HPSM Benefits

HPSM gives you access to a full range of health care benefits and services. Below is an overview of what you get, along with links to more details.

Member-Benefits

Health Care Services

HPSM covers many health care services, including:

  • Doctor and hospital visits
  • Prescription drugs
  • Long-term care in skilled nursing facilities
  • Preventive health exams, screenings, tests and immunizations
  • Pregnancy and maternity care
  • Dental and eye care (only for IHSS workers)
  • Medical emergencies: call 9-1-1 or go to the nearest ER
prescriptions

Prescription Drugs

Medications prescribed by your doctor are covered. Some medications may require prior authorization: talk to your doctor. Some over-the-counter medications may also be covered, but must be prescribed by your doctor.

Costs

Costs

Monthly premium 

HealthWorx HMO members pay a monthly fee. The amount is determined by their employer.

Share-of-cost (SOC) payments

Some services have a co-pay and others have no co-pay:

  • Pregnancy and maternity care – $0
  • Doctor and hospital visits (such as medically necessary home visits) – $5
  • Emergency room visits – $25
Nurse Advice Line

Nurse Advice Line

This toll-free phone hotline is open 24 hours a day, 7 days a week. Just call 1-833-846-8773.

Registered nurses are on hand to answer questions about your symptoms. They can tell you how urgently you need to see a doctor and may give you advice for self-care at home.

Learn more

care coordination

Care Coordination program

Helps get your doctors and HPSM all working to give you the focus and support you need to stay healthy. Your personal Case Manager helps you set health goals and make a plan for achieving them.

For more information, visit our Care Coordination page or call 650-616-2060

Health Education

HPSM’s Health Education Unit

Provides information on a range of topics and support programs, such as:

  • How to quit tobacco and other similar products
  • Managing your diabetes, asthma, blood pressure and more
  • The Baby + Me Program, which connects pregnant women and new moms with a range of support resources – and offers participants up to $100 in Target GiftCardsTM 
The Bullseye Design, Target and Target GiftCard are registered trademarks of Target Brands, Inc. Terms and conditions are applied to gift cards. Target is not a participating partner in or sponsor of this offer.
care coordination

Free interpreter services

If your doctor does not speak your language, interpreter services are available by phone and video. Just ask your doctor to call an interpreter during your visit. In special cases, an interpreter can go to the visit with you.

Learn more

Telemedicine

Doctor’s visits by phone or video

Many providers can give you advice over the phone or see you by video. Telephone and video visits are fully covered. Call your primacy care provider (PCP) to check if they provide telephone or video visits.

Learn more

Health Education

Mental health and substance use

Covered by: San Mateo County Behavioral Health and Recovery Services (BHRS). Call for information about mental health providers and other specific mental health services. You can also talk to your PCP about mental health and substance use disorders issues: they will then work with BHRS to get you the help you need.

More information: Call 1-800-686-0101 TTY: 1-800-943-2833 or visit smchealth.org/bhrs

Dental and vision care

Dental and eye care

Covered by: Service Employees International Union, Local 521 (only for IHSS workers).

More information: Call 1-800-322-6384 TTY: 1-800-842-6635 or visit seiu521.org