2020 Health Benefits Open Enrollment Open Enrollment Period August - - PowerPoint PPT Presentation

2020 Health Benefits Open Enrollment

Open Enrollment Period August 14, 2020 to September 14, 2020 Plan Year October 1, 2020- September 30, 2021

Agenda

• Open Enrollment, Eligibility, Benefit Offerings and Costs
• Medical Plans
• Dental Plan
• Vision Plan
• Employee Assistance Program
• Life and AD&D Insurance
• Long-Term Disability Insurance
• Section 125 Flexible Spending Accounts
• Dependent Verification Review

Open E en Enrollmen ent, Eligib ibili lity, B , Benefit fit Offerings ngs & & Costs

What is Ben Benef efits Open pen Enrollm llment?

It’s the one time each year you can make changes to the following health benefits:

• Medical plan selection
• Dependent enrollment changes without a qualified event
• Section 125 Flexible spending accounts (IRS requires new elections each

year)

• Voluntary long-term disability plan participation

All open enrollment information, forms and resources can be found at www.scccd.edu/openenrollment Remem ember er - ch changes m made d durin ring t the o

• pe

pen enroll llment pe peri riod w will be ill beco come effective O October 1, 1, 2020. 2020.

Emplo loyee E Elig igibilit lity

All regular, full-time management, confidential, classified, and faculty employees, as well as their eligible dependents.

Eligibility guidelines can be found in the bargaining unit agreements or Board Policy/Administrative Regulations.

Dependent E Elig igib ibili lity ty

Elig ligib ible depe pendents in inclu lude:

• Legally married spouse
• Registered Domestic Partner
• Child(ren)* – A “child” includes a natural biological child, adopted child, step-child, a child you

have legal guardianship over (such as foster child) and a child for whom coverage is required due to a medical support order.

*Dependent children are eligible to continue on the health plans up until the age of 26.

Elig ligib ible d depe pendents do not in inclu lude:

• a spouse (and stepchildren) following legal separation or a final decree of dissolution of

marriage or divorce;

• any person who is on active duty in a military service, to the extent permitted by law.

It is is the emplo loyee’s r respo ponsibi bility t to notif ify the Dis District Human R Resources O Offic ice – benefi efits s staff ff and m make c changes t to t the h healt lth in insurance pla plans wit within in 3 30-days f from t the q quali lifying e event date.

Depende dent E Eligi gibilit lity S Suppo porting ing Do Docum ument ents

To enroll your eligible dependent(s), the following documentation must accompany the enrollment form.

Dependent Type Official Document SSN Verification Spouse Certified copy of the marriage certificate Copy of the Social Security Card Registered Domestic Partner Copy of Declaration of Domestic Partnership with the California Secretary of State Copy of the Social Security Card Biological Child(ren) Certified copy of the birth certificate naming employee as child’s biological parent Copy of the Social Security Card Step-Child(ren) Certified copy of the birth certificate(s) naming current legally, married spouse as the child’s biological parent. Applicable spouse documentation required as well. Copy of the Social Security Card Foster Child, Legal Guardianship or Adopted Child Certified copy of the birth certificate(s), along with legal court documentation showing adoption, legal responsibility and/or guardianship of the child(ren). Copy of the Social Security Card

Mid-year changes

(outside of Open Enrollment)

If you have a qualifying life event during the plan year and you wish to make a change to your health insurance plans, you must take action within 30-days from the qualifying event date.

Examples of qualifying life events: Examples of qualifying life events:

• Marriage
• Divorce
• Birth of a child
• Adoption of a child
• Eligible dependent loses their health care coverage (not currently enrolled on your plans)

You will be required to submit: You will be required to submit:

• Health Insurance Plan Change Enrollment Form
• Supporting documentation (marriage certificate, birth certificate, court order, final

judgment for divorce)

Dependent Eligibility Review Reminder

• The District, as part of the EdCare Group, conducts a dependent

eligibility review every three (3) years.

• The next review will take place in 2022.
• A Dependent Eligibility Review allows the EdCare group make sure

the health benefit plans are compliant with state law, are competitive, and cost effective for our members (you).

• The review also helps the EdCare Group manage overall plan costs

which benefits all members.

Hea Health Insurance Ben Benef efit Offerin ings

The District is part of a joint powers authority (JPA) known as EdCare. All

• f the health insurance plan offerings are self-funded, except for the

Kaiser HMO plans. Our insurance broker is Barthuli & Associates. Our broker team assists the District with the health plans and is available to assist members with general questions, claims, etc. Phone: (559) 385-7510 Website: http://www.edcaregroup.com/

Hea Health Insurance Ben Benef efit Offerin ings

• Four (4) Medical Plan Options
• Modern Care PPO
• Bronze PPO
• Kaiser HMO High Plan
• Kaiser DHMO Low Plan
• PPO Dental Plan
• Vision Plan
• Employee Assistance Program (EAP)
• Group Life & AD&D Insurance
• Voluntary Long-Term Disability Insurance
• Voluntary benefits (such as AFLAC & American Fidelity)

2020 2020-2021 2021 H Health P Plan C Cost

• sts
• The District pays the premiums in full for dental, life, vision and EAP insurances.
• There is no additional cost to add dependents to your medical, dental, vision, life

and EAP plans. Medica cal I l Insurance ce Pla lans for for C CSEA, SCFT a and nd Mana nagement & & Con

• nfident

ntial

All voluntary products are paid for by the employee. Plan Monthly Employee Payroll Deduction Bronze PPO Medical Insurance Plan $194 Modern Care PPO Medical Insurance Plan $381 Kaiser Low DHMO Medical Insurance Plan $0 Kaiser High HMO Medical Insurance Plan $619.54

2020 2020-2021 2021 H Health P Plan C Cost

• sts
• The District pays the premiums in full for dental, life, vision and EAP insurances.
• There is no additional cost to add dependents to your medical, dental, vision, life

and EAP plans. Medica cal I l Insurance ce Pla lans for for POA OA

All voluntary products are paid for by the employee.

Plan Monthly Employee Payroll Deduction Bronze PPO Medical Insurance Plan $158 Modern Care PPO Medical Insurance Plan $345 Kaiser Low DHMO Medical Insurance Plan $0 Kaiser High HMO Medical Insurance Plan $583.54

Medi dical P Plans ns

Ka Kaiser H r HMO P Plans Ben Benefit Sum ummary

BENEFITS HIGH HMO LOW DHMO

Lifetime Maximum None None Annual Copay Maximum $1,500 One-party $3,000 Two or more members $4,000 One-party $8,000 Two or more members Calendar Year Deductible None *$2,000 One-party/$4,000 Two or more Coinsurance Paid in full except copayments as indicated *20% after deductible Office Visit $25 copay/visit $20 copay/visit Chiropractic Not Covered Not Covered Well Baby Care No Charge No Charge Physical Exams No Charge No Charge Hospital Inpatient Benefits $500 per admit *20% after deductible Hospital Outpatient Surgery $100 copay per procedure *20% after deductible Emergency Room $100 copay per visit (waived if admitted) *20% after deductible Urgent Care $25 copay/visit $20 copay/visit

Ka Kaiser H r HMO P Plans Ben Benefit Sum ummary - Cont ntinued ued

BENEFITS HIGH HMO LOW DHMO

Skilled Nursing Facility Paid in full. Limited to 100 days per benefit period. *20% after deductible Home Health Care Paid in full. Limited to 100 days per calendar year. Paid in full. Limited to 100 days per calendar year. Local Ground or Air Ambulance $100 copay *$150 copay after deductible Surgeon & Surgeon Assistant Paid in full Paid in full Anesthesiologist Paid in full Paid in full Physician Consultations Paid in full Paid in full Radiation Therapy Paid in full Paid in full Physician Hospital & Skilled Nursing Facility Visits Paid in full Paid in full Diagnostic Lab and X-Ray $10 *$10 after deductible

Ka Kaiser H r HMO P Plans Ben Benefit Sum ummary - Cont ntinued ued

BENEFITS HIGH HMO LOW DHMO

Durable Medical Equipment Paid in full 20% Maternity No charge and $500 copay/admit hospital services No charge and *20% after deductible for hospital services Mental/Nervous Outpatient $25 copay/visit $20 copay/visit Mental/Nervous Inpatient $500 per admit *20% after deductible Alcoholism and Substance Abuse – Outpatient $25 copay/visit. No limits. $20 copay/visit. No limits. Alcoholism and Substance Abuse – Inpatient Detox: $500 per admit *20% after deductible Prescription Drugs (oral contraceptives are covered) Retail: $10 Generic, $30 Brand Name. Up to 30-day supply. MAIL ORDER: $20 Generic, $60 Brand. Up to 100-day supply. SPECIALTY DRUGS: 20% not to exceed $150. 30-day supply. Retail: $10 Generic, $30 Brand Name. Up to 30- day supply. MAIL ORDER: $20 Generic, $60 Brand. Up to 100- day supply. SPECIALTY DRUGS: 20% not to exceed $150. 30- day supply.

Mode

• dern C

Care P PPO B Benef efit Summa mary

BENEFITS IN-NETWORK OUT-OF-NETWORK

Lifetime Maximum Unlimited for Essential Health Care Calendar Year Deductible

*Subject to deductible

Individual - $400 Family -$1200 (3 member max) Individual - $5,000 Coinsurance 10% 50% Medical Annual Out-of-Pocket Maximum Individual- $3,000 Family- $9,000 (Includes deductible, copays and coinsurance) Individual- $10,000 Family – No Max (does not include deductible, copays and coinsurance) Prescription Drug Out-of-Pocket Maximum Individual - $3,000 Family - $7,500 N/A Office Visit $30 general/$60 specialist copay/visit 50% coinsurance

*Subject to deductible

LiveHealth Online - Telemedicine $0 copay N/A Chiropractic $30 copay/visit, then 10% up to $500 calendar year maximum *Subject to

deductible

Up to a maximum $15 reimbursement, after

• deductible. $500 calendar year maximum.

*Subject to deductible

Well Baby Care Paid in Full 50% coinsurance

*Subject to deductible

Physical Exams Paid in Full Not covered Hospital Inpatient Benefits $250 per day copay (max $750) per admission; 10% coinsurance

*Subject to deductible

$250 per day copay (max $750) per admission; 50% coinsurance.

*Subject to deductible

Modern rn C Care PPO PPO Be Benefi fit Sum ummary

• cont

ntinued nued

BENEFITS IN-NETWORK OUT-OF-NETWORK

Hospital Outpatient Surgery Note: Ambulatory is applicable for same-day and overnight $150 copay at ambulatory surgical center; $200 copay at a facility (hospital); 10% coinsurance

*Subject to deductible

$150 copay at ambulatory surgical center; $200 copay at facility (hospital); 50% coinsurance $750 copay for Summit Surgical

*Subject to deductible

Emergency Room $300 copay/visit (waived if admitted); 10% coinsurance

*Subject to deductible

$250 copay/visit (waived if admitted); 50%coinsurance

*Subject to deductible

Urgent Care $50 copay/visit, 10% coinsurance

*Subject to deductible

$50 copay/visit. 50% coinsurance

*Subject to deductible

Skilled Nursing Facility 10% coinsurance for semi-private

• room. Limits.

*Subject to deductible

50% coinsurance for semi-private

• rooms. Limits.

*Subject to deductible

Home Health Care 10% coinsurance. Limits.

*Subject to deductible

50% coinsurance. Limits.

*Subject to deductible

Modern rn C Care PPO PPO Be Benefi fit Sum ummary

• cont

ntinued nued

BENEFITS IN-NETWORK OUT-OF-NETWORK

Local Ground or Air Ambulance 10% coinsurance

*Subject to deductible

$150 copay/occurrence 50% coinsurance. Limits, unless true emergency then paid as in- network benefits.

*Subject to deductible

Surgeon & Assistant Surgeon 10% coinsurance

*Subject to deductible

50% coinsurance

*Subject to deductible

Anesthesiologist 10% coinsurance

*Subject to deductible

50% coinsurance

*Subject to deductible

Inpatient Physician Consultations 10% coinsurance

*Subject to deductible

50% coinsurance

*Subject to deductible

Radiation Therapy 10% coinsurance

*Subject to deductible

50% coinsurance

*Subject to deductible

Physician Hospital & Skilled Nursing Facility Visits 10% coinsurance

*Subject to deductible

50% coinsurance

*Subject to deductible

Diagnostic Lab and X-Ray $30 copay or $75 for complex 10% coinsurance

*Subject to deductible

$30 copay or $75 for complex 50% coinsurance

*Subject to deductible

Modern rn C Care PPO PPO Be Benefi fit Sum ummary

• cont

ntinued nued

BENEFITS IN-NETWORK OUT-OF-NETWORK

Durable Medical Equipment 10% coinsurance, orthotic devices not covered.

**Subject to deductible

50% coinsurance, orthotic devices not covered.

*Subject to deductible

Maternity (Employee and Spouse) Covered as any other illness

*Subject to deductible

Covered as any other illness *Subject to

deductible

Mental/Nervous Outpatient $30 copay/visit 50% coinsurance

*Subject to deductible

Mental/Nervous Inpatient $250 copay per day (max $750) 10% coinsurance

*Subject to deductible

$250 copay per day (max $750) 50% coinsurance

*Subject to deductible

Alcoholism and Substance Abuse Outpatient $30 copay/visit 50% coinsurance

*Subject to deductible

Alcoholism and Substance Abuse Inpatient $250 copay per day (max $750) 10% coinsurance

*Subject to deductible

$250 copay per day (max $750) 50% coinsurance.

*Subject to deductible

Prescription Drugs

Note: A) Generic and Preferred Brand Drugs are listed

• n the Basic Plus Formulary

B) Mandatory Generic REQUIRED. Only copayments apply to out-of-pocket max. Patient responsible for the cost difference between generic and brand when generic is available. C) ADHD coverage for children up to age 18. Limitations apply.

Retail Copay: $10 Generic, $45 Preferred Brand, $80 Non-Preferred Brand (34-day supply) Mail Order Copay: $20 Generic, $90 Preferred Brand, $160 Non-Preferred Brand (90-day supply) Specialty Drug Copay: $250 Retail Coverage is limited for drugs purchased

• utside of the drug card program. A

covered person must submit a copy of the paid drug receipt, along with a photocopy of his/her prescription ID card, to the drug card vendor. He/She will be reimbursed the contract price of the drugs, less the copay requirement and other appropriate charges.

Br Bronze PP e PPO Ben Benefit Summa mmary

BENEFITS IN-NETWORK OUT-OF-NETWORK

Lifetime Maximum Unlimited for Essential Health Care Calendar Year Deductible

*Subject to Deductible

Individual - $5,000 (2 member max) Not Covered Coinsurance 30% Not Covered Medical and Prescription Annual Out-of- Pocket Maximum (Family max is $13,700

but please review SPD for more information)

Individual- $6,850 (includes deductible, copays, and coinsurance) (2 member max) Not Covered Office Visit $60 copay/visit Not Covered LiveHealth Online (Telemedicine) $0 copay N/A Chiropractic $60 copay/visit, then 30% ; up to $500 calendar year maximum

*Subject to Deductible

Not Covered Well Baby Care Paid in Full Not Covered Physical Exams Paid in Full Not Covered Hospital Inpatient Benefits 30% coinsurance

*Subject to Deductible

Not Covered Hospital Outpatient Surgery 30% coinsurance

*Subject to Deductible

Not Covered Emergency Room $300 copay/visit (waived if admitted). 30% coinsurance

*Subject to Deductible

$150 copay/visit 30% coinsurance

Br Bronze PP e PPO Ben Benefit Sum ummary - Cont ntinued ued

BENEFITS IN-NETWORK OUT-OF-NETWORK

Urgent Care 30% coinsurance

*Subject to Deductible

Not Covered Skilled Nursing Facility 30% coinsurance for semi-private

• room. Limit.

*Subject to Deductible

Not Covered Home Health Care 30% coinsurance. Limits.

*Subject to Deductible

Not Covered Local Ground or Air Ambulance 30% coinsurance

*Subject to Deductible

Not Covered (unless a true emergency) Surgeon & Assistant Surgeon 30% coinsurance

*Subject to Deductible

Not Covered Anesthesiologist 30% coinsurance

*Subject to Deductible

Not Covered Inpatient Physician Consultations 30% coinsurance

*Subject to Deductible

Not Covered Radiation Therapy 30% coinsurance

*Subject to Deductible

Not Covered Physician Hospital & Skilled Nursing Facility Visits 30% coinsurance

*Subject to Deductible

Not Covered Diagnostic Lab and X-Ray 30% coinsurance

*Subject to Deductible

Not Covered

Br Bronze PP e PPO Ben Benefit Sum ummary - Cont ntinued ued

BENEFITS IN-NETWORK OUT-OF-NETWORK

Durable Medical Equipment 30% coinsurance, orthotic devices not covered.

*SUBJECT TO DEDUCTIBLE

Not Covered Maternity (Employee and Spouse) Covered as any other illness

*SUBJECT TO DEDUCTIBLE

Not Covered Mental/Nervous Outpatient $60 copay/visit Not Covered Mental/Nervous Inpatient 30% coinsurance

*SUBJECT TO DEDUCTIBLE

Not Covered Alcoholism and Substance Abuse Outpatient $60 copay/visit Not Covered Alcoholism and Substance Abuse Inpatient 30% coinsurance

*SUBJECT TO DEDUCTIBLE

Not Covered Prescription Drugs

Note: A) Generic and Preferred Brand Drugs are listed on the Basic Plus Formulary. B) Mandatory Generic REQUIRED. Only copayments apply to out-of-pocket max. Patient responsible for the cost difference between generic and brand when generic is available. C) ADHD coverage for children up to age 18. Limitations apply.

Retail Copay: $10 Generic, $45 Preferred Brand, $80 Non-Preferred Brand (34-day supply) Mail Order Copay: $20 Generic, $90 Preferred Brand, $160 Non-Preferred Brand (90-day supply) Specialty Drug Copay: $250 Retail Coverage is limited for drugs purchased

• utside of the drug card program. A covered

person must submit a copy of the paid drug receipt, along with a photocopy of his/her prescription ID card, to the drug card

• vendor. He/She will be reimbursed the

contract price of the drugs, less the copay requirement and other appropriate charges.

Kaiser HMO/DHM DHMO O Medi dical P Plans ns

Kaise aiser r High H HMO & MO & Kaise aiser r Low DHMO M MO Medica cal P Plan lans s

The District will continue to offer the same two Kaiser medical plans with the same benefits and reduced employee premium rates.

• Part of the Kaiser Northern region.
• Members on the low plan are encouraged to use the Kaiser Fee Schedule to

estimate out of pocket cost.

• All monies paid towards the out of pocket maximum for both plans, or

deductible for the Kaiser Low plan, will carry forward through December 31,

• 2020. If you switch Kaiser plans, all out of pocket costs start over.
• Current Kaiser members may continue to use same ID card.
• If you newly enroll (change to) Kaiser this plan year, you will receive a new ID

card.

Kaiser er M Member er S Servi vices es

• Telemedicine services by email, phone and video visits.
• Non-urgent email to your doctor.
• MyHealth Manager
• Refill prescriptions.
• Make appointments.
• View lab results.
• Wellness coaching
• Educational classes
• Support Programs

Moder ern n Care a and d Br Bronze PPO PPO Medi dical P Plans ns

Mo Modern Care a and Br Bronze PPO O Medi dical al P Plans s

The District will continue to offer the Modern Care PPO and Bronze PPO medical plans.

• The medical provider network continues to be Anthem Blue Cross – California and Out-of-

State.

• In-network providers can be found throughout the nation.
• The Modern Care PPO Plan continues to provide in-network and out-of-network benefits.
• The Modern Care PPO Plan continues to be a 90/10 coinsurance plan.
• The Bronze PPO Plan continues to be a 70/30 coinsurance plan.
• LiveHealth Online continues to be available with a $0 copay for members.

Pr Pres escription Dru rug Ben Benef efits fo for r Bo Both PPO PPO Pl Plans

All benefits will remain the same

Maint nten enanc nce e Pres escription

• n D

Drug M Mail Or Order R Requireme ment f for P r PPO Me Membe mbers

Mail order remains required for maintenance prescription drugs after two fills at the retail pharmacy. There are two options for mail order, BK Pharmacy and Walgreens. BK Ph Pharmac acy

• Local pharmacy storefront.
• Members may pick up maintenance prescriptions at the local BK Pharmacy, located at

6741 N. Willow #106, Fresno, CA 93710.

• Members can request BK Pharmacy mail your prescription(s) to your home or courier (in

the Fresno/Clovis area) to your home or office at no additional charge. Walgreen eens

• Walgreens is an option for mail order.
• Members may transfer a maintenance prescription to a Walgreens Pharmacy by having

the prescribing physician’s office telephone the new prescription in or by delivering a new written prescription to Walgreens.

PPO PPO Pl Plan Ven endors

The medic ical p l provid ider n netwo work i is A Anthem Blue C Cross – Californ rnia a and nd Out Out-of

• f-St

State.

Del elta Hea Health Systems Administrator for all medical claims. Questions in regards to claims/provider billing should be directed to Delta Health Systems. Members can access Explanation of Benefits (EOB’s), claim status, claim data, and print a temporary ID card on the member portal. Mental H al Healt alth & Substan ance ce A Abuse S Service ices/Benefits Administered by Halcyon Behavioral. Halcyon Behavioral has its own network of

• providers. To find a provider for in-network benefits, call Halcyon at (888) 425-

4800. Chir iropract actic S Service ices/Benefit its Administered by PhysMetrics. PhysMetrics has its own network of providers.

• Providers. To find a provider for in-network benefits, call PhysMetrics at (877)

519-8839.

PPO PPO Pl Plan Ven endors

Speech Therap apy, O Occu cupat ational T al Therap apy & Physical T cal Therap apy S Services/Benefit its Administered by PhysMetrics. PhysMetrics has its own network of providers. To find a provider for in-network benefits, call PhysMetrics at (877) 519-8839. Prescr crip iptio ion Drug B Benefit its with I Integrat ated d Prescr crip iptio ion M Man anage agement ( (IPM) Administered by Integrated Prescription Management (IPM). For any questions regarding prescriptions, call IPM at (877) 860-8846.

ID Cards ds f for

• r P

PPO M Memb ember ers

• If you are currently enrolled on the Modern Care PPO plan, and will remain on

the Modern Care PPO plan for the upcoming plan year, you may continue to use the same medical ID card.

• If you are currently enrolled on the Bronze PPO plan, and will remain on the

Bronze PPO plan for the upcoming plan year, you may continue to use the same ID card.

• For employees who newly enroll (change plans) into a PPO plan effective

October 1, 2020, you will receive new medical ID cards in the mail on/around October 1, 2020.

• Please note, medical ID cards are issued in the employee’s name only.

Baby C by Conn nnect ct P Program ram

• For expecting employees and spouses enrolled on the Modern Care PPO plan
• r Bronze PPO plan to ensure of a healthy pregnancy.
• Provides friendly and professional support from a Maternity Specialist/Health

Coach for expecting mothers from the first trimester through post-partum.

• No c
• cos
• st to participate in the program and is 100% confidential.
• Registered members are required to interact with the Health Coach via

telephone or email every two weeks while enrolled in the program.

• Members are encouraged to register during the first trimester to be eligible for

incentives; however, members can register at any time during the pregnancy.

LiveHeal alth O h Online ine f for A All PPO Memb ember ers

Provide ided a at no c no cost ($0 c copay ay) t to m members e enrolle lled o d on a a PPO medi dical p cal plan ans.

• Visit with a board certified medical physician via your smartphone, tablet, or computer.
• Get expert advice, a treatment plan and prescriptions, if needed.
• Use for minor conditions such as the flu, minor rashes, tooth pain, pink eye, allergies, cold &

fever, sore throat, skin infections, headaches, diarrhea, etc.

• Some examples of when to use:
• When your doctor’s office is unable to get you in.
• When you are sick in the middle of the night and the doctor’s office and/or urgent care are

closed.

• When you are not sure if your condition requires a visit to an Urgent Care or the

Emergency Room.

• Modern Care members – Urgent care copay is $50, then 10% coinsurance. ER copay is $300, plus the

10% coinsurance (copay waived if admitted).

• Bronze members – Urgent care copay is 30% coinsurance. ER copay is $300, plus the 30% coinsurance

(copay waived if admitted).

Rem emin inder a abou

• ut t

t the C e Coor

• rdinati

tion

• n o
• f

Ben enefi fits F For

• rm f

for

• r PPO Members
• The Coordination of Benefits (COB) form is a common request to determine

if you, or your dependents, have other health insurance coverage. This is used to determine the order of how benefits are paid (primary insurer and secondary insurer).

• The COB form must be filled out and sent back to Delta Health Systems

timely in order to avoid claim delays.

• If a claim is delayed (on-hold pending the COB), your provider is not being

paid.

• You can find all your claims in the Delta Health Systems member portal.
• For all claim questions and assistance, contact Delta Health Systems at

(800) 433-2566.

Den Dental I Ins nsur uranc nce

Den ental I Insura rance Pl e Plan

New ew Effec ective Oc October 1 1, , 2020 : : Compo posites w will n now be be cover ered on all t teet eeth Ameritas remains the PPO dental network with the same rich benefits. You may continue to use the same ID card(s).

Service ices Benefi efit Prev even entive e Service ices Exams, cleanings, x-rays, space maintainers – incentive level 70%, 80%, 90%,100% Deduct ctib ible le None Basic S c Service ices Fillings, oral surgery, periodontics, endodontics, crowns – incentive level 70%, 80%, 90%, 100% Majo jor S Service ices Bridges, dentures, prosthodontic appliances and mouth guards – 50% Annu nnual Maxim imum $1,750 in-network/$1,500 out–of-network per calendar year Accid cidental I l Inju jury Max ax $1,000 per calendar year for conditions caused directly by external, violent and accidental means Orth thodo donti tia 50% up to $1,250 (lifetime benefit) Pre re- determina nation of n of Benefi efits When en a a course o e of dental t trea eatmen ent i is expec ected ed t to exceed eed $ $300, p pred edet eter ermination o

• f ben

enef efits i is recommen ended ed.

Vi Vision I

• n Insuranc

nce

Vision I Insura rance Pl e Plan

VSP remains the vision network with the same benefits. There are no ID cards. Co Copay $10 for examinations and prescription glasses Exams ms Once every 12 months. Con

• ntact L

Lense ses (in lieu of glasses) Once every 12 months. $130 allowance for contact lenses. Fitting and evaluation not included in allowance. May pay up to $60 for fitting/evaluation. Lense ses f s for G Glasse asses ( s (per pa pair) One pair every 12 months. Single vision, lined bifocal and lined trifocal lenses covered 100%. Various co-pays apply to lens enhancements. Frames es One pair every 24 months. Participating provider allowance of $170. Pr Primary E Eyecare Treatment and diagnosis of eye conditions like pink eye, vision loss and monitoring of cataracts, glaucoma and diabetic retinopathy. Limitations and coordination with medical coverage may apply. Ask your VSP doctor for details. $20 co-pay.

Employee ee Assistan ance Program

Em Employee A Assi sist stanc ance Progr gram am (EAP) AP)

• Halcyon Behavioral continues to be the administrator for the employee assistance

program.

• Available to eligible employees and anyo

yone ne within the eligible employee’s household.

• Each person is allowed three (3) f

free sessio ions i in a six m month period, p per i issue.

• Confidential, professional referrals and face-to-face counseling for a wide array of personal

and work-related concerns.

• Services offered include counseling, web based services, legal assist, financial assist, family

assist. Halcyon E EAP c cus ustomer s r service for r be benefit o

• r claims q

que uestions i is 8 888-42 425-4800. 4800.

Life a and A d AD& D&D Insurance

Life & AD&D &D Insu suran rance

• The District provides Group Term Basic Life Insurance and AD&D insurance for

benefit eligible employees.

• Administered by VOYA Financial.
• Provides $50,000 of basic life and AD&D insurance. Management and

Confidential Employees also receive an additional employer-paid age-based benefit.

• $5,000 of life insurance coverage for enrolled dependent(s) on the medical

plan.

• Beneficiary updates can be submitted to the District Human Resources

Office any time throughout the year.

Long ng-Term Di Disabi bility ( (LTD) D) Insurance P Plan

Volunt untar ary Long T Term D Disabi bilit lity Insur uranc ance

• Employees hired on or after 9/1/13 may purchase at cost a voluntary long-term disability

insurance plan.

• Administered by VOYA Financial.
• Employees who wish to apply during open enrollment will need to go through an Evidence
• f Insurability (EOI) Questionnaire subject to approval.

Benefi efit Monthly disability benefit of 60%, up to a maximum $5,000, of eligible income in accordance to the Long-Term Disability Summary Plan Document. Premi emium Ra Rate The voluntary long-term disability premium rate is based on your age and your salary at the start of the current policy year (October 1st). Contributions are deducted on a post-tax basis.

Section 125 125 Flexibl ble S e Spend ending ng Accoun

• unts

Section 125 Flexible Spending Account Plans

Sec Secti tion 125 125 en enrollmen ent p per eriod: August 19, 2020 through September 11, 2020 Sec Secti tion 125 125 plan y yea ear: October 1, 2020 through September 30, 2021 Make your a r appo ppointment by by calling (559) 230-2107 ext 0

• Section 125 Flexible Spending Accounts (FSA) are governed by the IRS and allow eligible employees to set

aside money from your paycheck each month, on a pre-tax basis, to use for qualified medical expenses and dependent day care expenses.

• Dependent Care Account allows you to contribute pre-tax dollars to qualified dependent day care expenses.

The maximum amount you may contribute each year is $5,000 (or $2,500 if married and filing separately).

• Healthcare Flexible Spending Account allows you to set an amount of pre-tax dollars each year into a HFSA

account for medical expenses (medical, dental and vision). Then throughout the year as you use services you reimburse yourself by filing a claim. The current maximum amount you may contribute is $2,750.

• Use It or Lose It Rule - Under IRS regulations, if you do not use your full election amount during the plan year,

the remaining funds are forfeited.

Voluntary y Produc ducts

Voluntar ary P y Produc ucts

There are voluntary products available such as:

• Life Insurance
• Accident Insurance
• Short-Term Disability Insurance
• Critical Illness Insurance
• Cancer Insurance
• Section 125 Flexible Spending Accounts
• Tax Sheltered Annuities

For more information on the voluntary products, please contact the individual vendors. Contact information can be found on the open enrollment website.

Ques estions?

For questions, please feel free to contact the District Human Resources Office at benefits@scccd.edu or by calling (559) 243-7100

• r

the District’s health insurance broker, Barthuli & Associates at (559) 385-7510

THANK YOU!