For Active, Extra-Help/Temporary, and Retired Employees

Benefits Information

For Active Employees

• Plan Year 2023 Active Employees Summary of Benefits and Coverage (PDF)

  This chart lists the medical plan benefits offered for Plan Year 2023 with this Kern Legacy Health Plan.

• County of Kern Plan Document describing the Kern Legacy Health Plans for Active Employees (PDF)

  This document will help you understand and use the self-funded medical plan benefits provided by Kern County for Active Employees. You should review it and share it with those members of your family who are or will be covered by the Plan. It will give all of you an understanding of the coverages provided; the procedures to follow in submitting claims; and your responsibilities to provide necessary information to the Plan.

• Plan Year 2023 Active Employees Summary of Benefits Comparison Chart (PDF)

  This chart lists the medical plan benefits offered for Plan Year 2023 with all the Kern Legacy Health Plans for Active Employees.

• Plan Year 2024 Active Employees Summary of Benefits Comparison Chart (PDF)

  This chart lists the medical plan benefits offered for Plan Year 2024 with all the Kern Legacy Health Plans for Active Employees.

For Extra-Help/Temporary Employees

• Plan Year 2023 Extra-Help/Temporary Employees Summary of Benefits and Coverage (PDF)

  This chart lists the medical plan benefits offered for Plan Year 2023 with this Kern Legacy Health Plan.

• Plan Year 2023 Extra-Help/Temporary Employees Summary of Benefits Comparison Chart (PDF)

  This chart lists the medical plan benefits offered for Plan Year 2023 with all the Kern Legacy Health Plans for Extra-Help and Temporary Employees.

• Plan Year 2024 Extra-Help/Temporary Employees Summary of Benefits Comparison Chart (PDF)

  This chart lists the medical plan benefits offered for Plan Year 2024 with all the Kern Legacy Health Plans for Extra-Help and Temporary Employees.

For Retired Employees

• Plan Year 2023 Retirees Summary of Benefits Comparison Chart (PDF)

  This chart lists the medical plan benefits offered for Plan Year 2023 with all the Kern Legacy Health Plans for Retirees.

• Plan Year 2024 Retirees Summary of Benefits Comparison Chart (PDF)

  This chart lists the medical plan benefits offered for Plan Year 2024 with all the Kern Legacy Health Plans for Retirees.

Provider Information

• Provider Directory – Kern Health Care Network (PDF)
• Need to change your Primary Care Physician? Please contact Kern Legacy Health Plans at (661) 868-3280.

Additional Information

• Sample ID Card
  • Active and Retired Employees (PDF)
• Replace ID Card
• Kern Legacy Health Plans Member Portal – HealthEdge Gateway

  Use the Kern Legacy Health Plans Member Portal to search claims history, view/print ID cards, view your benefits, and search for in-network providers. Registration Instructions (PDF)

• No Prior Authorization List (PDF)

  This document lists all the procedures and services that do not require a Prior Authorization while seeking services through a contracted provider. Non-contracted providers must obtain a Prior Authorization when providing these procedures and services.

Forms

• Medical Reimbursement Claim Form (PDF)
• Coordination of Benefits Questionnaire (PDF)

  Complete this form and return to HealthEdge Administrators if you or any of your dependents have other medical insurance.

• Continuity of Care Request Form (PDF)

Medication List

• Medication List can be found by logging into your member portal at www.WellDyne.com or by calling Member Services at 1-888-479-0163.

Co-Pays

• ACA Preventative Medications are provided at no cost and deductible is waived.
• Preventative Medications are provided at a $10 copay and deductible is waived.
• Co-Pays after deductible met:
  • At WellDyne Mail Order Pharmacy or CVS Pharmacy (Non-Specialty Drugs, up to 90 day supply):

    • For Active and Extra-Help/Temporary Employees
      Generic/Preferred Brand/Non-Preferred Brand
      $0/$25/$50

    • For Retired Employees
      Generic/Preferred Brand/Non-Preferred Brand
      $0/$25/$50

  • At any Retail Pharmacy (Non-Specialty Drugs, up to 30 day supply):

    • For Active and Extra-Help/Temporary Employees
      Generic/Preferred Brand/Non-Preferred Brand
      $5/$50/$90

    • For Retired Employees
      Generic/Preferred Brand/Non-Preferred Brand
      $5/$50/$90

  • At WellDyne Specialty Pharmacy (Specialty Drugs, up to 30 day supply):

    • For Active and Extra-Help/Temporary Employees
      Generic/Preferred Brand/Non-Preferred Brand
      $50/$90/$120

    • For Retired Employees
      Generic/Preferred Brand/Non-Preferred Brand
      $50/$90/$120

Forms

• WellDyne Reimbursement Claim Form (PDF)
• WellDyne Mail Order Pharmacy Registration Form (PDF)
• OTC COVID-19 Tests Member Reimbursement Form (PDF)

  Complete this form and send it along with your purchase receipt to WellDyne to request reimbursement for over-the-counter COVID-19 tests you have paid for out-of-pocket.

Other Resources

• Specialty Medications are provided by WellDyne Specialty Pharmacy.
• Diabetic Medications/Supplies (PDF) are provided by WellDyne Mail Order Pharmacy (https://wellview.welldyne.com/ or contact Member Services at 1-888-479-0163).
• WellConnect is a digital tool that makes it easy for you to understand your prescriptions. (PDF)
• Easy 24/7 Access to manage your prescriptions. (PDF)
• Authorization Criteria for Botox Treatments (PDF)
• WellDyne Mail Order FAQ (PDF)

• PHI Disclosure Form (PDF)

• Authorization Services: Clinix Healthcare
• Claims Administration: HealthEdge Administrators
• Provider Network: Kern Health Care Network
• Pharmacy Benefits: WellDyne
• Health Plans Customer Service Phone Numbers (PDF)

The No Surprises Act establishes patient protections against surprise medical bills and includes several transparency and other provisions.

Key Provisions

• Health Insurance Requirements for coverage of emergency services regardless of network and for non-emergency services performed by out-of-network providers at in-network facilities in certain circumstances.
• Establishes guidelines for determining of out-of-network rates to be paid by health plans in the above instances and an independent dispute resolution (IDR) process.
• Prohibits out-of-network providers from balance billing patients for covered emergency services or certain covered non-emergency services provided at in-network facilities unless certain conditions are met.
• Requires both health plans and providers to assist patients in accessing health care cost information. (Advanced EOB and online price comparison tool)
• Ensures continuity of care when there is a change in the plans’ provider network in certain circumstances.
• Requires health plans to maintain an online price comparison tool.

As of July 1, 2022, Kern County will be utilizing Payer Compass at https://kern.mrf.payercompass.com/ to provide Price transparency reports for the Kern Legacy Network Plus and Kern Legacy Share Select Health Plans.

No Surprises Act Notice (PDF)