Health Service System - City & County of San Francisco

City Health Plan is a Preferred Provider Organization (PPO). A PPO allows you to choose any in-network or out-of-network healthcare provider. A PPO doesn't assign you a Primary Care Physician, so you have more responsibility for coordinating your own care. Also, you must pay a deductible each Plan Year for most services before this plan will pay benefits. When you obtain care from an in-network provider, the plan pays higher benefits, your out-of-pocket expenses are less, and claims are submitted for you by your doctor. If you obtain care from an out-of-network provider, the plan pays lower benefits and you may be required to pay for services directly and submit your own claims. Please refer to the Evidence of Coverage for a detailed list of this plan's covered services, exclusions and limitations.

Active Employees	Retired Without Medicare	Retired With Medicare
July 2009 - June 2010	July 2009 - June 2010	July 2009 - June 2010
Summary of Benefits	Summary of Benefits	Summary of Benefits

 

Claim & Reimbursement Forms

• US Medical Claim Form
• Non-US Medical Claim Form
• Rx Reimbursement Form

City Health Plan also offers these wellness benefits.

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.