medical HMO plans
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the basics
Chevron offers fully-insured Medical HMO Plan options to eligible U.S.-payroll employees. Medical HMO Plans are not available in all areas and the plan choices vary based on your zip code.
When you enroll in a Medical HMO Plan, you are automatically enrolled in:
- Medical coverage through the HMO you choose.
- Prescription drug coverage through the HMO you choose.
- Basic vision coverage through the HMO you choose.
- You also have access to behavioral health services through your HMO, but you are also automatically covered under the Chevron Mental Health and Substance Use Disorder (MHSUD) Plan with Beacon Health Options.
The Medical HMO Plans are health maintenance organization (HMO) health plans. This means you must use a provider who’s in the plan’s network to receive coverage. Otherwise, those services will not be covered (except in emergencies). Typically, you need a referral to a specialist under the Medical HMO Plans.
When you enroll, you can choose your coverage level. Your monthly cost for coverage varies based on the coverage level you choose:
- You Only
- You + One Adult
- You + Child(ren)
- You + Family
Employees
- You can enroll in the Medical HMO Plan if you're a U.S.-payroll employee and you're eligible for Chevron's health benefits.
Dependents
- You can also enroll your eligible dependents, just as you can with Chevron's other health plans.
- Eligible dependents generally include your spouse or domestic partner and children under the age of 26.
- Special rules apply to dependents that are incapacitated or physically or mentally disabled. If you feel that your dependent may qualify to continue coverage beyond age 26 due to being incapacitated or physically or mentally disabled, contact the HR Service Center, in advance of your dependent turning age 26, for further assistance and instructions about how to certify your dependent to be eligible for coverage.
Dependent Verification Process
You are required to verify the eligibility of any new dependents you enroll in your Chevron health plans in a dependent verification process. You have up to 60 days to obtain and submit requested documentation that verifies your dependent(s) are eligible to participate in Chevron’s health benefits. If you don’t provide acceptable documentation by the deadline, your dependent(s) will be disenrolled from coverage. Learn more about this process.
Expatriates
- U.S.-payroll expatriates on an expatriate assignment may not be eligible to participate in this plan, depending on your assignment type.
- Learn more about how your coverage changes while on assignment.
A deductible is the amount you must pay out-of-pocket for the covered care you receive before your plan begins to pay a share of costs through coinsurance or copayments. The average annual deductible for most Medical HMO Plans is $300. However, some Medical HMO Plans may have a different deductible, and a few have no deductible at all.
Mental Health and Substance Use Disorder
- If you're enrolled in the Medical PPO Plan, then there is no deductible for services under the Chevron Mental Health and Substance Use Disorder (MHSUD) Plan.
Learn More
- Review the Summary of Benefits and Coverage (SBC) for your plan to see the annual deductible amount for any Medical HMO Plans available to you. You'll need to contact the HMO directly starting each January to understand what is and is not applied to your deductible. (See contact information at the bottom of this page.)
All of Chevron’s medical plans offer access to one of two tax-advantaged accounts that permit you to contribute money so you can later use the money in your account to help pay for certain out-of-pocket health care costs.
- When you enroll in the Chevron Medical HMO Plan, you are eligible to participate in Chevron's health flexible spending account plan, the Health Care Spending Account (HCSA) with payroll contributions. Chevron does not contribute to this account.
- These plans are not compatible with a health savings account (HSA).
The Medical HMO Plans offer comprehensive coverage for the major medical services you’d expect, including office visits, emergency services, hospital care, lab services, outpatient care, pregnancy and newborn care and rehabilitative services. Coverage features to note include:
- 100 percent coverage with no copayment, coinsurance or deductible for certain preventive care services, as specified by the Affordable Care Act, when you see a network provider. Learn more about preventive care.
- Most Medical HMO Plans offer access to online health visits (also referred to as telehealth) as part of your benefit coverage. Contact your HMO Plan directly for information. (See plan contact information at the bottom of this page.)
- You have the choice to use the behavioral health benefits provided by your HMO Plan, or use the benefits provided under the Chevron Mental Health and Substance Use Disorder (MHSUD) Plan with Beacon Health Options. However, you cannot make a claim to both your HMO Plan and MHSUD Plan for the same service. If you are enrolled in a Chevron Medical HMO Plan and you choose to use your MHSUD Plan benefit, you must use a Beacon network provider to receive MHSUD Plan benefits. Out-of-network provider services are covered for emergencies only.
- Medical HMO Plan participants do not need to seek a second opinion through the Chevron Health Decision Support Program administrator prior to receiving knee, hip, back or spine surgery. That's because many Medical HMO Plans already have programs and procedures in place to address the positive benefits of seeking a second opinion. However, Medical HMO Plan participants are still encouraged and eligible to use the services of the Health Decision Support Program to seek a second opinion on any diagnosis or condition they may be facing.
- You have the opportunity to receive up to $750 off your annual medical plan premium when you participate in Chevron Health Rewards. Learn more about how to qualify for reduced premiums.
- 2023 Medical Plan Comparison (premiums, deductibles, etc.)
- 2023 Medical premiums (intranet)
- Participate in health rewards this year for reduced medical premiums next year
how to at-a-glance
If you're eligible to participate, enroll:
- If a Medical HMO Plan is available in your area, the BenefitConnect enrollment website will display the coverage option in your list of plan choices.
- On the BenefitConnect website.
- By calling the HR Service Center. Choose the option for Benefits, then Health coverage.
- You are also required to verify the eligibility of any new dependents you enroll by completing the dependent verification process.
Tip: When you enroll in health benefits on the BenefitConnect website or through the HR Service Center, know that your election is not immediate with each of the claims administrators. You must wait until your coverage is activated with the claims administrators before ID cards can be generated and for your coverage to display in the plan administrator's system.
- If you enroll during open enrollment, your ID cards will be generated in December, and your coverage fully activated on January 1 of the new year.
- If you enroll mid-year as a new hire or due to a qualifying life event, please allow at least 7 business days for BenefitConnect/HR Service Center to process your enrollment election with the claims administrators. Know that this could take slightly less or slightly more days, depending on when you enrolled. If you have questions about your election, contact the HR Service Center. (Choose the option for Benefits, then Health coverage.)
After you enroll, there are two opportunities to change your coverage ongoing:
Open Enrollment
Open enrollment is your annual opportunity to review and make changes to your coverage for the next plan year. Any changes you make to your benefits coverage during open enrollment become effective January 1 of the new year. If you miss the open enrollment deadline, you must wait until the next open enrollment period or if you experience a qualifying life event. You'll receive information each year about the dates of the open enrollment period and instructions for reviewing your coverage and making any desired changes.
Life Event
If you get married, have a baby, move or experience some other qualifying life event, you have 31 days to make changes to your benefits, if permitted by the event. If you miss this deadline, you'll have to wait until the next open enrollment period to change your benefits. To report a life event and understand what changes you may be eligible to make:
- Go to the BenefitConnect website and click the Report a Life Event link just under the main banner on the home page.
- Call the HR Service Center. Choose the option for Benefits, then Health coverage.
If you enroll in a Medical HMO Plan for the first time, you will receive an ID card from the claims administrator. You may also receive a new ID card periodically; always destroy your old card and be sure to present your new card to your provider at your next visit. You can also often download a digital version of your ID card from your plan's website or mobile app.
Tip: When you enroll in health benefits on the BenefitConnect website or through the HR Service Center, know that your election is not immediate with each of the claims administrators. You must wait until your coverage is activated with the claims administrators before ID cards can be generated and for your coverage to display in the plan administrator's system.
- If you enroll during open enrollment, your ID cards will be generated in December, and your coverage fully activated on January 1 of the new year.
- If you enroll mid-year as a new hire or due to a qualifying life event, please allow at least 7 business days for BenefitConnect/HR Service Center to process your enrollment election with the claims administrators. Know that this could take slightly less or slightly more days, depending on when you enrolled. If you have questions about your election, contact the HR Service Center. (Choose the option for Benefits, then Health coverage.)
The Medical HMO Plans are health maintenance organization (HMO) health plans. This means you must use a provider who’s in the plan’s network to receive coverage. Otherwise, those services will not be covered (except in emergencies). Typically, you need a referral to a specialist under the Medical HMO Plans.
To locate a network provider under your plan:
- Access your plan's website or mobile app
- Call your Medical HMO directly
See contact information at the bottom of this page.
If you’re enrolled in a Medical HMO Plan, you’ll be covered until the last day of the month in which your employment ends.
- You can elect COBRA coverage for you and your covered dependents for this plan. If you timely elect COBRA coverage, your medical coverage will be retroactive to the date your active employee coverage ended. If you wish to continue medical coverage, you must make an election to continue it.
- Medical coverage is available to eligible retirees. If you're eligible for retiree health benefits, there are different decisions and actions required of you.
- See if you're eligible for retiree health benefits on BenefitConnect. Go to I need to… on the top navigation, then choose Retiree medical eligibility.
- Learn about health benefits available to eligible pre-65 retirees here.
- Learn about health benefits available to eligible post-65 retirees here.
- Go to the Leaving Chevron resource on this website for more information about the things you need to do and the choices you need to make.
For Medical HMO - HMO Blue Texas participants
Continuation of Care Application | Continuity of Care generally, applies to hospitalization, pregnancy, and treatment for a serious and complex condition.
Continuity of Care generally, applies to hospitalization, pregnancy, and treatment for a serious and complex condition. Transition Assistance is a process that allows continued care for participants when certain situations occur, such as: your primary provider is terminated from the participating provider network; you're a new enrollee in an Anthem plan and your primary provider is not part of the network; your continuity of care is at risk for reasons over which you have no control.
plan documents
The summary plan descriptions (SPD) provides specific details about your benefits, such as eligibility, covered services and participation rules. If there recent updates to the SPD since the last publication date, look for the summary of material modification (SMM) included in the very front of the book.
The documents listed below are called a summary of material modification (SMM). An SMM explains recent updates to your plan that are not yet captured or updated in your summary plan description (SPD) since the last publication date. Be sure to review the SMM for an understanding of important plan updates.
- "Other dependent" legal guardian administrative clarification (January 1, 2021)
- New address for benefits correspondence (June 1, 2020)
- New dependent verification requirement (January 1, 2019) | Learn more
- New qualifying life event (January 1, 2019)
- Employee after-tax contributions eliminated (January 1, 2019)
- New fee for insufficient funds (January 1, 2019)
Review the Summary of Benefits and Coverage (SBC) to understand basic information about your plan, such as benefits, copayments, deductibles, and coinsurance.
- Go to the SBC section of this website to locate the document for your plan.
Supplement your medical coverage with a variety of optional benefits such as:
- Save for health care with a health account.
- Enroll in additional vision coverage with the Vision Plus Program.
- Get help with unanticipated costs your medical plan doesn't cover with Group Critical Illness insurance or Group Hospital Indemnity insurance.
- Plan ahead when you or a loved one cannot perform activities of daily living with Long Term Care insurance.
contacts
- Plan Type Medical Benefit
- State HI
- Eligibility U.S. Payroll Employees │ Dependent verification process required
- Enrollment Enroll on BenefitConnect or call the HR Service Center
- Claims Administrator HMSA
- Group Number 35305
- Phone 1-808-948-6372
- Website www.hmsa.com
- Virtual Visits / Telehealth Call the claims administrator directly to inquire.
- Get a Second Opinion Learn more here
- Claim Form Call the claims administrator directly or log in to their website
- Plan Type Medical Benefit
- State TX
- Eligibility U.S. Payroll Employees │ Dependent verification process required
- Enrollment Enroll on BenefitConnect or call the HR Service Center
- Claims Administrator BCBS TX
- Group Number 56249
- Phone 1-877-299-2377
- Website www.bcbstx.com
- Virtual Visits / Telehealth Virtual Visits or Bilingual 24/7 Nurseline at 1-800-581-0368
- Get a Second Opinion Learn more here
- Claim Form Call the claims administrator directly or log in to their website
- Plan Type Medical Benefit
- State CO
- Eligibility U.S. Payroll Employees │ Dependent verification process required
- Enrollment Enroll on BenefitConnect or call the HR Service Center
- Claims Administrator Kaiser
- Group Number 265
- Phone 1-800-632-9700
- Website my.kp.org/chevron
- Virtual Visits / Telehealth Kaiser Permanente Get Care (video, phone, chat). Call the claims administrator directly to inquire.
- Get a Second Opinion Learn more here
- Claim Form Call the claims administrator directly or log in to their website
- Plan Type Medical Benefit
- State HI
- Eligibility U.S. Payroll Employees │ Dependent verification process required
- Enrollment Enroll on BenefitConnect or call the HR Service Center
- Claims Administrator Kaiser
- Group Number 190
- Phone 1-800-966-5955
- Website my.kp.org/chevron
- Virtual Visits / Telehealth Kaiser Permanente Get Care (video, phone, chat). Call the claims administrator directly to inquire.
- Get a Second Opinion Learn more here
- Claim Form Call the claims administrator directly or log in to their website
- Plan Type Medical Benefit
- State CA
- Eligibility U.S. Payroll Employees │ Dependent verification process required
- Enrollment Enroll on BenefitConnect or call the HR Service Center
- Claims Administrator Kaiser
- Group Number 310
- Phone 1-800-464-4000
- Website my.kp.org/chevron
- Virtual Visits / Telehealth Kaiser Permanente Get Care (video, phone, chat). Call the claims administrator directly to inquire.
- Get a Second Opinion Learn more here
- Claim Form Call the claims administrator directly or log in to their website
- Plan Type Medical Benefit
- State OR
- Eligibility U.S. Payroll Employees │ Dependent verification process required
- Enrollment Enroll on BenefitConnect or call the HR Service Center
- Claims Administrator Kaiser
- Group Number 1878
- Phone 1-800-813-2000
- Website my.kp.org/chevron
- Virtual Visits / Telehealth Kaiser Permanente Get Care (video, phone, chat). Call the claims administrator directly to inquire.
- Get a Second Opinion Learn more here
- Claim Form Call the claims administrator directly or log in to their website
- Plan Type Medical Benefit
- State CA
- Eligibility U.S. Payroll Employees │ Dependent verification process required
- Enrollment Enroll on BenefitConnect or call the HR Service Center
- Claims Administrator Kaiser
- Group Number 100785
- Phone 1-800-464-4000
- Website my.kp.org/chevron
- Virtual Visits / Telehealth Kaiser Permanente Get Care (video, phone, chat). Call the claims administrator directly to inquire.
- Get a Second Opinion Learn more here
- Claim Form Call the claims administrator directly or log in to their website
- Plan Type Medical Benefit
- Eligibility U.S. Payroll Employees │ Dependent verification process required
- Enrollment Enroll on BenefitConnect or call the HR Service Center
- Claims Administrator Kaiser
- Phone 1-800-278-3296
- Website www.kp.org
- Virtual Visits / Telehealth Kaiser Permanente Get Care (video, phone, chat). Call the claims administrator directly to inquire.
- Get a Second Opinion Learn more here
- Claim Form Call the claims administrator directly or log in to their website
- Plan Type Medical Benefit
- Eligibility U.S. Payroll Employees │ Dependent verification process required
- Enrollment Enroll on BenefitConnect or call the HR Service Center
- Claims Administrator Kaiser
- Phone 1-800-278-3296
- Website www.kp.org
- Virtual Visits / Telehealth Kaiser Permanente Get Care (video, phone, chat). Call the claims administrator directly to inquire.
- Get a Second Opinion Learn more here
- Claim Form Call the claims administrator directly or log in to their website
- Plan Type Medical Benefit
- State WA
- Eligibility U.S. Payroll Employees │ Dependent verification process required
- Enrollment Enroll on BenefitConnect or call the HR Service Center
- Claims Administrator Kaiser
- Group Number 456700
- Phone 1-888-901-4636
- Website www.ghc.org
- Virtual Visits / Telehealth Kaiser Permanente Get Care (video, phone, chat). Call the claims administrator directly to inquire.
- Get a Second Opinion Learn more here
- Claim Form Call the claims administrator directly or log in to their website
This communication provides only certain highlights about benefit provisions. It is not intended to be a complete explanation. If there are any discrepancies between this communication and the legal plan documents, the legal plan documents will prevail to the extent permitted by law. Oral statements about plan benefits are not binding on Chevron or the applicable plan. Chevron Corporation reserves all rights, for any reason and at any time, to amend, change or terminate these plans or to change or eliminate the company contribution toward the cost of such plans. Such amendments, changes, terminations or eliminations may be applicable without regard to whether someone previously terminated employment with Chevron or previously was subject to a grandfathering provision. Unless required by applicable law, there are no vested rights with respect to any Chevron health and welfare plan benefit or to any company contributions towards the cost of such health and welfare plan benefits. Some benefit plans and policies described in this document may be subject to collective bargaining and, therefore, may not apply to union-represented employees.
plan documentation
contact
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