Employee Benefits

California Water Service Group and its subsidiaries offer medical, dental, and vision insurance to employees. General health benefit information is provided below. Additional and/or alternate benefits are available in some locations. Providers, members, and dependents of members can manage claims through the California Water Service Health Care Plan portal.

Medical

Plan Name: California Water Service Company Healthcare Plan
Policy Number: Insured’s Social Security Number or Insured’s Employee ID #
PPO Networks
      HealthSmart PPO:
      MultiPlan PPO:
 
Discount applied when bill is paid
Discount applied when bill is paid
Calendar Year Deductible: $100 per person; $300 per family (for families with 3 or more people)
Hospitalization Basic Benefit: Covers first $3,000 at 100% for inpatient hospitalizations (including inpatient stays for mental health and alcohol and drug rehabilitation) and outpatient surgeries, then Major Medical benefits apply. All other outpatient hospitalizations, including emergency room visits, are covered under Major Medical.
Major Medical (Physician visits, surgical prof fees, lab & x-ray, physical therapy): 80% of the balance after satisfying annual deductible, up to $3,000 out of pocket then account goes to 100% coverage for medical.
Prenotification of Inpatient Hospitalization: Call HealthSmart: 877-202-6379.
Out-Patient Mental Health & Drug/Alcohol Rehab: Payable under Major Medical

Prescriptions (including birth control)

     Managed by:

     Name Brand:

     Generic:

     Compound:

 

Express Scripts - Use your Express Scripts card when you go to the pharmacy or enroll in the Mail Order Program for ongoing prescriptions.

Paid at 80%

Paid at 90%

Not covered through Express Scripts. Submit to Cal Water Medical Plan for reimbursement. Coverage is limited to:

  1. Hormone replacement therapies; and
  2. If there are problems with FDA approved version of a prescription drug (e.g. You are unable to take the FDA approved drug in the form that is available or you are allergic to an ingredient in the FDA approved drug);

            *Compound topical pain creams are not covered

Accidents Basic Benefits: First $300 covered at 100%, no deductible. Must seek medical attention within 48 hours of accident. Accident details need to be submitted with each claim.
Chiropractic, Acupuncture, & Acupressure: Limit of 46 visits per calendar year. 1st visit paid at 80% after deductible has been met to a maximum of $150.00.  2nd through the 46th visit are paid at 80% to a maximum of $30.00 each visit.

Dental

To view dental claim status, details on claims already processed, or more specific information about benefits for you or a covered dependent, visit Delta Dental online.

YOU MUST CALL DELTA DENTAL TO OBTAIN YOUR DENTAL BENEFITS MAXIMUM INFORMATION: (800) 765-6003

Plan Name: California Water Service Company Dental Plan
Administrator: Delta Dental of California
Group Number: 16001
Calendar Year Deductible: $50 per person; $150 per family (for families with 3 or more people)
3 Year Maximum: $4,500 per person (from 01/01/2012 to 12/31/2014)
Benefits: Basic, major, and preventative paid at 80%, including crowns, and dentures
Prophys, Bitewing X-Rays Sealants: Must be separated by 5 months; deductible waived
Full Mouth X-Rays: Every 2 years
Prosthetic: Crown, dentures, caps, etc.
Replacements: Every 5 years
Pre-Authorizations: Not required but will be provided upon request
Orthodontic: Paid at 50%, up to $2,000 lifetime maximum per person
Wisdom Teeth: Extractions covered at 80%
Not covered:

Claims:
Prior extraction and cosmetic

Submit claims to:

Delta Dental of California
PO Box 997330
Sacramento, CA 95899-7330
(800) 765-6003

Vision

Plan Name: California Water Service Company Healthcare Plan
Policy Number: Insured’s Social Security Number or Insured’s Employee ID #
3 Year Benefits: $450 paid at 100%, no deductible, covers a 3-year period (from 01/01/2012 to 12/31/2014)
Coverage for: Contacts, lenses, frames, over the counter reading glasses, prescription sunglasses, service agreements
Eye Exams: Paid under medical plan at 80%, subject to medical plan deductible
Laser Eye Surgery: Please contact the Cal Water Healthcare Department to discuss the limited coverage available for Laser Eye Surgery (408) 367-8398

In the event there is a difference between these descriptions and plan documents, the official plan will govern.