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Health care for people who can’t get covered

There are no copays, no out-of-pocket costs for most services. Open enrollment begins later this year for qualifying individuals and families. Pictured, Eduardo Chavez, left, and Erandy Cruz qualified for Kaiser Permanente’s Community Health Care Program.

For 2 years, Erandy Cruz, 30, her partner, Eduardo Chavez, 28, and their 2 young children went without health insurance or health care.

Chavez put off hernia surgery. Cruz didn’t get regular ob-gyn appointments, breast cancer screenings, or any other kind of preventive care.

Then their 11-year-old daughter needed care urgently, and the Rancho Cordova, California couple realized they needed some kind of insurance because they could not afford even one doctor’s visit without it.

But how could they pay for a health insurance policy when their restaurant employers don’t offer it, they make too much money to qualify for California’s Medi-Cal program for low-income individuals, and buying a plan on the open market is too expensive?

“We were able to get the Community Health Care Program from Kaiser through a referral from our daughter’s school,” said Chavez, speaking from the offices of Community HealthWorks in Sacramento, one of several nonprofits and government agencies helping people sign up for the plan.

Comprehensive coverage, no monthly premiums

The health plan Chavez and Cruz enrolled in is for individuals who earn too much for Medi-Cal but can’t get coverage elsewhere.

Their story is common among Californians who have difficulties getting health insurance. When Cruz started working at a restaurant, the couple’s combined wages pushed their family over the income limit for Medi-Cal, and they couldn’t find an affordable policy anywhere else.

The Community Health Care Program is open to anyone in California whose income qualifies them, regardless of immigration status. For example, an individual whose income is between $20,122 and $43,740, or a family of 4 with an income between $41,401 and $90,000 would qualify.

Participants pay no monthly premium for comprehensive Kaiser Permanente health coverage, including preventive services. There are no copays or out-of-pocket costs for most care at Kaiser Permanente facilities.

Veronica Lopez, right, of Community HealthWorks in Sacramento, talks to Erandy Cruz, middle, and Eduardo Chavez, right, about Kaiser Permanente’s new Community Health Care Program.

Community HealthWorks, a community-based nonprofit, is one of several nonprofits and county government agencies helping people complete applications for the Kaiser Permanente Community Health Care Program. People interested in applying for the coverage also can go to the Community Health Care Program web site, download the forms and email them to Kaiser Permanente.

“This is a great program, and it’s very generous,” said Griselda Zamora, director of Community Health at Community HealthWorks. “It’s really good for clients like Erandy and Eduardo who work full time, but they make too much for Medi-Cal. They can’t get employer insurance and they can’t go to Covered California.”

The program rolled out in a pilot phase last fall and the application period has closed. But it will reopen again in November. For now, however, the plan is open for people who have experienced a qualifying event such as a loss of health coverage, becoming a parent, and other exceptions.

Applicants can also request program information or get help with questions by calling Kaiser Permanente at 1-800-464-4000 (TTY 711) 24 hours a day, 7 days a week (closed major holidays).

“We are excited to provide quality health insurance to people who would not otherwise have coverage,” said Yvette Radford, vice president, External and Community Affairs, Kaiser Permanente Northern California. “Without health insurance, people don’t have timely access to preventive screenings or health care in an emergency. That kind of coverage is critical to the well-being of our communities.”

Chavez and Cruz will make good use of their new health care plan. Chavez plans to get his hernia taken care of and Cruz is ready to start regular women’s health appointments. The kids also need to get their well child checkups.

“We never thought we’d have any insurance before we found this,” Cruz said



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