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I have CalPERS, which plan can I use to go to NorthBay?

For the calendar year of 2018 and 2019, great news, you have several choices. Western Health Advantage (WHA) offers all NorthBay Healthcare providers in their network. Additionally, with the CalPERS Care, Choice, and Select PPO plans, NorthBay Healthcare hospitals and physicians are preferred providers and in-network. For Retirees, United Healthcare (Medicare Advantage PPO plan) is accepted with NorthBay Healthcare.


Should you have further questions about this, please feel free to call us at (707) 646-3280.

Does NorthBay Healthcare accept Covered California?

There are many health plan options through Covered California, we accept the Western Health Advantage health plan.

I don’t qualify for Covered California, what plans do you have?

Everyone qualifies for Covered California (also known as ObamaCare), the question is whether you qualify for a government subsidy to cover all or some of the cost of the plan you chose. To get assistance enrolling in Covered California, we encourage you to contact either Solano Coalition for Better Health at 1-800-978-7547 or info@solanocoalition.org or a local health insurance broker.

How much is NorthBay Healthcare insurance?

NorthBay Healthcare is the provider of care, not the health insurance plan. The benefits will vary depending on the health insurance plan. Contact your health insurance company to learn how they cover out-of- area urgent and emergency care.

Does NorthBay accept Medicare?

Yes, NorthBay Healthcare, including both our hospitals, NorthBay Medical Center and NorthBay VacaValley Hospital, and our providers in the outpatient offices accept Medicare.

What should I look for in a health plan?

First, decide what is important to you about the care you currently receive. Some questions to ask yourself are:

  1. Do you have specific physicians you want to continue to see, or are you willing to change physicians?
  2. Do you prefer to pay a higher monthly premium and have minimal out-of-pocket expenses? Or ,would you rather have a lower monthly premium and pay more when you receive care?
  3. Do you prefer a HMO or PPO plan design?
  4. What is your approximate monthly budget for healthcare?

What is an HMO? 

HMO = Health Maintenance Organization. This kind of plan requires you to receive care from only providers within its network. You are typically not reimbursed for out-of-network care. You are also required to have a Primary Care Physician and you must receive a referral from that specific doctor in order to see a specialist.

What is a PPO?

PPO = Preferred Provider Organization. This type of plan covers care from a network of a wide variety of doctors and hospitals. If you decide to select a provider outside of this network, you may do so, but for a higher cost. You are also not required to have a Primary Care Physician, and consequently do not need a referral from one in order to see a specialist.

My son/daughter is away at college, are they covered with NorthBay?

NorthBay Healthcare is the provider of care, not the health insurance plan. The benefits will vary depending on the health insurance plan. Contact your health insurance company to learn how they cover out-of- area urgent and emergency care.

What is a Medicare Supplement Insurance (Medigap)?

Medicare has deductibles and coinsurance fees that you would have to pay if you only have Original Medicare. To help cover these costs, you may purchase a Medicare Supplement Insurance (Medigap) policy, sold by private companies, and they will help pay some of the health care costs that Original Medicare does not cover such as deductibles and coinsurance. Additionally, Medicare supplemental plan also offer coverage for services that Original Medicare doesn't cover, like coverage for medical care outside of the U.S. Please note that Medigap policies don't cover everything, for example they don't cover long-term care, vision or dental care, or hearing aids.

What Medicare Supplemental plans does NorthBay accept?

NorthBay Healthcare accepts all Medicare supplemental insurance plans, such as AARP, Mutual of Omaha, etc.

How do I choose which Medigap plan to purchase?

We recommend working with a health insurance broker that specializes in Medigap policies.

Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as "Medicare Supplement Insurance." Insurance companies can sell you only a "standardized" policy identified in most states by letters. All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs.

Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which ones they offer. Insurance companies that sell Medigap policies:

  • Don't have to offer every Medigap plan
  • Must offer Medigap Plan A if they offer any Medigap policy
  • Must also offer Plan C or Plan F if they offer any plan

My employer is changing plans, I must leave Kaiser which is the only plan I have ever had, my new plan is a PPO that covers a percentage of the medical care, how much will I have to pay for an office visit, maternity care, etc?  Where can I see a listing of prices?

This is one of those situations where we should talk, as there are many details we need to cover. Also, I want to help prepare you for the many differences between a classic HMO insurance plan and a PPO plan that gives you much more flexibility and options when receiving medical care. Let’s plan for at least a 30 minute conversation.

Some example questions are:

  • What plan are you changing to?
  • Is it a PPO with a Health Savings Account tied to it?
  • What are the plan benefits?
  • What is the maximum out of pocket?

If we are in-network with your PPO, NorthBay Healthcare and the health plan have contracted discounted rates and unfortunately those discounted rates are not publicized anywhere.

Additionally, should you be hospitalized, due to the possibility of complications it is very challenging to quote exact prices, but rather a range of pricing. I can explain how a PPO works, and how the maximum out-of-pocket limit helps a family plan for approximation of possible cost.

After we talk, I can help you select physicians to care for you and your family.

I'm a federal employee with Blue Cross/Blue Shield, is my insurance accepted at NorthBay?

First, we apologize for this complicated and confusing reply.  If your plan is a PPO - the short answer is maybe, it depends on which PPO plan you have. If you have the Basic plan, both NorthBay hospitals and NorthBay Medical Group are out of network. If you have the Standard plan, we can only say we are most likely "out-of-network".


To best answer that question, we need more information from your identification card. Please contact us at 707-646-3280 to further help you.

Still have questions?

If you still have questions about open enrollment, please feel free to contact our open enrollment specialist at AskKelly@NorthBay.org or directly by phone at (707) 646-3280.