May I change plans between open enrollment periods?
What if I move outside the service area covered by the Plan?
What happens to my eligibility for coverage if I travel to another State or outside the Country?
QUESTION: May I change plans between open enrollment periods?
ANSWER: No. You may change plans only during the open enrollment period that usually occurs in July, with plan changes taking effect August 1st. The only exception is when you are enrolled in one of the Plan's HMOs and you move outside the service area.
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QUESTION: What if I move outside the service area covered by the Plan?
ANSWER: If you move outside the service area covered by PacifiCare or Kaiser, you will be immediately enrolled in the self-funded indemnity plan.
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QUESTION: What happens to my eligibility for coverage if I travel to another State or outside the Country?
ANSWER: The indemnity plan covers services rendered in any State or Country. Both Kaiser and PacifiCare, limit coverage outside the service hours to emergency and urgent care only.
Indemnity Plan: You should show the provider your San Francisco Electrical Workers identification card so that they can contact First Health for preauthorization of treatment. If the provider or medical facility is non-contracting, First Health may still be able to negotiate more favorable terms as a savings to you and the Plan. If you travel to a foreign country, be sure to save your itemized statements. The Plan Office, when necessary, will convert the amounts payable to American dollars and reimburse you in accordance with the Plan's benefit schedule.
Kaiser and PacifiCare will cover only the costs for emergency services that are rendered outside of the service areas. If you are a Kaiser member and you are treated on an emergency basis at a non-Kaiser facility, you or a representative should call them as soon as reasonably possible (1-800-777-1370 inside the U.S. or 1-800-225-552-4737outside the U.S.) for instructions. If you are covered by PacifiCare and are unable to contact either the Plan Office or PacifiCare prior to going to a facility for emergency or urgently needed services, you or your representative must notify PacifiCare within 24 hours (or as soon as reasonably possible) to inform them of the location, duration, and nature of the services provided and for instructions on how to submit a claim for reimbursement.
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