Frequently Asked Questions
What is VEBA?
How do I know if I have VEBA Direct?
What is Evidence of Coverage (EOC)?
Your “Evidence of Coverage” (EOC) provides details about what the plan covers, how much you pay, how the plan works, and more. To view the EOC for VEBA Direct, click here.
Which medical groups are included in VEBA Direct?
- Childrens Health Plan of California / Rady Children’s Health Network
- Sharp Community Medical Group
- Sharp Community Medical Group – Chula Vista
- Sharp Community Medical Group – Coronado
- Sharp Community Medical Group – Grossmont
- Sharp Rees-Stealy Medical Group
- UCSD Medical Group Affiliates
- UCSD Medical Group
If a family member does not make a PCP selection during enrollment, VEBA Direct will chose the member’s PCP.
What do I do if I have a problem?
What if I need Emergency Health Care Services?
If you believe you are experiencing an emergency medical condition, call 911 or go directly to the nearest hospital emergency room for treatment. You do not need to get Prior Authorization if you reasonably believe Emergency Health Care Services are needed to seek treatment for an Emergency Medical Condition that could cause you harm.
You, or someone else on your behalf, must notify VEBA Direct’s TPA (UnitedHealthCare) or your PCP within 24 hours, or as soon as reasonably possible, following your receipt of Emergency Health Care Services so that your PCP can coordinate your care and schedule any necessary follow-up treatment. When you call, please be prepared to give the name and location of the Facility and a description of the Emergency Health Care Services that you received.
How do I get help with my Out-of-Network bill?
How do I file a grievance?
You or Your covered dependent may file an appeal or grievance with VEBA Direct to any Adverse Benefit Determination You or Your Covered Dependent receive notifying you that a claim has been denied. You may also file an appeal to address any grievance You or Your Covered Dependent have regarding access to, or services received from, VEBA Direct or any of its contracted medical or behavioral health service providers. Please review the Evidence of Coverage for more detailed information regarding this process.
First-Level Appeal or Grievance – You may call VEBA Direct’s TPA (UnitedHealthCare) customer service department at 1-800-624-8822 or at www.myuhc.com. A Customer Service representative will document your oral Grievance. You may also file a grievance using the Online Grievance form at www.myuhc.com or write to the Appeals Department at:
Appeals & Grievances UnitedHealthCare
P.O. Box 6107
Mail Stop CA124-0160
Cypress, CA 90630-9972
Second-Level Appeal or Grievance – If the grievance or appeal is denied at the first level, You or Your Covered Dependent have the right to file a written appeal of the denial within sixty (60) calendar days following receipt of the denial of the first level/step appeal. To do this, you must contact the VEBA Direct Office of the Ombudsperson by phone at 888.276.0250, email at [email protected], or write to:
California Schools VEBA
c/o Office of the Ombudsperson (VEBA Direct)
1843 Hotel Circle South, Suite 300
San Diego, California 92108