Garden Grove Unified School District. Health and Welfare Benefits

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1 Garden Grove Unified School District Health and Welfare Benefits

2 Benefit Package As a benefited employee, you are entitled to a comprehensive benefits package including: Medical Dental Vision Life Insurance

3 Employee Contributions--Premium Taken directly from your paycheck tenthly Employee Only $50 Employee + I Dependent $100 Employee + 2 or More Dependents $150 Note: Sign both lines of your Election and Authorization form for tax exempt participation

4 Eligible Dependents Legally Married Spouse Marriage Certificate required Registered Domestic Partner Proof of state registration required Children Under Age 26 Birth Certificate required

5 Open Enrollment September The time to make changes Add / remove dependents (outside of a qualifying event) Change health or dental plans Deadlines: Insurance Department must receive all forms by: Medical/Dental/Vision September 30 th 2015 at 5:00 p.m. PayPro FSA September 23 rd 2015 at 5:00 p.m.

6 Qualifying Event Certain changes in your status allow you to change the dependents on your plan. New marriage / Domestic partnership New birth / Adoption Loss of other coverage in certain circumstances Divorce or Legal Separation requires you to remove your spouse / former spouse. All changes MUST be made within 30 days of the qualifying event

7 Medical Plans GGUSD Self-Insured PPO GGUSD Self-Insured EPO United Healthcare HMO

8 Preferred Provider Organization (PPO) Nationwide Network Office Visit Co-Pay $25 Emergency Room Co-Pay $100 Deductible $300 per person / Max $900 per family Out of Pocket Maximum ( to include Pharmacy Co-Pays) In-Network: Individual $2,500 / Family $7,500 *Non-Network: Individual $3,500 / Family $12,700 (Member always pays amount exceeding allowable rates.) Pharmacy Co-Pays $5, $10, $35 Participating Providers 20% co-insurance Non-Participating Providers 30% co-insurance Member must also pay fees exceeding allowable rates.

9 Exclusive Provider Organization (EPO) - California Only Office Visit Co-Pay $25 Emergency Room Co-Pay $100 Deductible $300 per person / Max $900 per family Out of Pocket Maximum ( to include Pharmacy Co-Pays) Individual: $2,500 / Family: $7,500 Pharmacy Co-Pays $5, $10, $ CHANGE Hospitals: Inpatient Services/Outpatient Surgery Co-insurance: Tier 1-0% / Tier 2-20% Must use ONLY Participating Network Providers Inpatient Services/Outpatient Surgery at Hospitals: Reference GGUSD List of Tier 1 & Tier 2 ONLY Available at ggusd.us / ebam.com (NOT anthem.com) All other covered services: anthem.com Search "Blue Cross PPO Prudent Buyer Large Group

10 EPO Tiered Hospital List (sample)

11 Finding In-Network Providers on the PPO and EPO plans Access instructions for Anthem Blue Cross provider search: (Depts/Ins/Info) / call EBA&M at Check before EVERY appointment; changes can occur throughout year. Print search result. Be sure to see provider at exact STREET ADDRESS & SUITE # listed. When searching by name, keep search broad All Specialties Difficulty locating by name? Search by location. EPO Hospitals (Inpatient Services / Outpatient Surgery) Only hospitals on list at ggusd.us or ebam.com Co-insurance: Tier 1-0% / Tier 2-20%

12 PPO and EPO Plans Pharmacy Provider Managed by American Health Care Separate Card Telephone: Refer to online formulary for drug availability. Register at: americanhealthcare.com

13 United Healthcare HMO - California Only Office Visit Co-Pay $25 Emergency Room Co-Pay $100 Hospital Admission Charge $100 per day $300 max per admission Out of Pocket Maximum Individual: $2,000 / Family: $6,000 Must use only United Healthcare providers Must choose a primary care physician Must see only doctors within a chosen group Must get referrals to see most specialists Pharmacy Co-Pays $5, $15, $30

14 Medical Overview (1/3) PPO Deductible = $300 / indv l $900 / family EPO Deductible = $300 / indv l $900 / family HMO No Deductible Out-of-Pocket Max In-Network: $2,500 / indv l $7500 / family Non-Network: $3,500 / indv l $12,700 / family Out-of-Pocket Max In-Network: $2,500 / indv l $7500 / family Non-Network: Not Available Out-of-Pocket Max In-Network: $2,000 / indv l $6,000 / family Non-Network: Not Available

15 Medical Overview (2/3) PPO Primary/Specialist office visit = $25 co-pay + 20% EPO Primary/Specialist office visit = $25 co-pay HMO Primary/Specialist office visit = $25 co-pay ER = $100 co-pay + 20% coinsurance ER = $100 co-pay ER = $100 co-pay Pharmacy co-pay $5 / $10 / $35 Pharmacy co-pay $5 / $10 / $35 Pharmacy co-pay $5 / $15 / $30

16 Medical Overview (3/3) PPO In-Network co-insurance 80% / 20% Non-Network co-insurance 70% / 30% plus amount exceeding allowable rates EPO In-Network only co-insurance 100% / 0% Hospital Inpatient Services / Outpatient Surgery Tier 1 Hospitals 100% / 0% Tier 2 Hospitals 80% / 20% HMO In-Network only HMO providers = 100% Hospital Inpatient Services / Outpatient Surgery $100/day ($300 max per admit)

17 Key Differences PPO Highest Out of Pocket, most flexible Provider network: Anthem website Nationwide In-Network & Non- Network coverage Referral free access (some services still require precertification) EPO Middle Out of Pocket, more flexible than HMO Provider network: - inpatient services or outpatient surgery at Hospital: GGUSD Tiered Hospital list only - all other covered services: Anthem website CA only In-Network coverage only In-Network Referral free access (some services still require precertification) HMO Lowest Out of Pocket, least flexible Provider network: UHC website CA only In-Network coverage only Limited to PCP and medical group; PCP referral needed for most specialists

18 Dental Garden Grove Self-Insured Dental United Concordia

Annual deductibles $25 individual $75 family maximum

19 Garden Grove Self-Insured Dental Plan Choose your own dentist Use network for additional savings! Annual deductibles $25 individual $75 family maximum Annual limit $2,000 Coverage 90% / 10% Orthodontia Plan pays 50% $2,800 lifetime max

20 United Concordia (HMO) Must use United Concordia dentists 100% coverage for most covered services Orthodontia (limited coverage) Employee pays $1500 for banding for those under 19 $2000 for banding for those age 19 and older

21 Vision Service Plan Eye exam $25 One eye exam per year Date of service to Date of service Lenses or contact lenses every 12 months Frames every 24 months $120 Allowance Second Pair Benefit $200 Allowance toward lenses (for glasses) or additional contact lenses

Life Insurance Death Benefit Class 1 Employees $50,000 Class 2 Employees (management) $70,000 Limited coverage for dependents: Spouse $1,000 Unmarried

22 Life Insurance Death Benefit Class 1 Employees $50,000 Class 2 Employees (management) $70,000 Limited coverage for dependents: Spouse $1,000 Unmarried Children 14 days to 6 months $100 6 months to 21 years $1000 (Full-time students to 25) Don t forget to keep the Insurance Department updated on beneficiaries

23 125 Flexible Spending Account Tax Exempt Medical $2,550 maximum per year $200 minimum per year Dependent Day Care $5,000 maximum filing jointly $2,500 maximum filing singly Change for Instead of additional 75 days to create claims, $500 rollover Deadline: Sept 23, 5:00 p.m.

24 How to be a wise consumer... Urgent Care vs. Emergency Room Prescriptions - Generic vs. Brand Name Call Insurance Department first if unsure Ask questions of your doctor and pharmacist Keep your EOBs for your records Stay in network- including doctors, facility, hospital, lab, etc. Keep Insurance Dept updated: address changes, other insurance

26 Explanation of Benefits - EOB (sample)

27 Conclusion Forms to be completed Insurance Election and Authorization Form Note: Pre-tax deduction authorization is for insurance premium, not flex account Life Insurance Beneficiary Designation Form Medical Enrollment Form Dental Enrollment Form

28 Questions? Please feel free to contact us with any questions regarding your coverage Kim Bessey Evette Chiang Jan Hill (Departments, Insurance)

Garden Grove Unified School District. Retiree Health and Welfare Benefits

Garden Grove Unified School District Retiree Health and Welfare Benefits 2016-2017 Medical Premium for Retirees Under 65 Retiree Only $450 yearly Retiree & Spouse / Domestic Partner $900 yearly Rates for