department at (510) 577-3551 to request an enrollment packet.

To qualify:

• You must first complete an enrollment application. Please contact us at (510) 577-3551 to request an application packet in English, Chinese or Spanish.
• Once your application has been received, and you are “enrolled” in our database, you must be issued checks totaling 160 hours over 2 consecutive months, with at least 1 hour in each month.

*Example

August	September	October	November
Checks issued for 80 hours	Checks issued for 80 hours	Application received by 10th	Covered!
Checks issued for 159 hours	Checks issued for 1 hour	Application received by 10th	Covered!

Please note: Applications must be received by the 10th of the month to begin the waiting period in that month.

Your check issue date (at the top of your paycheck stub) must show in the State’s payroll data base in order for you to get “credit” in that month for those paid hours. For example: if your check issue date is September 15th, you’ll be “credited” in the month of September for those paid hours.

It is important that you consistently receive paychecks equaling 80 or more paid hours each month, or you may lose your benefit coverage. If you are paid fewer than 80 hours for one month, you will receive a courtesy warning letter. This allows you time to work with payroll if there was an error with your timesheets. If you are paid fewer than 80 hours for a second consecutive month, you will be terminated from the benefit plan and have to meet the initial qualifications, 160 paid hours over a two month period, once again.

It is critical that you understand the distinction between worked hours and PAID hours. We can only know how many hours you worked when you are actually paid for that time, so PAID hours are our method of tracking eligibility. We receive a file every month from the State payrolling center that tells us exactly how many hours you were paid during the prior month. For example, on April 15th, we will be told how many hours you were paid during the month of March.

It is imperative that you address timesheet/payroll issues directly with payroll in a timely manner, so that these issues do not effect your benefit coverage. The number for Alameda County IHSS Payroll is (510) 577-1877.

Your enrollment stays active in our system even if you are terminated from the plan and are no longer working. This means that if you ever begin working for IHSS again, and meet the eligibility requirements, you will automatically be picked back up for coverage. If you no longer wish to be eligible for coverage, you must contact us to voluntarily disenroll. You may call (510) 577-3551 to disenroll.

Monthly Premiums (What comes out of your paycheck*):

• $20.00 per month – includes Medical, HMO Dental and Vision.
• $45.00 per month – includes Medical, PPO Dental and Vision.

*Premiums are deducted from the first check issued to you at the beginning of each new month. It does not matter what county that timesheet is from, whichever timesheet reaches the processing center first is the one the deduction is taken from. If for any reason we are unable to capture your premium, for example, if you did not submit a timesheet or the timesheet was rejected, we will invoice you directly for the premium payment.

Unpaid invoices (premiums) may result in a termination of coverage and/or removal of your enrollment.

Some examples of the benefits:

	Medical Benefits (costs are subject to change, these are examples only) A personal doctor (primary care provider) office visit ($10 co-pay) Preventive care (no co-pay) X-rays and other diagnostic tests (no co-pay) Inpatient care ($100 per admission) Family planning (no co-pay) Advice nurse, health education, and audio health library (no co-pay) Prescription drugs ($10-$15 co-pay per prescription) Emergency care ($35 co-pay, but $0 if admitted to the hospital) Specialty care ($10 co-pay) Mental health services ($10 for outpatient services, $100 co-pay for inpatient care)
	Dental Benefits A choice between two dental plans: HMO style plan PPO style plan Most preventive medical care and basic dental exams, teeth cleaning and x- rays are FREE!
	Vision Benefits Vision services – including eye exams Glasses OR contact lenses

What happens to my Health Benefits if I stop working?

Continuation of Coverage (COBRA)

• If you lose your benefits with IHSS due to not meeting eligibility requirements, you may be eligible to continue your same coverage with COBRA for up to 18-36 months. You will receive more information on COBRA during the last month of your grace period.

Timesheets

• Remember: Your eligibility could be in jeopardy if you do not turn in your timesheets on time! We base your eligibility on paid hours data and the check issue date, not the hours worked. Please be sure to submit your timesheets as soon as the pay period ends.

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