Health Service System - City & County of San Francisco

City Health Plan is a Preferred Provider Organization (PPO). A PPO is a medical plan that gives you freedom of choice between PPO providers who offer their services at discounted rates, and non-PPO providers.

When you obtain care from a PPO provider, the plan pays higher benefits, up to 85% after the required deductible, and your out-of-pocket expenses are less. When you use a PPO provider, he/she will submit claims on your behalf.

If you obtain care from a non-PPO provider, the plan pays lower benefits and you may be required to pay for services directly to the provider and submit your own claims to the plan.

You must pay the applicable deductible each Plan Year for most services before this plan will pay benefits. After your deductible requirement has been met, you will pay a percentage of the cost of services provided.

Please refer to the applicable City Health Plan Evidence of Coverage for a detailed list of covered services, exclusions and limitations.

Active Members

• HSS Benefits-at-a-Glance 2008-2009 (pdf)
• City Plan Evidence of Coverage (pdf)

Retired Members without Medicare

• HSS Benefits-at-a-Glance 2008-2009 (pdf)
• City Plan Evidence of Coverage (pdf)

Retired Members with Medicare

• HSS Benefits-at-a-Glance 2008-2009 (pdf)
• City Plan Evidence of Coverage (pdf)

Claim & Reimbursement Forms

• US Medical Claim Form (pdf)
• Non-US Medical Claim Form (pdf)
• Rx Reimbursement Form (pdf)

City Health Plan also offers wellness benefits to all HSS members participating in this plan. Check out these Wellness Benefit Highlights.

Visit the City Health Plan website at https://www.myuhc.com.

Telephone the City Health Plan (administered by UnitedHealthcare) at (866) 282-0125. The HSS group number is 705287.