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San Joaquin Health Care 2004 JPA Handbook

Program Review
Enhancements for Plan Year 2004
The SJJPA continues to provide our members with high quality and innovative employee benefit programs. This booklet is designed to guide you through the selection process and as a comprehensive, on-going reference guide. For detailed information on the coverage types offered to its employees, please read the Plan Document or Evidence of Coverage you will receive after enrollment into the plan.

Claims Processing
For those SJJPA members enrolled in the SISC III PPO plan options: your claims are processed by Blue Cross in Woodland Hills. Please submit claims to Blue Cross, P.O. Box 60007, Los Angeles, CA 90060-0007.

Medical Plan Options
Members of the SJJPA may select medical coverage under a PPO or HMO plan. The PPO plans are offered (sponsored) through Self Insured Schools of California (SISC). The network of doctors is Blue Cross Prudent Buyer. With this network, you will have a wide selection of providers to choose from. You may select a provider that is not in the network; however, the claim will be paid at a reduced level of coverage, and you will be responsible for the balance of the charges not covered by the Plan which may be more than if you had selected a provider in the network.

For those of you interested in enrolling in an HMO plan, there are two from which to select: Kaiser or Blue Shield. Each of these plans offer members comprehensive benefits with low co-payments. If you select one of these HMO options, you will be required to select a primary care physician who will direct your medical care. You will only receive medical coverage through the Plan’s participating providers.


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San Joaquin JPA Handbook 2004