Expecting and New Parents

For many expecting parents, welcoming a new child into the world is the first time they've heavily utilized their medical insurance.

Below are key benefit basics to ensure you understand how your medical coverage works:

• Your copay is the predetermined amount you pay for healthcare services at the time of care. You will continue to pay co-pays until you reach your Out-of-Pocket maximum. 
  • For example, if you're enrolled in the Blue Shield Tandem PPO plan, your routine Maternity Care visits will have a $35 copay for each appointment with an in-network provider. 
• The deductible is the fixed dollar amount you must pay every calendar year before insurance starts to cover a larger portion of your bills (also known as coinsurance). Preventative care is excluded, and is always 100% covered by Blue Shield, even when you haven't reached your deductible or Out-of-Pocket maximum. Copays do not count toward your annual deductible. 
  • For example, if you're enrolled in the Blue Shield Tandem PPO plan, your deductible is $1,250 for employee only coverage, and $2,500 for family coverage. The plan won't pay anything for most services until you've met your $1,250 deductible. Some of these additional fees that could count toward your deductible include  include Once you reach your deductible, co-insurance kicks in.
• Co-Insurance is the percentage of the costs of a covered health care service (usually a percentage of an eligible expense) you pay after you've met your annual deductible. You will pay a percentage of a covered service while your health insurance plan pays the remainder. Co-insurance may kick in with larger procedures such as a C-section at an in-network doctor or hospital, or for hospital stays for you and your baby. 
  • For example, if you're enrolled in the Blue Shield Tandem PPO plan and you've met your deductible, the plan pays 75%, your coinsurance share of the cost is 25%. You are billed for your coinsurance after your visit.
• Preventative care include screenings and other services that have no copay if you use an in-network provider. Preventative prenatal care, breast-feeding support, supplies and counseling are all considered prevantive care, and one breast pump will be covered per pregnancy.
• Keep costs down by ensuring you have in-network providers with your medical plan, as out-of-network providers usually require higher co-insurance payments, or may even offer little to no coverage depending on your plan election.

Our County medical plans include Wellmother basics and visits for a set copay, based on your medical plan enrollment. Visit our medical webpage for a Summary of Benefits and Coverage for all our County medical plans. 

The County offers pre-tax savings accounts for healthcare expenses, known as a Flexible Spending Account, and for out-of-pocket dependent care costs, such as daycare centers, in-home childcare, and before or after school care for your dependent children under age 13. Visit our Tax Spending Account webpage to learn more. 

Planning for parental leave can feel overwhelming, but we’re here to help you get started. Depending on your situation, you may be eligible for leave under the Family and Medical Leave Act (FMLA), the California Family Rights Act (CFRA), and/or Pregnancy Disability Leave (PDL).

To understand your options and next steps, please contact your Department HR representative or visit the County’s Leave of Absence webpage for detailed information and resources.

Coordinating your time off and understanding how you’ll be paid during a leave is an important part of planning ahead. Depending on your situation, you may be eligible to coordinate benefits such as California State Disability Insurance (CA SDI), VOYA Short-Term Disability Insurance, and/or PORAC benefits with your available paid time off options. To understand your options and next steps, please contact your Department HR representative or visit the County’s Leave of Absence webpage for detailed information and resources.

After the birth, adoption, or legal guardianship of your child, remember to add your child to your medical, dental, and vision insurance through the County’s benefits system! You have 31 days from the event date to make changes and upload the required documentation—such as the official birth certificate or adoption paperwork.

• It’s important to act promptly so your child is enrolled and covered; otherwise you may not be able to add them until the next open enrollment period.

• Visit our Benefits Enrollment and Qualifying Events webpage to get started and learn more about the process, and if you need help, please contact your Department HR representative.
• Benxcel.net single-sign-on is available here. 

The County has several Lactation locations throughout the County. Contact your Department HR representative for location information near you. The County's Lactation Policy can be found here. 

All County medical plans include Breat Pump benefits through your plan. 

• Under the Durable Medical Equipment (DME) benefit, a breast pump is covered at $0 cost when you use a participating provider in the plan network.

• Providers who are out-of-network will be at higher cost and coinsurance depending on your selected medical plan. Visit our webpage for Evidence of Coverage documents for your specific health plan. 

For assistance on determining breast pump costs, contact your Accolade health assistant online or by phone at  1-866-406-1275.

Finding childcare is an important step in planning your return to work, and the County offers helpful resources to support you. The CAPSLO Children Resource Connection can help you locate licensed childcare providers, determine eligibility for childcare payment assistance, and access a toy lending library. You also have acces to Anthem's Employee Assistance Program (EAP) which offers a Childcare Search Tool.  

CAPSLO Childcare Resource Connection 
CAPSLO Childcare Resource Connection 

Anthem Employee Assistance Program

EAP Search Tool, Company Code: PRISM

CAPSLO Childcare Resource Connection 

• Find childcare providers, qualify for childcare payment assistance and a toy lending library

CAPSLO Childcare Resource Connection 

Anthem Employee Assistance Program

Access EAP's Childcare Search Tool, Company Code: PRISM

Take me to the EAP Search Tool 

As you prepare to return to work after your leave, you’ll need to provide your department with a medical release from your health care provider indicating whether you’re able to return without restrictions or with accommodations, and work with your HR representative on next steps.

We also want to support your transition back into the workplace. If you plan to continue lactating, please ask your HR representative about available lactation location and accommodations for you can express milk comfortably and privately at work. Additionally, don’t forget about the childcare resources available to you, like the CAPSLO Childcare Resource Connection and the Anthem EAP Childcare Search Tool, to help you find care that fits your needs.