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Please note:  If you or one of your dependents is Medicare-eligible, be aware of phone scams in connection with the new Medicare Prescription Drug Program.  For more information, please review the Medicare Consumer Alert from the Centers for Medicare & Medicaid Services (CMS).

Medical:
Custom PPO Health Plan
   (888) 233-7915 or (858) 292-3542
   Group Number JPAK052 - A (Active)
                       JPAK052 - B (Retirees, Group II)
                       JPAK052 - BB (Retirees, Group I)
                       JPAK052 - C (COBRA)

       PPO Plan Outline
       PPO Provider Directory      How to Use the Online Directory
       PPO Summary Plan Document
       PPO Plan Document
       HIPAA Privacy Notice - Fringe Benefits Consortium

    PacifiCare Behavioral Health
      (800) 999-9585
      Group Number 10000922
       Schedule of Benefits
       PacifiCare Provider Network
       PacifiCare Behavioral Health Plan Description
      PacifiCare Behavioral Health Claim Form

   Express Scripts (for prescriptions covering a 90-day supply)
      (800) 206-4005
      Register online to order refills:  www.express-scripts.com

Kaiser HMO Plan
   (800) 464-4000
   Group Number 104317-0100 (Active)
                      104317-0101 (Retirees)
                      104317-7101 (COBRA)
                      104317-5200 (Part Time Faculty)
   Kaiser 2008 Active Employee EOC
   Kaiser 2008 EOC - Chiropractic - Active Employees
   Kaiser 2008 EOC - Senior Advantage (Retirees)
   Kaiser 2008 EOC - Chiropractic - Retirees
   Kaiser 2007 EOC - Part Time Faculty

Dental:
Delta Dental                      How to Use the Delta Dental Website
   (866) 499-3001
   Delta Preferred Option is for employees hired on or after January 1, 1996
   Group Number 7028-2905 (Active)
                      7028-2906 (COBRA)
                      7028-2907 (Retiree)
        Delta Preferred Option Plan Outline
        2008 DPO EOC

   Delta Premier is for employees hired before January 1, 1996
   Group Number 7128-2901 (Active)
                      7128-2903 (Retiree)
                      7128-2904 (COBRA)
        Delta Premier Plan Outline
        2008 Premier EOC

   Dental Claim Form (for out of network claims in either plan)
    HIPAA Privacy Notice - Delta Dental
    Find a dentist when traveling outside the United States

Vision:
Vision Service Plan (VSP)
   (800) 877-7195
   Group Number 712201-0019
   Out of network claim form can be found in the above website
   VSP Fact Sheet
   HIPAA Privacy Notice - Vision
 

For more information about benefits, please contact Lucy Nelson, Benefits Specialist, at ext. 2889 or lnelson@palomar.edu.

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