Kern Legacy Network Plus covers:
- Medical and Pharmacy Services.
- Dental and Vision are separate benefits not included in the Kern Legacy Health Plan.
What are my benefits? You have two tiers of benefits available to you, allowing for access to an expansive network of providers.
- EPO Benefit Tier: Primary benefit tier using the EPO Network, with no annual deductible, and low to no copays.
- EPO Network - Includes a large selection of primary care providers and specialty care centered around Kern Medical. There are specialty categories that are exclusive to Kern Medical and affiliated physicians. There are also certain specialty categories that include local community providers.
- Plus Benefit Tier: Additional benefit tier that includes a low annual deductible that must be met before coverage on this tier will begin. You can choose a specialty care provider or facility listed in the Plus Network when you need medical care.
- Plus Benefit Deductible
Per Individual (Employee/Employee +1): If you are covered under the Plan as an employee only or you have a spouse or other individual dependent on the Plan, you each must meet $250 deductible with qualified Plus medical expenses before the Plan will begin coverage on the Plus benefit.
Family 3+: If you cover more than two people on the Plan, two members must meet their individual deductibles of $250 which will equal $500 in qualified Plus medical expenses before coverage will begin for all family members on the Plus benefit.
Once you meet the annual deductible, the Plan will pay 80% and you will pay 20% of the contracted rate for services provided by Plus Network providers and/or at Plus Network facilities.
Upon Enrollment You Must:
- Select a Primary Care Physician (PCP) from the EPO Network for each covered member of the Plan. You have an expansive list of PCP’s (PDF) to choose from.
New for 2019, if you require a consultation with specialist you can self-refer to either an EPO Network or a Plus Network specialist.
Please Note: To maximize your savings use the EPO Network. You will pay more to consult with a Plus Network specialist.
Authorization for additional follow-up visits after the initial consultation and most procedures will still require prior authorization from the Plan.