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County of Kern Point of Service Plan

Member Services  ♦  Point of Service Plan

Announcements

11/18/2013   Historical Medical Payments and Print-outs from Managed Care Systems
Managed Care Systems (MCS), the former administrator for the Point of Service Plan, has reactivated the old member portal to allow access to Explanation of Benefit (EOB) statements for claims paid by MCS during or before September 2013 (note that some services even prior to September 2013 may be paid by Zenith-American Solutions, not MCS). You will be able to view and print your old EOBs from the website only for a limited time.
 
Member Overview

The County of Kern Point of Service (POS) Employee Medical Plan is the County's oldest and most fully featured employee medical plan option. The County of Kern POS plan has the most expansive network of the available employee medical plan options and is the only plan to include both in-network and out-of-network coverage. For those employees or dependents not residing in Kern County, the County of Kern POS plan also offers statewide and nationwide coverage through the Anthem Blue Cross and Blue Cross/Blue Shield networks.

As of October 1, 2013, the County of Kern POS plan will have completed the transition to the new third-party administrators and new provider network. Zenith American Solutions will provide claims administration, Clinix Healthcare will provide authorization services, and Burns Consulting Associates will administer the County’s new, independent provider network, the Kern Health Care Network. Catamaran (formerly Catalyst Rx) will still manage your pharmacy benefits.

Beginning September 23, 2013 POS members should use their New Member ID Card for seeking services under the POS Plan; card(s) will be mailed by the week of September 16. Also note that the new phone number 1-855-KERNPOS, or 1-855-537-6767, will also be active beginning September 23, 2013.

Medical Benefits

Summary of Benefits and Coverage  (PDF)

Local POS Member Benefits

 

Type of Plan/Benefit Level In-Network Out-of-Network
Who Directs Your Care Contracted Primary Care Physician (PCP) Member
(some services require member to obtain prior authorization)
Who Provides Your Care Providers contracted with this plan. Specialist visits require a referral or a Prior Authorization. Prior authorization must be obtained for services not available in the network. Any licensed provider rendering covered services when referral/authorization was not obtained for In-Network benefits. When providers who are contracted on the national network are used as out-of-network providers, their fee discount reduces your out-of-pocket expenses.
Annual Deductible $0 $200 per individual
$400 per family (2 mbrs @ $200)
Calendar Year Out-of-Pocket Max (Once this maximum is paid by the member, the plan pays a higher amount - up to 100% coverage) n/a: copay always applies $2,000 per person
$4,000 per family (2 mbrs @ $2000)
Primary Physician Visit $15 copay 70% coverage R&C¹
Specialist Physician Visits $25 copay 70% coverage R&C¹
Well Baby Care (up to age 2) $0 copay 70% coverage R&C¹
Periodic Health Evaluations² $0 copay not covered
Outpatient Surgery / Procedure $0 copay at KMC or $100 copay 70% coverage R&C¹
Inpatient Hospitalization $0 copay at KMC or $150 copay per day, up to $750 yr max 70% coverage R&C¹
Emergency Room $75 copay (waived if admitted) $75 copay (waived if admitted)
Urgent Care $15 copay 70% coverage R&C¹
Mammogram & Pap Smear $0 copay Not Covered
Immunizations  (office visit copay may apply) $0 copay 70% coverage R&C¹
Diagnostic Lab/X -Ray $0 copay 70% coverage R&C¹
Physical, speech and occupational therapy $0 copay (max. 60 visits/year combined) 70% coverage R&C¹ (max. 60 visits/year combined)
Durable Medical Equipment $0 copay 70% coverage R&C¹
Allergy Testing & Diagnosis $0 copay 70% coverage R&C¹
Chiropractic $20 maximum benefit/visit (max. 30 visits per year)
Prescription See Prescription Benefits

¹ After deductible has been met. R&C = Reasonable and Customary charges.

² Over 2 years old

This is a summary of the most-frequently-asked-about benefits. This chart does not explain benefits, out-of pocket maximums, exclusions, or limitations, nor does it list all benefits. For a complete explanation, please refer to the Summary Plan Description.  (PDF)

For information on dental and vision coverage, visit Kern County Health Benefits

Out-of-Area (OOA) Member Benefits (click to expand/hide)

 

Prescription Benefits

Prescription benefits for the County of Kern POS plan are administered by Catamaran. (Details on the Catalyst Rx/Catamaran name change)  (PDF)

Catamaran Member Services Website

The POS prescription benefit includes generic, brand-name, and specialty medications. POS members can fill their prescriptions at Kern Medical Center pharmacies at reduced copays for generic and preferred name-brand medications and, through the POS Plan’s Over-the-Counter (OTC) prescription benefit, you can also receive some OTC non-sedating antihistamines (NSA) and Proton Pump Inhibitor (PPI) medications for $0 copay with a physician’s prescription.

POS Prescription Benefit copays
Prescription - Retail 30-day supply at Catamaran-affiliated pharmacy:
     $5 Generic ($0 at KMC Pharmacies)
    $15 Preferred Name-Brand ($0 at KMC Pharmacies) *
    $30 Non-Preferred Name-Brand *
Prescription - Mail order 90-day supply through Catamaran Home Delivery:
     $10 Generic
     $30 Preferred Name-Brand *
     $60 Non-Preferred Name-Brand *

If no generic available. Higher cost if generic is available.

Mail Order/Home Delivery Program
 

Mail Order Frequently Asked Questions  (PDF)

Mail Order Registration and New Prescription Order Form  (PDF)

Mail Order Prescription Fax Form  (PDF)

Grievance/Appeals Procedure

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