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Frequently Asked Questions

What is VEBA?

California Schools Voluntary Employee Beneficiary Association (VEBA) is a 501c(9) non-profit trust that delivers high quality, affordable and accessible health care for education, municipal and public agency employees. Formed in 1993 — through the combined efforts of school superintendents and representatives of both the California Teachers Association (CTA) and the California School Employees Association (CSEA) — VEBA currently serves more than 65 participating employers and over 150,000 Members, throughout Southern California.

How do I know if I have VEBA Direct?

Please see your employer benefit information to learn which one of the plan(s) and benefits options are available to you. 

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?

Sometimes you may have an unexpected problem. When this happens, your first step should be to call our VEBA Advocacy team at 888-276-0250 or VEBA Direct’s TPA (UnitedHealthCare) at 1-800-624-8822. We will assist you and attempt to find a solution to your situation

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?

If you feel that you were improperly billed for services that you received from an Out-of-Network provider, please call VEBA Direct’s TPA (UnitedHealthCare) at 1-800-624-8822.

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