San Francisco Health Plan
The San Francisco Health Plan is a benefit 100% paid for by Robert Half and is provided in lieu of contributions to the San Francisco City Option. This plan consists of preventive care, indemnity coverage and dental benefits.
Preventive care covers preventive care services (such as immunizations and screenings) at 100% when you use an in-network provider through First Health.
Indemnity coverage provides cash payments for basic health care services, such as doctor’s office visits, diagnostic X-rays and lab work, hospital stays and surgical procedures. It helps offset out-of-pocket expenses such as deductibles and coinsurance. You can use any network provider for service, but if you use the First Health Network, you may get discounts.
The dental plan includes 100% coverage for preventive care plus benefits for basic and major treatment.
This plan also includes Teladoc (on-demand medical experts by phone or video) and the AWP Rx prescription discount program.
San Francisco Health Plan – Preventive Care Plus Plan
The San Francisco Health Plan, administered by The American Worker, provides preventive care services that meet the ACA’s requirements for minimum essential coverage. The plan covers preventive care services at 100 percent when you use an in-network provider. The plan does not include coverage for non-preventive services, such as emergency room care, hospital stays or non-preventive doctor’s office visits.
You have access to the First Health Network, which provides discounts for in-network physicians and hospitals. To find a provider, visit FirstHealthLBP.com. You also have the option to use a primary care provider of your choice that is not listed in the First Health Network; however, your out-of-pocket costs will be higher outside the network.
The U.S. Preventive Services Task Force periodically updates the list of covered services and sets the requirements such as age, gender and/or health conditions for services to be covered. For a current list, visit healthcare.gov/preventive-care-benefits. Plan limitations and exclusions apply.
| SERVICES COVERED BY PREVENTIVE CARE PLUS PLAN | |
|---|---|
| All Adults | ► SCREENINGS: Abdominal aortic aneurysm, alcohol misuse, blood pressure, cholesterol, colorectal cancer, depression, diabetes (type 2), hepatitis B, hepatitis C, HIV, lung cancer, obesity, syphilis, tobacco use ► COUNSELING: Alcohol misuse, diet, obesity, sexually transmitted infection prevention, tobacco use ► IMMUNIZATIONS: Diphtheria, hepatitis A, hepatitis B, herpes zoster, human papillomavirus (HPV), influenza (flu shot), measles, meningococcal, mumps, pertussis, pneumococcal, rubella, tetanus, varicella (chickenpox) ► OTHER: Aspirin use to prevent cardiovascular disease |
| Women, Including Pregnant Women or Women Who May Become Pregnant | ► SCREENINGS: Anemia, breast cancer mammography, cervical cancer, chlamydia infection, domestic and interpersonal violence, gonorrhea, HIV, human papillomavirus (HPV), osteoporosis, Rh incompatibility, sexually transmitted infection, syphilis, tobacco use, urinary tract or other infections ► COUNSELING: Breast cancer chemoprevention, breast cancer genetic testing (BRCA), breastfeeding, contraception, domestic and interpersonal violence, gestational diabetes, HIV ► OTHER: Breastfeeding supplies for pregnant and nursing women, FDA-approved contraceptive methods, folic acid supplements, well-woman visits for recommended services |
| Children | ► SCREENINGS: Autism, blood pressure, cervical dysplasia, depression, developmental dyslipidemia, hearing, hematocrit or hemoglobin, hemoglobinopathies or sickle cell, hepatitis B, HIV, hypothyroidism, lead, obesity, phenylketonuria, sexually transmitted infection, tuberculin, vision ► ASSESSMENTS: Alcohol and drug use, behavioral, oral health risk ► COUNSELING: Obesity, sexually transmitted infection prevention ► IMMUNIZATIONS: Diphtheria, haemophilus influenza type B, hepatitis A, hepatitis B, human papillomavirus (HPV), inactivated poliovirus, influenza (flu shot), measles, meningococcal, pertussis, pneumococcal, rotavirus, tetanus, varicella (chickenpox) ► OTHER: Fluoride chemoprevention supplements, gonorrhea preventive medication for the eyes of newborns, height, weight and body mass index (BMI) measurements, iron supplements, medical history |
| Teladoc* | Teladoc gives you access to U.S. board-certified doctors 24/7 by phone, online or via your mobile device.* For certain minor, non-preventive services, Teladoc doctors can diagnose, treat and prescribe medication, when necessary, for a variety of issues. Using Teladoc: ► You can access medical care from anywhere without taking time off work. ► You’ll hear back quickly, as the median call-back time is just 10 minutes. ► You’ll reduce your out-of-pocket expenses by avoiding an urgent care or emergency room visit. |
| Prescription Drug Coverage | Copays of $5, $10 or $15 are available for preferred generic drugs at in-network pharmacies (limited to the formulary drug list); there is no coverage at non-network pharmacies. ► You’ll receive a discount for non-preferred generic and brand-name drugs at in-network pharmacies. ► More than 63,000 in-network pharmacies nationwide, including almost all chain and independent pharmacies. ► For questions or to locate a pharmacy, call The American Worker at 1.855.495.1192. |
San Francisco Health Plan – Indemnity
The Group Hospital Indemnity Plan provides cash payments for health care expenses that your medical plan may not cover, including doctor’s office visits, diagnostic X-rays and lab work, hospital stays and surgical procedures.
The plan pays in addition to other coverage you may have and can help cover out-of-pocket expenses, such as deductibles and coinsurance, when receiving medical treatment.
The plan does not require you to stay in-network, so you can visit any provider you choose for services.
| Benefit | San Francisco Health Plan - Indemnity |
| DOCTOR’S OFFICE BENEFIT | Pays $125/day, 6 days/person/year |
| OUTPATIENT DIAGNOSTIC LAB | Pays $100/testing day, 4 days/person/year |
| OUTPATIENT DIAGNOSTIC X-RAY | Pays $200/testing day, 3 days/person/year |
| OUTPATIENT DIAGNOSTIC ADVANCED STUDIES | Pays $500/testing day, 3 days/person/year |
| PREVENTIVE CARE | Pays $150/day, 1 day/person/year |
| ACCIDENTAL INJURY CARE | Pays up to $2,500 maximum per occurrence |
| EMERGENCY ROOM SICKNESS | Pays $500/day, 2 days/person/year |
| SURGERY | |
| DAILY INPATIENT | Pays $3,000/day |
| DAILY INPATIENT MAXIMUM | 1 day/person/year |
| DAILY OUTPATIENT | Pays $1,500 |
| DAILY OUTPATIENT MINOR | Pays $300 |
| OUTPATIENT SURGERY FACILITY | Pays $250/day, 1 day/year |
| OUTPATIENT BENEFIT MAXIMUM | 1 day/person/year |
| ANESTHESIA | Pays 30% of surgical benefit |
| INPATIENT-ONLY SERVICES | |
| DAILY IN-HOSPITAL INDEMNITY | Pays $1,300/day, 500-day lifetime maximum |
| HOSPITAL ADMISSION | Pays $2,000 lump sum per confinement |
| INTENSIVE CARE UNIT | Pays $2,600/day, 30 days/person/year |
| SUBSTANCE ABUSE | Pays $650/day, 30 days/person/year |
| MENTAL ILLNESS | Pays $650/day, 10 days/person/year |
| SKILLED NURSING | Pays $650/day, 60 days/person/stay |
| FIRST HEALTH NETWORK* | First Health provides access to a large network of physicians and hospitals to reduce out-of-pocket expenses. • First Health logo on medical ID card for fast and easy recognition by the provider • Re-priced claims will be assigned directly to the provider to simplify the claims process To find a provider, visit FirstHealthLBP.com. |
The San Francisco Indemnity Plan is underwritten by Nationwide Life Insurance Company.
*First Health and Teladoc are not provided by Nationwide Life Insurance Company. These are non-insurance benefits provided by separate vendors.
San Francisco Health Plan – Dental
The San Francisco Health Plan also includes dental benefits, which covers preventive and diagnostic services at 100% with no waiting period. It also provides coverage for basic and major dental services, after satisfying the applicable waiting period. All services require a $20 per visit deductible to be met.
You may use any provider, but you will pay less when you visit someone in the plan network. To locate providers, visit ameritas.com and select Find a Provider > Dental > Network Provider > Classic (PPO) network.
| San Francisco Health Plan - Dental | ||
| Calendar-year Maximum | Up to $500 / member / year | |
| Deductible | $20 / visit | |
| Covered Service | Waiting Period | Coverage |
| Preventive & Diagnostic (exams, cleanings, X-rays, etc.) | None | Covered at 100% of U&C charges* |
| Basic Treatment (amalgams, composites, endodontics, periodontics, extractions, etc.) | 3 Months | Covered at 80% of U&C charges* |
| Major Treatment (onlays, crowns, prosthodontics, etc.) | 12 Months | Covered at 50% of U&C charges* |
| *Usual and Customary: what is typically charged for the same or similar service in a given geographic area |
| When You Become Eligible | Your Eligible Dependents | When You Enroll | Benefits Effective Date |
| • After satisfying the 90-day employment requirement and working within the San Francisco geographic area on average at least eight or more hours a week | • Spouse or domestic partner • Children (up to age 26) | • You are automatically enrolled upon initial eligibility • Dependents can be added at any time | • The first of the month after you become eligible |
Qualified San Francisco contract talent will be automatically enrolled in the San Francisco Health Plan. Your enrollment will be communicated to you via email and an ID card will be mailed to your home address. You will continue to be enrolled every month in which you average eight or more hours worked per week in the prior month in San Francisco. At any time after becoming eligible for the San Francisco Health Plan, you may enroll your dependents. While you are enrolled in this plan, Robert Half will not contribute to the San Francisco City Option on your behalf.
If you don’t want to participate in the San Francisco Health Plan described above, you can choose to opt out and have Robert Half contribute to the City Option on your behalf instead. If you prefer to not have San Francisco Health Care Security Ordinance (HCSO) contributions made on your behalf, you must provide a voluntary written waiver of the HCSO. Coverage will be canceled on the next available date after receipt of a completed Opt-Out Form.
How to Enroll Dependents, Opt Out of the San Francisco Health Plan or Voluntarily Waive Robert Half Contributions:
ENROLL YOUR DEPENDENTS using the Dependent Form
- To enroll an eligible dependent, you’ll need their name, Social Security number, date of birth and gender.
OPT OUT using the Opt Out of San Francisco Health Plan Form
- By completing this form, you are opting out of the San Francisco Health Plan and choosing instead to have Robert Half contribute to the SF City Option on your behalf.
VOLUNTARILY WAIVE HCSO contributions using the Voluntary Waiver Form
- By completing this form, Robert Half will not make required HCSO contributions on your behalf to either the Plan or the SF City Option.
- Each year, you must reaffirm your choice to voluntarily waive these contributions by completing this form.
- You can revoke your voluntary waiver at any time.
You can request any of the forms be sent via email by making a request through The American Worker mobile app site. Below is the link and the text code to access the mobile app site.
- Text RHAWP to 1.855.932.4533
Coverage Termination and Coverage Continuation
- Your San Francisco Health Plan coverage terminates at the end of the month in which you did not work the required minimum number of hours in San Francisco. You have the ability to continue your San Francisco Health Plan coverage through COBRA. If you incur a medical claim after your San Francisco Health Plan coverage terminates, your claim will not be paid unless you elect COBRA.
- Example: If you did not work at least eight hours each week on average in San Francisco in May, your San Francisco Health Plan coverage terminates May 31. If you submit a claim for medical expenses incurred on June 15, your claim will not be paid unless you elect to continue your coverage on COBRA.
| CARRIER(S) | CARRIER CONTACT(S) |
| Nationwide | Phone 1.855.495.1192 Visit RHAWPbenefits.com |
| First Health Network* | To find a provider online, visit FirstHealthLBP.com Phone: 1.800.226.5116 |
| Teladoc* | Visit Teladoc.com Phone: 1.800.Teladoc (1.800.835.2362) |
| AWP Value Rx* (Rx Discount Card provided by CerPassRx) | Visit AWPValueRx.com Phone: 1.844.636.7506 |
| Ameritas Dental | Ameritas.com |
*First Health, Teladoc and AWP Value Rx are non-insurance benefits.
