Health Insurance Issues

What to Do if You Have a Health Insurance Complaint For PERSCARE

1. Contact their claims processing center at (800) 444-2595. Have your Social Security number ready.

2. You have the right to ask to speak to a supervisor if you are not satisfied with the answer you receive.

3. If the supervisor is unable to help you, you may file an appeal with Blue Shield’s appeals board. Ask the supervisor to initiate an appeal on your claim.

PERS Health Benefits Hotline

If you are still not satisfied, contact PERS’ Health Benefits Hotline: (800) 352-2238. This is a phone bank staffed by experienced health benefits personnel. They can deal with your problem or refer you to the appropriate department for assistance. Lines are often busy so be persistent in calling.

HICAP for Retirees

Retirees are also eligible for help free of charge from HICAP (the Health Insurance Counseling and Advocacy Program). Offices are located in each county. Consult your local telephone directory for the office nearest you or call the California Department of Aging at (800) 434-0222 for a referral.

Other Health Insurance Problems

The Health Benefits Hotline, (800) 352-2238, can also help you with problems with other PERS-approved health plans. We recommend you contact your plan’s customer service representative first before calling PERS.

If you think your rights regarding health insurance coverage have been violated, contact the CASE Office at 1-800-699-6533.

Healthy and Safe Working Conditions

Your CASE union contract and the California Occupational Safety and Health Act (Cal/OSHA) contain a number of provisions designed to protect the right of workers to safe and healthful working conditions. Articles 7.13 & 7.14 of your union contract along with the Cal/OSHA law gives you the right to:

• A safe and healthy working environment.

• Receive training in general safe work practices and specific training with regard to hazards unique to any job assignment.

• Be given information the employer has — including the Material Safety Data Sheet (MSDS) — about potential health hazards of materials and chemicals a worker uses or may be exposed to.

• Refuse to perform work which would violate the labor code or a Cal/OSHA standard or order in which such violation would pose a real and apparent hazard to your health.

• See the employer’s log of Occupational Injuries and Illnesses, Cal/OSHA Form 200.

• Watch the employer monitor and measure harmful substances in the workplace that are subject to Cal/OSHA standards.

• Form joint union-management health-and-safety committees in your department and serve on state time.

• Protective clothing to protect your clothing from damage or stains.

• Safety equipment such as goggles, helmets, safety harnesses and turnout gear.

• Training on infectious diseases.

• Precautions against exposure to the AIDS virus — Department of Corrections.

• Request an inspection of the worksite by making a complaint about unsafe or unhealthy working conditions to Division of Occupational Safety & Health (DOSH). DOSH will keep the name of the person who makes a complaint confidential.

The Law

Cal/OSHA — The California Occupational Safety and Health Act (Cal/OSHA) was enacted in 1973 to ensure safe and healthy working conditions for California workers. The Department of Industrial Relations (DIR) administers the Cal/OSHA program. The Division of Occupational Safety and Health (DOSH) within DIR has the authority to enforce all laws, standards and orders protecting worker safety and health on the job. Cal/OSHA standards are contained in the California Administrative Code–Title 8, Industrial Relations.

Cal/OSHA covers virtually all workers in the state, including those employed by state and local governments. Cal/OSHA does not cover federal employees.

Take Action

If you have reason to believe your place of employment or your employer’s practices are unsafe or unhealthy, you may file a complaint with any office of the Division of Occupational Safety and Health or a grievance under the union contract Article 10, Health and Safety.

If you think your rights to a safe and healthy work environment have been violated, contact the CASE Office at 1-800-699-6533.

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