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.
Health Care Services
HPSM covers many health care services, including:
- Doctor and hospital visits
- Prescription medicines
- 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
Prescription medicines
Medicines prescribed by your doctor are covered. Some medicines may require prior authorization: talk to your doctor. Some over-the-counter medicines may also be covered, but must be prescribed by your doctor.
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
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.
Care Management program
Helps get your doctors and HPSM all working to give you the focus and support you need to stay healthy. Your personal Care Manager helps you set health goals and make a plan for achieving them.
For more information, visit our Care Management page or call 650-616-2060
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
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.
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 primary care provider (PCP) to check if they provide telephone or video visits.
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 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