activities · 24
what they do
direct service · 24
- Administer health benefits enrollment and eligibility Health Benefits Online Access PortalProvides secure online access for members to review eligibility and elect health benefits, ensuring streamlined administration of coverage options.
- Administer health benefits enrollment and eligibility Health Benefits Online Access PortalProvides secure online access for members to review eligibility and elect health benefits, ensuring streamlined management of coverage options.
- Cover pregnancy and pediatric careProvides coverage for pregnancy and pediatric care at no cost to members, ensuring access to essential services for maternal and child health.
- Cover preventive care and screenings at no costProvides preventive care services including immunizations, diagnostic tests (e.g., x-rays, bloodwork), pregnancy and pediatric care, and preventive medications at no cost to members.
- Deliver care through network and virtual services Telehealth Consultations & Virtual CareRequires use of in-network providers for coverage (with exceptions for emergencies and authorized referrals) and offers 24/7 access to a nurse advice line through Health Net, as well as virtual physical therapy through Hinge Health at no cost to members and covered dependents age 18+.
- Deliver comprehensive HMO health coverage Integrated Behavioral Health ServicesProvides comprehensive healthcare coverage through an HMO plan, including medical, hospital, mental/behavioral health, and substance use disorder benefits, with service availability in Southern California and Baja California within fifty miles of the California-Mexico border.
- Deliver dental, vision, and life insurance benefits Union and Association Health Benefits AdministrationOffers dental benefits through one of three dental plans, vision coverage for frames and lenses via Vision Service Plan (VSP), and automatic Life Insurance and Accidental Death & Dismemberment (AD&D) coverage to eligible individuals regardless of medical plan enrollment.
- Implement health benefit plan improvementsRegularly implements enhancements and changes to the health benefit plan to improve member access, affordability, and quality of care.
- Incentivize preventive health check-upsOffers financial incentives to members who complete annual physical exams, including a $250 check for members and their spouses/domestic partners and a $500 annual bonus under the MLK Care Medical Plan.
- Incentivize preventive health check-upsOffers financial incentives—$250 or $500 bonuses—to members and their spouses or domestic partners who complete an annual physical check-up, promoting engagement in preventive care.
- Manage prescription drug benefits Community Pharmacy ServicesProvides prescription drug coverage to eligible employees and dependents through Express Scripts, including a mail order pharmacy program that delivers 90-day supplies of maintenance medications to members' homes, with low copayments for generics and brand-name drugs at retail and via mail order.
- Offer dental and vision benefits Union and Association Health Benefits AdministrationOffers dental benefits through one of three dental plans and vision coverage for frames and lenses through Vision Service Plan (VSP) to all eligible employees and dependents.
- Offer prescription drug benefits through Express ScriptsProvides prescription drug coverage to eligible employees and dependents via Express Scripts, including a mail order pharmacy program that delivers 90-day supplies of maintenance medications to members' homes, with low copayments for generics and brand-name drugs at retail and through mail order.
- Offer virtual physical therapy Telehealth Consultations & Virtual CareProvides virtual physical therapy services at no cost to members and covered dependents age 18 and over through a partnership with Hinge Health.
- Operate medical and dental clinics in Los AngelesOperates a medical office and dental clinic in Los Angeles that provide affordable, high-quality healthcare services to members, with the dental office actively serving patients since July 28.
- Operate medical and dental clinics in Los AngelesRuns a medical office and a dental office in Los Angeles that provide affordable, high-quality health care and are actively serving patients, including over 10,000 members of Local 11 and their families.
- Provide care coordination and 24/7 health support Telehealth Consultations & Virtual CareOffers 24/7 access to a nurse advice line through Health Net for medical triage and screening, and delivers coordinated primary and specialty care, disease management, and screening and treatment for physical and mental health conditions, including award-winning diabetes care.
- Provide comprehensive HMO health coverage Integrated Behavioral Health ServicesOffers an HMO plan that includes medical, hospital, mental/behavioral health, and substance use disorder benefits, with coverage available in Southern California and Baja California within fifty miles of the California-Mexico border; requires use of in-network providers except for emergencies or authorized referrals.
- Provide life insurance and AD&D coverage Group Life and AD&D InsuranceProvides automatic Life Insurance and Accidental Death & Dismemberment (AD&D) coverage to eligible individuals, regardless of medical plan enrollment.
- Provide preventive and diagnostic care at no costOffers preventive care screenings, immunizations, diagnostic tests (e.g., x-rays, bloodwork), and preventive medications at no cost to members, supporting early detection and health maintenance.
- Provide primary, specialty, and disease management careDelivers primary and specialty care, disease management, preventive services, and screening and treatment for physical and mental health conditions, including award-winning diabetes care, to over 10,000 members of Local 11 and their families.
- Support mental and emotional well-being Behavioral Health & Substance Use Benefits AdministrationProvides a Member Assistance Program (MAP) from Carelon to support personal, family, and emotional challenges, and covers mental/behavioral health and substance use disorder services through its HMO plan.
- Support mental health and personal well-being Behavioral Health & Substance Use Benefits AdministrationProvides access to the Member Assistance Program (MAP) from Carelon to support members and dependents with personal, family, and emotional challenges, alongside comprehensive mental/behavioral health and substance use disorder benefits.
- Update and improve health benefit plansImplements ongoing improvements and changes to the health benefit plan for members to enhance coverage and service delivery.
strategies · 14
how they think
Theories of action extracted from this org's own source material. Click any to see the full field of orgs running the same approach.
- Digital Member Engagement and Benefits Management digital_patient_engagementEmpowers members through a secure online portal that supports benefits enrollment, eligibility management, appointment scheduling, communication with care teams, and access to health records and lab results.
- Digital member engagement and benefits management online_benefits_managementEmploys a secure online portal to manage member eligibility, benefits enrollment, appointment scheduling, communication with care teams, and access to health records, supporting administrative efficiency and patient engagement.
- HMO Model with Integrated Network hmo_modelUses a Health Maintenance Organization (HMO) model to deliver comprehensive healthcare coverage through a contracted, integrated network of providers, ensuring coordinated and affordable care.
- HMO-based integrated care delivery hmo_modelUses a Health Maintenance Organization (HMO) model to deliver comprehensive healthcare through a contracted, integrated network of providers, requiring members to use in-network care and designating primary care physicians to coordinate treatment and referrals.
- In-Network Care Requirement in_network_care_requirementRequires members to use in-network providers for non-emergency care to maintain coverage, supporting cost control and quality assurance within the approved provider network.
- Integrated Care Delivery Model integrated_care_modelDelivers holistic, comprehensive care by partnering with community health providers and offering co-located services such as primary care, mental health support, and virtual physical therapy through integrated care centers.
- Integrated behavioral and physical health support integrated_care_modelDelivers holistic care by integrating mental health services, member assistance programs, virtual physical therapy, and primary care through partnerships with community health providers and dedicated health centers.
- Member Assistance Program for Holistic Support member assistance programProvides free, confidential support for members facing personal, family, or mental health challenges, extending care beyond medical needs to promote overall well-being.
- Multi-Plan Medical Coverage Options multi-plan medical coverageOffers multiple medical plan options to union members and their families, enabling choice in coverage while maintaining access to quality care through a union-sponsored benefits structure.
- Multi-plan benefits structure with union sponsorship union-sponsored health benefitsProvides union members and their families with access to multiple medical plan options under a union-sponsored health benefits framework, enabling choice in coverage while maintaining comprehensive care standards.
- Pharmacy Benefits Management with Mail Order Incentive pharmacy_benefits_managementContracts with a national pharmacy benefits manager to administer prescription drug coverage and incentivizes the use of mail-order pharmacy for maintenance medications to improve convenience and reduce costs.
- Pharmacy benefits optimization pharmacy_benefits_managementContracts with a national pharmacy benefits manager and promotes mail-order pharmacy use for maintenance medications to improve convenience, medication adherence, and cost efficiency.
- Primary Care Gatekeeper and Coordination primary_care_gatekeeperRequires members to designate a primary care physician who acts as a gatekeeper, coordinating all medical care, managing referrals, and obtaining prior authorizations for specialty services to ensure appropriate and cost-effective utilization.
- Primary care gatekeeper and coordination model primary_care_gatekeeperRequires members to select a primary care physician who acts as a gatekeeper, coordinating all medical care, managing referrals to specialists, and obtaining prior authorizations to ensure appropriate and cost-effective use of services.
named programs · 8
what they call their work
Health Net HMO Plan
HMO medical plan offering coverage through Health Net’s Salud y Mas network in Southern California and SIMNSA network in Baja California, Mexico; includes $5 primary care copay and $150 ER copay
MLK Care Medical Plan
Comprehensive medical plan providing $0 cost-sharing for primary care, preventive services, diagnostics, hospital stays, mental health, and more through MLK Community Medical Group in South Los Angeles; includes $150 ER copay
Member Assistance Program (MAP)
Counseling and support services for mental health, substance use, and personal challenges
Mental Health and Substance Use Disorder Benefit
Coverage for outpatient and inpatient mental health and substance use treatment through Carelon; includes ABA therapy and telehealth visits
Physical Therapy Program
Virtual physical therapy through Hinge Health at no cost to members and covered dependents age 18+; includes personalized care plans and 1-on-1 support
Prescription Drug Benefit
Pharmacy benefit administered by Express Scripts with $3 generic and $6 brand name drug copays at network pharmacies; includes mail order and specialty drug programs
UNITE HERE Health Center
On-site medical and dental care facility in Los Angeles exclusively for MLK Care participants and eligible family members
Virtual Physical Therapy with Hinge Health
No-cost virtual physical therapy program for members and dependents age 18+ to treat joint and muscle pain through personalized exercise plans and telehealth support.
relationships · 20
who they work with
- Accredo Partner — Provides support for members prescribed specialty drugs with high copays, often resulting in $0 member cost.
- Carelon Partner — Provides a network of providers for mental health and substance use disorder treatment, including outpatient and inpatient services and ABA therapy.
- Carelon Partner — Provides mental health and substance use support through the Member Assistance Program (MAP).
- Express Scripts Partner — Contract pharmacy network for prescription benefits.
- Express Scripts Partner — Contracted pharmacy benefits manager that administers prescription drug benefits for the fund.
- Express Scripts Partner — Covers medications (generic, brand name, and specialty) under the Prescription Benefit.
- Express Scripts Partner — Pharmacy benefits partner that covers prescriptions through contracted pharmacies.
- Express Scripts Partner — Provides prescription drug coverage for all eligible employees and dependents.
- First Health Partner — Network used for urgent care services under the MLK Care Medical Plan.
- Health Net, Inc. Partner — Contracted provider of the HMO medical plan offering comprehensive healthcare coverage.
- Hinge Health Partner — Provides virtual physical therapy access to MLK Care Medical Plan members.
- Hinge Health Partner — Provides virtual physical therapy services at no cost to eligible members.
- Kaiser Foundation Health Plan Partner — Contracts with the organization to provide HMO medical coverage to members.
- MLK Community Medical Group Partner — Provides primary and specialty medical care to members of the MLK Care Medical Plan.
- Martin Luther King Community Healthcare Partner — Partnered to deliver care for the MLK Care Medical Plan.
- Martin Luther King, Jr. Community Hospital Partner — Provides emergency care and is the central facility for the MLK Care Medical Plan service area.
- Okta Partner — Partners with Okta to manage user authentication and account security.
- VSP Vision Care Partner — Provider of affordable vision benefits.
- VSP Vision Care Partner — Provides affordable vision benefits to members.
- Vision Service Plan (VSP) Partner — Provides vision coverage for frames and lenses.