San Francisco Part-Time Health Benefits - Boon Plan

San Francisco Health Care Security Ordinance Benefit Plan

As an employee in San Francisco, Alto Pharmacy is providing this plan at no cost to you once you qualify for coverage.

Eligibility

To qualify, you must work a minimum of 104 hours in the preceding quarter. Once you qualify, you will be automatically enrolled in this plan; there is no need to complete any enrollment forms.

**If you have other healthcare coverage and don’t want to be enrolled in this plan, you must complete, sign and return the Voluntary Waiver Form (on the right) to Alto Benefits Team. You will also need to provide documentation proof of your healthcare services from another employer or government program.**

Please note, this plan covers only you the employee and does not cover your dependents with the exception of WellMEC plan. The WellMEC plan provides you and any eligible dependent children with minimum essential coverage (MEC) that covers 100% of the government’s listed Preventive and Wellness Benefits. To enroll your eligible dependent children in the plan, please call 866.868.4139.

These benefits are broken into three classes based on the hours you work. The average monthly hours worked in one quarter determine the benefit class in the next quarter.

Class I: 34 -90 hours per month Class II: 91-130 hours per month Class III: 131-172 hours per month

The monthly average of hours worked in January – March will determine the benefit class for April – June The monthly average of hours worked in April -June will determine the benefit class for July-September The monthly average of hours worked in July-September will determine the benefit class for October -December The monthly average of hours worked in October – December will determine benefit class for January- March

Please refer to your benefit summary of Schedule of Benefits to learn more about the plan.

Please visit www.sfhcso.services and watch the video for a detailed overview on how to use your benefits.

If you go in-network, you get the PPO discounts and Boon will pay the provider directly. If you go out-of-network, you must obtain an itemized statement suitable for filing insurance from your provider (to include CPT Codes) and mail that to the address on your ID card. Boon will send you a check for the scheduled benefit amount.

About Your Plans

Aetna Fixed Indemnity Plan (AFIP)

The Aetna Fixed Indemnity Plan is a limited medical plan which covers a wide range of healthcare services and provides a fixed dollar amount for certain services such as hospital stays and surgical care, physician office visits, lab/x-ray and prescription drugs. To look up providers, click the Medical Provider Finder button on the right, enter your zip code, and under the Medical Plans section select the "Aetna Fixed Benefit Plan."

Caremark is the prescription carrier for the AFIP plan. You may be asked to provide your social security number when first filling a prescription. Caremark will use your social security number to verify your coverage. If you have questions about participating retail pharmacies or need assistance, please call 866-292-3374 or visit the Caremark website at www.caremark.com. The Caremark Pharmacy network includes CVS, Rite Aid, Walgreens, Target, Safeway, as well as many more national chains. There are more than 68,000 pharmacy locations nationwide in the network.

For any questions regarding this plan, please contact Boon Member Services at 866-292-3374. Representatives are available to assist you Monday through Friday 6:00am – 7:00pm and Saturday through Sunday 9:00am – 12:00pm, Central Time.

WellMEC

The WellMEC plan provides you with minimum essential coverage (MEC) that covers 100% of the government’s listed Preventive and Wellness Benefits. WellMEC offers coverage in addition to your Aetna Fixed Indemnity Plan for wellness and preventative services. For any questions regarding this plan, please contact Boon Member Services at 866-868-4139. Representatives are available to assist you Monday through Friday 6:00am – 7:00pm and Saturday through Sunday 9:00am – 12:00pm, Central Time. To Look up Providers, enter your zip code, under Medical Plans select the "Aetna Fixed Benefit Plan"

HealthiestYou

HealthiestYou is the telehealth provider for these plans. You may visit www.healthiestyou.com or call customer service at 855-894-9627 for assistance. Please be sure to download the app.

Dental Plan

See Boon Guide for Benefit Details. For Dental Services, the plan requires that a deductible is met before a benefit is paid. A deductible is the amount you must pay for eligible expenses before the plan begins to pay benefits. To look up providers, click the Dental Provider Finder button to the right, enter your zip code, under the Medical Plan section select the "Aetna Fixed Benefit Plan" then on the next page click the “Dental Care” option.

Vision Plan

See Boon Guide for Benefit Details. For Vision services, you can get discounts through EyeMed, a nationwide network of eye care providers or go to any vision provider of your choice. In order to get reimbursed for vision benefits, send copies of your paperwork to the address on the ID card. To look up providers, click the Vision Provider Finder button to the right, enter your zip code, under the Medical Plan section select the “Aetna Fixed Benefit Plan” then on the next page click the “Vision” option.