Employee Benefits Booklet Certificated. Lake Elsinore Unified School District

Transcription

1 Employee Benefits Booklet Certificated Lake Elsinore Unified School District This booklet is intended to provide highlights of your benefits only; it is not an Evidence of Coverage (EOC) plan document. Official plan and insurance documents govern your right and benefits under each plan. For more details about your benefits, including a complete list of exclusion and limitations, please refer to each carrier s EOC. The EOC s are available on the District Website under Employee Benefits.

2 Benefits Eligibility Employee Eligibility In general, you are eligible for medical, dental, vision, and life insurance benefits if you are: A probationary or permanent employee; and You work 20 hours or more per week in your regular assignment. In addition, job share participants may enroll in District plans under certain conditions. If you are a represented employee, we encourage you to review your collective bargaining agreement (CBA) each year to verify your specific eligibility requirements. Dependent Eligibility If you enroll yourself in District benefits, you can also enroll your eligible dependents. You must provide appropriate proof of the dependent relationship when you enroll your dependent (see below). You must enroll yourself and your dependents within 30 days of becoming eligible for District benefits. You may enroll eligible dependents at the same time you enroll yourself. Eligible dependents include: Your legal spouse as defined by state law. (Required documentation: a marriage certificate & current IRS 1040) Your California-registered domestic partner subject to AB 205. A Californiaregistered domestic partner is the same gender as you or may be opposite-gender only if at least one partner is over age 62. (Required documentation: a certified copy of the Declaration of Domestic Partnership filed with the Secretary of State.) Domestic Partner not subject to AB 205: Signed notarized SISC affidavit A natural child or step-child from birth to age 26; a legally adopted child or a child who is in the process of being adopted; a child for whom the member has legal and physical custody/guardianship. A child who is in the process of being adopted is considered legally adopted when SISC receives legal evidence of (i) the intent to adopt; and (ii) the member has either: (a) the right to control the health care of the child; or (b) assumed a legal obligation for full or partial financial responsibility for the child in anticipation of the child s adoption. Proof of eligibility will be required when adding a new dependent for an existing employee and at the time of hire for a new employee. Failure to submit supporting documentation within 30 calendar days of the qualifying event may result in the child or child of a domestic partner being denied coverage. Disabled Dependent: A disabled dependent may be eligible to continue coverage beyond age 26 if unmarried and a dependent for Federal Income Tax purposes (proof required); the member must request a Disabled Dependent Certification form within 30 days of the loss of coverage. The completed and signed form must then be reviewed and approved by the carrier s Medical Review board. This booklet is intended to provide highlights of your benefits only; it is not an Evidence of Coverage (EOC) plan document. Official plan and insurance documents govern your right and benefits under each plan. For more details about your benefits, including a complete list of exclusion and limitations, please refer to each carrier s EOC. The EOC s are available on the District Website under Employee Benefits.

3 Who must enroll in coverage: All employees who work 90% or more of the full-time equivalent for the applicable job classification are required to participate in all health benefits offered by the district. If the district has a three-tier rate structure, dependent coverage is optional for those products. An eligible employee who works less than the 90% may enroll when first eligible or decline coverage. Your Cost for Benefits If you are eligible for District benefits, there is a CAP that is contributed by the District according to your CBA. This information is available later in this summary. If you are a part time employee, the percentage of the CAP will be calculated according to your assigned hours per day and months per year. The deductions are monthly according to your number of paychecks per year. When to Enroll The District s plans are effective October 1 through September 30. You must enroll yourself and your dependents within 30 days of becoming eligible for District benefits. You may enroll eligible dependents at the same time you enroll yourself. You are allowed to enroll in benefits and make changes to your benefits only: When you are initially eligible; During the annual Open Enrollment period; or If you experience a qualifying status change. Enrolling When you are First Eligible You must enroll yourself and your dependents within 30 days of becoming eligible for District benefits. You may enroll eligible dependents at the same time you enroll yourself. ****If you do not come in within the 30 days, you will automatically be enrolled in the Bronze Tiered PPO Plan (Affordable Care Act) by the Safety/Risk Department. The Bronze Tier plan payment will come in under the District contribution amount. Please note: Employees with a hire date from the 1 st thru the 15 th of the month, benefits will be effective on the first day of the following month (i.e. DOH-January 10 th, benefits will be effective February 1 st ). Employees hired after the 15 th, benefits will not be effective for up to 45 calendar days (i.e. DOH-January 16 th, benefits will be effective March 1 st ). Making Changes During Open Enrollment Once you have enrolled in benefits, you generally are not allowed to make changes until the next annual Open Enrollment. Open Enrollment is your one chance each year to review your coverage and make changes to your benefits. It is also your chance to enroll if you declined coverage when you first became eligible. This booklet is intended to provide highlights of your benefits only; it is not an Evidence of Coverage (EOC) plan document. Official plan and insurance documents govern your right and benefits under each plan. For more details about your benefits, including a complete list of exclusion and limitations, please refer to each carrier s EOC. The EOC s are available on the District Website under Employee Benefits.

4 Open Enrollment is usually August 10 th to August 26 th, and any changes made during this period take effect October 1 st. Making Changes During the Year Other than during Open Enrollment, you can make changes to your benefits during the year only if you experience a qualifying status change. Any changes must be made within 30 days of the qualifying status change. A qualifying status change might include: A change in family status, such as marriage or registration of a domestic partnership, the birth or adoption of a child, divorce or dissolution of a domestic partnership, or the death of a dependent. You must provide the benefit department with proof of the event (such as a marriage certificate, birth certificate, death certificate, divorce order, or court order.) The loss of existing coverage for you and/or your eligible dependents (for example, the termination of coverage that was provided through your spouse s employer). Please provide proof of loss with date and names. A qualified court or administrative order that requires you to provide coverage for an eligible dependent. Any benefit changes must be consistent with the qualifying status change. Provided you make changes within 30 days of the event, the change will take effect on the date of the event for a birth, adoption, or placement for adoption; changes you make as a result of other qualifying status changes will take effect the first day of the month after you submit the appropriate documentation to Safety & Risk Services department. SISC IRS 125 Plan: *Flexible Spending Accounts: Health and Dependent Care As part of the Section 125 Plan these benefits are available on a pre-tax basis for your school district (Unreimbursed Medical and Dependent Daycare expense reimbursement accounts). A Section 125 Plan allows you to select from a list of eligible benefits that will meet your needs. The benefits that you choose are then paid for by you on a beforetax basis. Salary reduction means that you are able to use "pre-tax" dollars to pay for certain benefits that you may have previously paid for with "after-tax" dollars. American Fidelity Voluntary Products: *Disability Insurance A Disability Income Insurance Plan can provide a portion of your income during your covered Accident or Sickness. SB (LEUSD employees do NOT pay into SDI: State Disability Insurance) *Accident Insurance*Cancer Insurance*Life Insurance Contact American Fidelity at (866) for more information. This booklet is intended to provide highlights of your benefits only; it is not an Evidence of Coverage (EOC) plan document. Official plan and insurance documents govern your right and benefits under each plan. For more details about your benefits, including a complete list of exclusion and limitations, please refer to each carrier s EOC. The EOC s are available on the District Website under Employee Benefits.

5 An Overview of Your Benefits The District offers you and your eligible dependents a comprehensive selection of health and welfare benefits. Health Care Benefits The District offers seven medical plans per classification: 1. Option 1: Anthem PPO with a deductible of $500 per individual up to $1000 per family- 80%. 2. Option 2: Anthem PPO with a deductible of $200 per individual up to $500 per family- 90%. 3. Option 3: Anthem PPO with a deductible of $300 per individual up to $600 per family- 100%. 4. Option 4: Bronze Tiered Plan-PPO with a deductible of $5000, only employee + child(ren) are eligible. 5. Option 5: Anthem HMO Priority Select: office copay of $ Option 6: Anthem HMO: office copay of $ Option 7: Kaiser HMO: office copay of $30 (Rx $10/$30) The District offers two dental plans and one vision plan. These are tiered based on enrollment of single, two-party or family: 1. Delta Dental Incentive Plan (PPO) 2. Delta Dental Preferred Option (PPO) Plan 3. Medical Eye Services (MES) Flexible Spending Accounts (FSAs): FSAs give you the option to set aside pre-tax funds to pay for certain eligible health care and dependent care expenses. Information is available on the District website (Employee benefits) under IRS Flex 125. Group Life and AD & D: The District provides all benefit eligible employees with life and AD & D (accidental death & dismemberment) to help provide financial protection. Voluntary supplemental coverage is available to employees at an additional cost. Your medical benefits are designed to help maintain the wellness and health of you and your family. The District offers two types of medical plan options: HMO and PPO. With the HMO options, you must receive care from providers in the plan s network; the plan won t pay any benefits for care received outside the network except in an emergency. With the PPO plan, you have the flexibility to receive care from any provider; however, the plan will pay a higher level of benefits when you receive care from a provider who participates in the plan s network. Keep in mind that certain benefits in each plan may vary, depending on your bargaining unit. The prescription costs for each Anthem PPO and HMO is $10 generic, $35 brand name with a $200 deductible per calendar year (generics are free at Costco). This booklet is intended to provide highlights of your benefits only; it is not an Evidence of Coverage (EOC) plan document. Official plan and insurance documents govern your right and benefits under each plan. For more details about your benefits, including a complete list of exclusion and limitations, please refer to each carrier s EOC. The EOC s are available on the District Website under Employee Benefits.

6 Your Summary of Benefits SISC 80-G $30 Anthem Classic PPO This Summary of Benefits is a brief overview of your plan's benefits only. The benefits listed are for both in state and out of state members, there may be differences in benefits depending on where you reside. For more detailed information about the benefits in your plan, please refer to your Certificate of Insurance or Evidence of Coverage (EOC), which explains the full range of covered services, as well as any exclusions and limitations for your plan. In addition to dollar and percentage copays, members are responsible for deductibles, as described below. Please review the deductible information to know if a deductible applies to a specific covered service. Certain Covered Services have maximum visit and/or day limits per year. The number of visits and/or days allowed for these services will begin accumulating on the first visit and/or day, regardless of whether your Deductible has been met. Members are also responsible for all costs over the plan maximums. Plan maximums and other important information appear in italics. Benefits are subject to all terms, conditions, limitations, and exclusions of the Policy. Subject to Utilization Review Certain services are subject to the utilization review program. Before scheduling services, the member must make sure utilization review is obtained. If utilization review is not obtained, benefits may be reduced or not paid, according to the plan. Explanation of Maximum Allowed Amount Maximum Allowed Amount is the total reimbursement payable under the plan for covered services received from Participating and Non- Participating Providers. It is the payment towards the services billed by a provider combined with any applicable deductible, copayment or coinsurance. PPO Providers The rate the provider has agreed to accept as reimbursement for covered services. Members are not responsible for the difference between the provider's usual charges & the maximum allowed amount. Non-PPO Providers For non-emergency care, reimbursement amount is based on: an Anthem Blue Cross rate or fee schedule, a rate negotiated with the provider, information from a third party vendor, or billed charges. Members are responsible for the difference between the provider's usual charges & the maximum allowed amount. For Medical Emergency care rendered by a Non-Participating Provider or Non-Contracting Hospital, reimbursement is based on the reasonable and customary value. Members may be responsible for any amount in excess of the reasonable and customary value. When using Non-PPO and Other Health Care Providers, members are responsible for any difference between the covered expense & actual charges, as well as any deductible & percentage copay. Calendar year deductible for all providers (4th quarter carryover applies) Co-pay for emergency room services Annual Out-of-Pocket Maximums Covered Services PPO: Per Member Copay Non-PPO: Per Member Copay 1 Preventive Care Services $500/member; $1,000/family $100/visit (waived if admitted directly from ER) PPO Providers $2,000/member; $4,000/family *Member copayments and coinsurance for Emergency Medical Care with a Non-PPO Provider also apply to the PPO Out-of-Pocket Maximums. The following do not apply to out-of-pocket maximums: non-covered expense. After a member reaches the out-of-pocket maximum, the member remains responsible for costs in excess of the covered expense. Lifetime Maximum Unlimited Preventive Care Services including*, physical exams, preventive screenings (including screenings for cancer, HPV, diabetes, cholesterol, blood pressure, hearing and vision, immunizations, health education, intervention services, HIV testing), and additional preventive care for women provided for in the guidelines supported by the Health Resources and Services Administration. *This list is not exhaustive. This benefit includes all Preventive Care Services required by federal and state law. Physician Medical Services Office & home visits Hospital & skilled nursing facility visits Surgeon & surgical assistant; anesthesiologist or anesthetist Drugs administered by a medical provider (certain drugs are subject to utilization review) Diabetes Education Programs (requires physician supervision) Teach members & their families about the disease process, the daily management of diabetic therapy & selfmanagement training CONTINUED ON NEXT PAGE No copay (deductible waived) $30/visit 2 (deductible waived) 20% 20% 20% $30/visit 2 (deductible waived) Not covered

7 Your Summary of Benefits SISC 90-C $30 Anthem Classic PPO This Summary of Benefits is a brief overview of your plan's benefits only. The benefits listed are for both in state and out of state members, there may be differences in benefits depending on where you reside. For more detailed information about the benefits in your plan, please refer to your Certificate of Insurance or Evidence of Coverage (EOC), which explains the full range of covered services, as well as any exclusions and limitations for your plan. In addition to dollar and percentage copays, members are responsible for deductibles, as described below. Please review the deductible information to know if a deductible applies to a specific covered service. Certain Covered Services have maximum visit and/or day limits per year. The number of visits and/or days allowed for these services will begin accumulating on the first visit and/or day, regardless of whether your Deductible has been met. Members are also responsible for all costs over the plan maximums. Plan maximums and other important information appear in italics. Benefits are subject to all terms, conditions, limitations, and exclusions of the Policy. Subject to Utilization Review Certain services are subject to the utilization review program. Before scheduling services, the member must make sure utilization review is obtained. If utilization review is not obtained, benefits may be reduced or not paid, according to the plan. Explanation of Maximum Allowed Amount Maximum Allowed Amount is the total reimbursement payable under the plan for covered services received from Participating and Non- Participating Providers. It is the payment towards the services billed by a provider combined with any applicable deductible, copayment or coinsurance. PPO Providers The rate the provider has agreed to accept as reimbursement for covered services. Members are not responsible for the difference between the provider's usual charges & the maximum allowed amount. Non-PPO Providers For non-emergency care, reimbursement amount is based on: an Anthem Blue Cross rate or fee schedule, a rate negotiated with the provider, information from a third party vendor, or billed charges. Members are responsible for the difference between the provider's usual charges & the maximum allowed amount. For Medical Emergency care rendered by a Non-Participating Provider or Non-Contracting Hospital, reimbursement is based on the reasonable and customary value. Members may be responsible for any amount in excess of the reasonable and customary value. When using Non-PPO and Other Health Care Providers, members are responsible for any difference between the covered expense & actual charges, as well as any deductible & percentage copay. Calendar year deductible for all providers (4th quarter carryover applies) Co-pay for emergency room services Annual Out-of-Pocket Maximums Covered Services PPO: Per Member Copay Non-PPO: Per Member Copay 1 Preventive Care Services $200/member; $500/family $100/visit (waived if admitted directly from ER) PPO Providers $1000/member; $3000/family *Member copayments and coinsurance for Emergency Medical Care with a Non-PPO Provider also apply to the PPO Out-of-Pocket Maximums. The following do not apply to out-of-pocket maximums: non-covered expense. After a member reaches the out-of-pocket maximum, the member remains responsible for costs in excess of the covered expense. Lifetime Maximum Unlimited Preventive Care Services including*, physical exams, preventive screenings (including screenings for cancer, HPV, diabetes, cholesterol, blood pressure, hearing and vision, immunizations, health education, intervention services, HIV testing), and additional preventive care for women provided for in the guidelines supported by the Health Resources and Services Administration. *This list is not exhaustive. This benefit includes all Preventive Care Services required by federal and state law. Physician Medical Services Office & home visits Hospital & skilled nursing facility visits Surgeon & surgical assistant; anesthesiologist or anesthetist Drugs administered by a medical provider (certain drugs are subject to utilization review) Diabetes Education Programs (requires physician supervision) Teach members & their families about the disease process, the daily management of diabetic therapy & selfmanagement training CONTINUED ON NEXT PAGE No copay (deductible waived) $30/visit 2 (deductible waived) 10% 10% 10% $30/visit 2 (deductible waived) Not covered

8 Your Summary of Benefits SISC 100-D $20 Anthem Classic PPO This Summary of Benefits is a brief overview of your plan's benefits only. The benefits listed are for both in state and out of state members, there may be differences in benefits depending on where you reside. For more detailed information about the benefits in your plan, please refer to your Certificate of Insurance or Evidence of Coverage (EOC), which explains the full range of covered services, as well as any exclusions and limitations for your plan. In addition to dollar and percentage copays, members are responsible for deductibles, as described below. Please review the deductible information to know if a deductible applies to a specific covered service. Certain Covered Services have maximum visit and/or day limits per year. The number of visits and/or days allowed for these services will begin accumulating on the first visit and/or day, regardless of whether your Deductible has been met. Members are also responsible for all costs over the plan maximums. Plan maximums and other important information appear in italics. Benefits are subject to all terms, conditions, limitations, and exclusions of the Policy. Subject to Utilization Review Certain services are subject to the utilization review program. Before scheduling services, the member must make sure utilization review is obtained. If utilization review is not obtained, benefits may be reduced or not paid, according to the plan. Explanation of Maximum Allowed Amount Maximum Allowed Amount is the total reimbursement payable under the plan for covered services received from Participating and Non- Participating Providers. It is the payment towards the services billed by a provider combined with any applicable deductible, copayment or coinsurance. PPO Providers The rate the provider has agreed to accept as reimbursement for covered services. Members are not responsible for the difference between the provider's usual charges & the maximum allowed amount. Non-PPO Providers For non-emergency care, reimbursement amount is based on: an Anthem Blue Cross rate or fee schedule, a rate negotiated with the provider, information from a third party vendor, or billed charges. Members are responsible for the difference between the provider's usual charges & the maximum allowed amount. For Medical Emergency care rendered by a Non-Participating Provider or Non-Contracting Hospital, reimbursement is based on the reasonable and customary value. Members may be responsible for any amount in excess of the reasonable and customary value. When using Non-PPO and Other Health Care Providers, members are responsible for any difference between the covered expense & actual charges, as well as any deductible & percentage copay. Calendar year deductible for all providers (4th quarter carryover applies) Co-pay for emergency room services Annual Out-of-Pocket Maximums Covered Services PPO: Per Member Copay Non-PPO: Per Member Copay 1 Preventive Care Services $300/member; $600/family $100/visit (waived if admitted directly from ER) PPO Providers* $1,000/member; $3,000/family *Member copayments and coinsurance for Emergency Medical Care with a Non-PPO Provider also apply to the PPO Out-of-Pocket Maximums. The following do not apply to out-of-pocket maximums: non-covered expense. After a member reaches the out-of-pocket maximum, the member remains responsible for costs in excess of the covered expense. Lifetime Maximum Unlimited Preventive Care Services including*, physical exams, preventive screenings (including screenings for cancer, HPV, diabetes, cholesterol, blood pressure, hearing and vision, immunizations, health education, intervention services, HIV testing), and additional preventive care for women provided for in the guidelines supported by the Health Resources and Services Administration. *This list is not exhaustive. This benefit includes all Preventive Care Services required by federal and state law. Physician Medical Services Office & home visits Hospital & skilled nursing facility visits Surgeon & surgical assistant; anesthesiologist or anesthetist Drugs administered by a medical provider (certain drugs are subject to utilization review) Diabetes Education Programs (requires physician supervision) Teach members & their families about the disease process, the daily management of diabetic therapy & selfmanagement training CONTINUED ON NEXT PAGE No copay (deductible waived) $20/visit 2 (deductible waived) 0% 0% 0% $20/visit 2 (deductible waived) Not covered

9 Your Summary of Benefits Premier HMO Premier HMO 20 This Summary of Benefits is a brief overview of your plan's benefits only. For more detailed information about the benefits in your plan, please refer to your Certificate of Insurance or Evidence of Coverage (EOC), which explains the full range of covered services, as well as any exclusions and limitations for your plan. Anthem Blue Cross HMO benefits are covered only when services are provided or coordinated by the primary care physician and authorized by the participating medical group or independent practice association (IPA), except services provided under the "ReadyAccess" program, OB/GYN services received within the member's medical group/ipa, and services for all mental and nervous disorders and substance abuse. Benefits are subject to all terms, conditions, limitations, and exclusions of the Policy. Annual copay maximum: Individual $1,500; Family $3,000 The following copay does not apply to the annual copay maximum: for infertility services Covered Services Per Member Copay Preventive Care Services Preventive Care Services including*, physical exams, preventive No copay screenings (including screenings for cancer, HPV, diabetes, cholesterol, blood pressure, hearing and vision, immunizations, health education, intervention services, HIV testing), and additional preventive care for women provided for in the guidelines supported by the Health Resources and Services Administration. *This list is not exhaustive. This benefit includes all Preventive Care Services required by federal and state law. Smoking Cessation Program No copay Physician Medical Services Office & home visits $20/visit Specialists $20/visit Skilled nursing facility visits No copay Hospital visits No copay Injectable medications in physician's office (excluding allergy serum 20%/up to $150 maximum copay and immunization) Surgeon & Surgical assistant No copay Anesthesiologist or anesthetist No copay Acupuncture $20/visit Outpatient Medical Services (Services received in a hospital, other than emergency room services, or in any facility that is affiliated with a hospital) Outpatient surgery & supplies $100/admit Advanced Imaging $100/test All other X-ray & laboratory tests (including genetic testing) No copay Radiation therapy, chemotherapy & hemodialysis treatment & $20/visit Infusion therapy Other Outpatient Medical Services including: $20/visit Rehabilitation Therapy (Physical, Occupational, or Speech Therapy, limited to a 60-day period of care) General Medical Services (when performed in non-hospital-based facility) Advanced Imaging $100/test All other X-ray & laboratory tests (including genetic testing) No copay Allergy testing & treatment (including serums) $20/visit Radiation therapy, chemotherapy & hemodialysis treatment & $20/visit Infusion therapy Rehabilitation Therapy (Physical, Occupational, or Speech Therapy $20/visit or Chiropractic Care, limited to 60-days period of care) Emergency Care Physician & medical services No copay CONTINUED ON NEXT PAGE

10 Proposed Benefit Summary SISC-Self Insured Schools of California: $30 OV, $10-30 Rx Principal Benefits for Kaiser Permanente Traditional Plan (10/1/14 9/30/15) The Services described below are covered only if all of the following conditions are satisfied: The Services are Medically Necessary The Services are provided, prescribed, authorized, or directed by a Plan Physician and you receive the Services from Plan Providers inside our Southern California Region Service Area (your Home Region), except where specifically noted to the contrary in the Evidence of Coverage (EOC) for authorized referrals, hospice care, Emergency Services, Post-Stabilization Care, Out-of- Area Urgent Care, and emergency ambulance Services Annual Out-of-Pocket Maximum for Certain Services For Services subject to the maximum, you will not pay any more Cost Sharing during a calendar year if the Copayments and Coinsurance you pay for those Services add up to one of the following amounts: For self-only enrollment (a Family of one Member)... $1,500 per calendar year For any one Member in a Family of two or more Members... $1,500 per calendar year For an entire Family of two or more Members... $3,000 per calendar year Deductible or Lifetime Maximum None Professional Services (Plan Provider office visits) You Pay Most primary and specialty care consultations, exams, and treatment... $30 per visit Routine physical maintenance exams... No charge Well-child preventive exams (through age 23 months)... No charge Family planning counseling... No charge Scheduled prenatal care exams and first postpartum follow-up consultation and exam... No charge Eye exams for refraction... No charge Hearing exams... No charge Urgent care consultations, exams, and treatment... $30 per visit Physical, occupational, and speech therapy... $30 per visit Outpatient Services You Pay Outpatient surgery and certain other outpatient procedures... $30 per procedure Allergy injections (including allergy serum)... No charge Most immunizations (including the vaccine)... No charge Most X-rays and laboratory tests... No charge Health education: Covered individual health education counseling... No charge Covered health education programs... No charge Hospitalization Services You Pay Room and board, surgery, anesthesia, X-rays, laboratory tests, and drugs... No charge Emergency Health Coverage You Pay Emergency Department visits... $100 per visit Note: This Cost Sharing does not apply if admitted directly to the hospital as an inpatient for covered Services (see "Hospitalization Services" for inpatient Cost Sharing). Ambulance Services You Pay Ambulance Services... $50 per trip Prescription Drug Coverage You Pay Covered outpatient items in accord with our drug formulary guidelines at Plan Pharmacies or through our mail-order service: Most generic items... $10 for up to a 100-day supply Most brand-name items... $30 for up to a 100-day supply Durable Medical Equipment You Pay Most covered durable medical equipment for home use in accord with our durable medical equipment formulary guidelines... No charge Mental Health Services You Pay Inpatient psychiatric hospitalization... No charge Individual outpatient mental health evaluation and treatment... $30 per visit Group outpatient mental health treatment... $15 per visit (continues)

11 LETA Tiered Dental and Vision ANNUAL PREMIUMS MUST BE DIVIDED BY NUMBER OF PAYCHECKS (does not include deferred) Option 2 Single $16,584 $11,294 $5,290 $6,419 $7,549 $8,114 $9,017 $9,808 $10,937 $12,066 90% PPO Two Party $17,268 $11,294 $5,974 $7,103 $8,233 $8,798 $9,701 $10,492 $11,621 $12,750 Family $17,916 $11,294 $6,622 $7,751 $8,881 $9,446 $10,349 $11,140 $12,269 $13,398 Option 3 Single $17,328 $11,294 $6,034 $7,163 $8,293 $8,858 $9,761 $10,552 $11,681 $12, % PPO Two Party $18,012 $11,294 $6,718 $7,847 $8,977 $9,542 $10,445 $11,236 $12,365 $13,494 Family $18,660 $11,294 $7,366 $8,495 $9,625 $10,190 $11,093 $11,884 $13,013 $14,142 Anthem HMO Single $14,520 $11,294 $3,226 $4,355 $5,485 $6,050 $6,953 $7,744 $8,873 $10,002 Two Party $15,204 $11,294 $3,910 $5,039 $6,169 $6,734 $7,637 $8,428 $9,557 $10,686 Family $15,852 $11,294 $4,558 $5,687 $6,817 $7,382 $8,285 $9,076 $10,205 $11,334 Anthem HMO Single $12,756 $11,294 $1,462 $2,591 $3,721 $4,286 $5,189 $5,980 $7,109 $8,238 Priority Select Two Party $13,440 $11,294 $2,146 $3,275 $4,405 $4,970 $5,873 $6,664 $7,793 $8,922 Family $14,088 $11,294 $2,794 $3,923 $5,053 $5,618 $6,521 $7,312 $8,441 $9,570 Kaiser Single $14,640 $11,294 $3,346 $4,475 $5,605 $6,170 $7,073 $7,864 $8,993 $10,122 Two Party $15,324 $11,294 $4,030 $5,159 $6,289 $6,854 $7,757 $8,548 $9,677 $10,806 Family $15,972 $11,294 $4,678 $5,807 $6,937 $7,502 $8,405 $9,196 $10,325 $11, LETA Annual Premium Cost Medical Plan Delta Incentive w/mes & Life Total Annual Premium Cost Annual District Contribution based on full time Full Time Employee Annual Premium 90 % Contracted Employee 80 % Contract 75 % Contract 67 % Contract 60 % Contract 50 % Contract 40 % Contract Option 1 Single $14,664 $11,294 $3,370 $4,499 $5,629 $6,194 $7,097 $7,888 $9,017 $10,146 80% PPO Two Party $15,348 $11,294 $4,054 $5,183 $6,313 $6,878 $7,781 $8,572 $9,701 $10,830 Family $15,996 $11,294 $4,702 $5,831 $6,961 $7,526 $8,429 $9,220 $10,349 $11,478 Available to All EMPLOYEES*** DRAFT No Deduction No Deduction No Deduction No Deduction No Deduction No Deduction No Deduction No Deduction ***PPO Bronze Plan-Affordable Care Act-( $60 ea) No dental/vision and premium is based on single enrollment 5/26/20153:44 PM

12 Option 2 Single $16,704 $11,294 $5,410 $6,539 $7,669 $8,234 $9,137 $9,928 $11,057 $12,186 90% PPO Two Party $17,484 $11,294 $6,190 $7,319 $8,449 $9,014 $9,917 $10,708 $11,837 $12,966 Family $18,348 $11,294 $7,054 $8,183 $9,313 $9,878 $10,781 $11,572 $12,701 $13,830 Option 3 Single $17,448 $11,294 $6,154 $7,283 $8,413 $8,978 $9,881 $10,672 $11,801 $12, % PPO Two Party $18,228 $11,294 $6,934 $8,063 $9,193 $9,758 $10,661 $11,452 $12,581 $13,710 Family $19,092 $11,294 $7,798 $8,927 $10,057 $10,622 $11,525 $12,316 $13,445 $14,574 Anthem HMO Single $14,640 $11,294 $3,346 $4,475 $5,605 $6,170 $7,073 $7,864 $8,993 $10,122 Two Party $15,420 $11,294 $4,126 $5,255 $6,385 $6,950 $7,853 $8,644 $9,773 $10,902 Family $16,284 $11,294 $4,990 $6,119 $7,249 $7,814 $8,717 $9,508 $10,637 $11,766 Anthem HMO Single $12,876 $11,294 $1,582 $2,711 $3,841 $4,406 $5,309 $6,100 $7,229 $8,358 Priority Select Two Party $13,656 $11,294 $2,362 $3,491 $4,621 $5,186 $6,089 $6,880 $8,009 $9,138 Family $14,520 $11,294 $3,226 $4,355 $5,485 $6,050 $6,953 $7,744 $8,873 $10,002 Kaiser Single $14,760 $11,294 $3,466 $4,595 $5,725 $6,290 $7,193 $7,984 $9,113 $10,242 Two Party $15,540 $11,294 $4,246 $5,375 $6,505 $7,070 $7,973 $8,764 $9,893 $11,022 Family $16,404 $11,294 $5,110 $6,239 $7,369 $7,934 $8,837 $9,628 $10,757 $11, LETA Annual Premium Cost LETA Tiered Dental and Vision ANNUAL PREMIUMS MUST BE DIVIDED BY NUMBER OF PAYCHECKS (does not include deferred) Medical Plan Delta Preferred w/mes & Life Total Annual Premium Cost Annual District Contribution based on full time Full Time Employee Annual Premium 90 % Contracted Employee 80 % Contract 75 % Contract 67 % Contract 60 % Contract 50 % Contract 40 % Contract Option 1 Single $14,784 $11,294 $3,490 $4,619 $5,749 $6,314 $7,217 $8,008 $9,137 $10,266 80% PPO Two Party $15,564 $11,294 $4,270 $5,399 $6,529 $7,094 $7,997 $8,788 $9,917 $11,046 Family $16,428 $11,294 $5,134 $6,263 $7,393 $7,958 $8,861 $9,652 $10,781 $11,910 Available to All EMPLOYEES*** DRAFT No Deduction No Deduction No Deduction No Deduction No Deduction No Deduction No Deduction No Deduction ***PPO Bronze Plan-Affordable Care Act-( $60 ea) No dental/vision and premium is based on single enrollment 5/26/20153:44 PM

13 Plan Benefit Highlights for: PPO $2,000 with Orthodontic Group No: Active and Cobra, (Retirees - exclude Orthodontic) Eligibility Deductibles Deductibles waived for D & P? Maximums Waiting Period(s) Benefits and Covered Services* Diagnostic & Preventive Services (D & P) Exams, 2 cleanings, x-rays Basic Services Fillings, simple tooth extractions, sealants Endodontics (root canals) Covered Under Basic Services Periodontics (gum treatment) Covered Under Basic Services Oral Surgery Covered Under Basic Services Major Services Crowns, inlays, onlays and cast restorations Prosthodontics Bridges, dentures, implants Orthodontic Benefits Adults and dependent children Orthodontic Maximums Dental Accident Benefits Primary enrollee, spouse (includes domestic partner) and eligible dependent children to age 26 In-Network: N/A Out-of-Network: $25 per person, $75 per family, per plan year In-Network: N/A Out-of-Network: No The maximum benefit paid per calendar year is $2,000 per person in-network The maximum benefit paid per calendar year is $1,000 per person out-of-network Basic Benefits None In-PPO Network** Major Benefits None Orthodontics None Out-of-PPO Network** 100 % 50 % 100 % 50 % 100 % 50 % 100 % 50 % 100 % 50 % 100 % 50 % 50 % 50 % 100% 100% Separate $3,000 Lifetime maximum per person 100% (separate $1,000 maximum per person per calendar year) 50% Benefit Highlights Delta Dental PPO SM * Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental contract allowances and not necessarily each dentist s actual fees. ** Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and program allowance for non-delta Dental dentists. Delta Dental of California 100 First St. San Francisco, CA Customer Service Claims Address P.O. Box Sacramento, CA deltadentalins.com This benefit information is not intended or designed to replace or serve as the plan s Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company s benefits representative.

14 Plan Benefit Highlights for: PPO Incentive $1,000, with Orthodontic Group No: Active and Cobra, Retirees(exclude orthodontic) Network: Premier *The plan provides an additional $200 toward the calendar year maximum when you visit a PPO dentist. Look for this information for the dentist of your choice on the Delta find a provider website to take advantage of this additional amount: (Other network affiliations: Delta Dental PPO) In this incentive plan, Delta Dental pays 70% of the contract allowance for covered basic services and major services during the first year of eligibility. The coinsurance percentage will increase by 10% each year (to a maximum of 100%) for each enrollee if that person visits the dentist at least once during the year. If an enrollee does not use the plan during the calendar year, the percentage remains at the level attained the previous year. If an enrollee becomes ineligible for benefits and later regains eligibility, the percentage will drop back to 70%. Eligibility Deductibles Deductibles waived for D & P? Maximums Waiting Period(s) Primary enrollee, spouse (includes domestic partner) and eligible dependent children to age 26 N/A N/A The maximum benefit paid per calendar year is $1,200* per person in-network (this amount includes the additional $200 for using a PPO dentist. See note above under Network) The maximum benefit paid per calendar year is $1,000 per person out-of-network Basic Benefits None Major Benefits None Benefits and Covered Services* Diagnostic & Preventive Services (D & P) Exams, 2 cleanings per cal year, x-rays Basic Services Fillings, simple tooth extractions, sealants Endodontics (root canals) Covered Under Basic Services Periodontics (gum treatment) Covered Under Basic Services Oral Surgery Covered Under Basic Services Major Services Crowns, inlays, onlays, and cast restorations Prosthodontics Bridges, dentures, implants Orthodontic Benefits Adults and dependent children Orthodontic Maximums Dental Accident Benefits In-PPO Premier Network** Non-Delta Providers** % % UCR % % UCR % % UCR % % UCR % % UCR % % UCR 50 % 50% UCR 50 % 50% Separate $2,000 Lifetime maximum per person 100% (separate $1,000 maximum per person per calendar year) * Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan. Reimbursement is based on Delta Dental contract allowances and not necessarily each dentist s actual fees. ** Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists and program allowance for out-of-network dentists. Delta Dental of California 100 First St. San Francisco, CA Customer Service Claims Address P.O. Box Sacramento, CA deltadentalins.com This benefit information is not intended or designed to replace or serve as the plan s Evidence of Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for your plan, please consult your company s benefits representative.

15 TWO-TIERED ANCHOR BRONZE PPO PLAN Services Participating Providers Calendar Year Deductible(s)* $5,000/$10,000 Calendar Year Out-Of-Pocket Maximum** $6,350/$12,700 Includes Deductible, co-pays and co-insurance Office Visits $60 first 3 visits, subject to deductible and coinsurance thereafter Inpatient Hospital Room, Board & Support Services (prior authorization required) Emergency Room Facility Expenses: Professional Expenses: Accident Care (48 hrs)/emergency Room Facility Expenses: 70% $100 co-pay 70% 70% $100 co-pay 70% Professional Expenses: 70% Well Baby/Child Preventive Care Deductible Waived Routine physical exam/immunizations 100% Routine Preventive Care- Deductible Waived Employee 100% Diagnostic X-Ray & Lab 70% Physical Medicine (PT, OT, Chiro) 70% (some limits may apply) Acupuncture 70% up to 12 visits per year $50 per visit Durable Medical Equipment Rental or Purchase of DME 70% Hearing Aid (Up to $700 every 24 months) 70% Hospice 70% Ambulance (Ground or Air) 70% Home Health Care hour visits/yr (prior authorization req'd) 70% Psychiatric & Substance Abuse Inpatient Outpatient Outpatient Prescription Drugs Administered by medical carrier & subject to deductible Generic Drugs Brand Name Drugs * Deductibles have a 4th quarter carryover **Out of Pocket Maximum does not have a 4th quarter carryover Retail - 30 days $9 $35 70% 70% (See Office Visit Copays) Mail - 90 days $18 $90 The group plan benefits must be communicated without modification to the members. The district may not partially pay, reimburse or otherwise reduce the member's responsibility for deductibles, copays, co-insurance, OOP Maximums, etc. This PPO Plan is offered only with the pharmacy benefit illustrated above. Districts may offer this plan without impacting the total number of plans allowed per SISC guidelines. Employees enrolled in this plan may NOT enroll into SISC dental, vision, and/or life insurance plans. No enrollment option for spouse/domestic partner and/or retiree. Please see FAQ page on Minimum Value Plan Options for more information. This is only a brief summary of benefits. For a complete list of benefits, please refer to the plan document. 25 Medical Plans

16 SISC PLAN C / $20 Your employer understands the importance of good visual health and the need for regular eye examinations. This Vision Plan, administered by Medical Eye Services (MESVision), is designed to provide you with access to qualified eye care professionals and coverage for a comprehensive vision examination and materials (eye glasses or contact lenses). Along with MESVision s outstanding customer service, you and your eligible dependents now have access to over 16,000 participating providers including Ophthalmologists, Optometrists and Opticians/Optical Chain locations. OBTAINING SERVICES IS EASY Follow these simple steps: 1. Select a provider. Select a participating vision care provider by visiting Obtaining services from a Participating Provider will maximize your benefits. 2. Make an appointment. Make an appointment with the Participating Provider of your choice and inform them of your vision coverage. 3. You re done! Your doctor will take care of the rest. The Participating Provider will contact MESVision to verify your eligible benefits and submit a claim for payment for services covered by your plan. 4. If covered services are received from a non-participating provider, you are responsible for paying the provider in full. You or the provider must submit the itemized bill and a copy of your prescription with the Claim Form to MESVision. Reimbursement will be made to the insured person up to the schedule of allowances shown for nonparticipating providers. LIMITATIONS Contact Lenses and fitting except as specifically provided; Eyewear when there in no prescription change, except when benefits are otherwise available; Lenses or Frames which are lost, stolen or broken will not be replaced, except when benefits are otherwise available; Lenses such as beveled, faceted, coated or oversize exceeding the allowance for covered lenses; Tints other than pink or rose #1 or #2, except as specifically provided; Two pair of glasses in lieu of bifocals, unless prescribed. This is a brief outline of the plan and is not to be accepted or construed as a substitute for the provisions of the contract. SUMMARY OF VISION BENEFITS Benefits: Co-pay: $20.00 Comprehensive Vision Exam: One every calendar year Lenses: One pair every calendar year Frame: One every calendar year Contact Lenses:** One pair every calendar year The Policy provides full coverage for Covered Services when you go to a Participating Provider of the MESVision network. If Covered Services are provided by a Non-Participating Provider, charges will be paid, but not to exceed the following Schedule of Allowances. Participating Non-Participating Provider Provider Comprehensive Examination Covered Up to $ Single Vision Lenses Covered Up to $ Bifocal Lenses Covered Up to $ Trifocal Lenses Covered Up to $ Progressive Lenses Up to $89.50 Up to $ Aphakic Monofocal Covered Up to $ Aphakic Multifocal Covered Up to $ Frame Up to $130.00* Up to $ Contact Lenses ** Non-Elective Covered Up to $ Elective Up to $ Up to $ * Participating Providers allow a selection of frames that retail up to $ with lenses that fit an eyesize less than 61 millimeters. If a more expensive frame is selected, you are responsible for the additional cost above $ If the lenses received are 61 millimeters or above, the charge for the oversize lenses is your responsibility. Retail frame benefits will be converted to wholesale equivalent prices at certain provider locations, see our website or provider directory for further information. ** This benefit is in addition to the comprehensive vision examination, but in lieu of lenses and frame. If contact lenses are for cosmetic or convenience purposes, the Policy will pay up to $ toward the contact lens evaluation, fitting costs and materials. Any balance is your responsibility. If contact lenses are medically necessary, they are a fully covered benefit. Approval from MESVision is required. Please refer to your Policy if you require additional information. Discounts: A 20% discount is available for cosmetic extras, such as tints, coatings and other add-on charges to standard lenses, after Covered Services are rendered. The discount may be applied to charges for the frame or contact lenses (except disposable or replacement contact lenses) over the stated allowances. The 20% discount also applies to additional pairs of glasses and/or pairs of standard contact lenses. To determine whether a provider offers the 20% discount, an insured individual can review their Participating Provider Directory, call MESVision or visit Discounts are available through TLCVision for conventional and custom LASIK procedures with the TLCVision Advantage Program. If you have any questions about your vision benefits, please contact Medical Eye Services at: PO Box 25209; Santa Ana, CA / or Q$130 $105 $5 Co-pay 3/26/2010

17 navitus.com Share a Clear View NAVI-GATE FOR MEMBERS Pharmacy Benefi t Information at Your Fingertips Have questions about your pharmacy benefi ts with Navitus Health Solutions? Visit for answers! For information specifi c to your plan, visit Navi-Gate for Members. Activate your account online using the Member Login link and an activation will be sent to you. The site provides a wealth of information and is available 24 hours a day, seven days a week. Navi-Gate for Members allows you to access personalized pharmacy benefi t information online. Some of the features offered include: MY PRESCRIPTION BENEFITS View general information about your pharmacy benefi t. PHARMACY SEARCH Find a participating pharmacy in your local area search for 24-hour pharmacies, and it provides a map to help you fi nd a pharmacy. DRUG SEARCH Learn about prescription and over-the-counter drugs, how they are used, warnings and more. Navi-Gate for Members Offers Easier Access to Your Prescription Benefi t Information HEALTH INFO Keep on top of important health news and information. MAIL ORDER Learn about available mail order options, if applicable to your pharmacy benefi t. WHAT S MY COPAY? Determine your estimated cost for specifi c prescriptions. CUSTOMER CARE: 24 HOURS A DAY, 7 DAYS A WEEK 1025 West Navitus Drive Appleton, Wisconsin N

18 navitus.com Share a Clear View MEDICATION HISTORY Medication history is displayed for enrollees and dependents in the form of a table for a specifi ed date range. DRUG INTERACTIONS Understand how the effect of a particular drug is altered when taken with another drug or food. Contains thousands of drug interactions between prescriptions, over-thecounter drugs, as well as herbal, vitamin and nutritional products. Includes severity rankings so steps can be taken to lessen harmful effects. Please contact Navitus Customer Care if you have any additional questions or concerns. We hope you fi nd Navi-Gate for Members informative and useful. TO ACCESS, GO TO: > MEMBERS > MEMBER LOGIN CUSTOMER CARE: 24 HOURS A DAY, 7 DAYS A WEEK 1025 West Navitus Drive Appleton, Wisconsin 54913

19 Important Information About Your Benefits This section includes some important notices about your right and responsibilities as a participant in the District s plans. If you have any additional questions about this information, feel free to contact the Safety & Risk Services department at (951) , ext Important Notice About Your Rights and Benefits Under Each Plan This booklet is intended to provide only highlights of your benefits; it is not an Evidence of Coverage (EOC) plan document. Official plan and insurance documents govern your rights and benefits under each plan. For more details about your benefits, including a complete list of exclusions and limitations, please refer to each carrier s EOC. A copy of the EOC can be obtained from the Lake Elsinore Unified School District website: Notice of Health Insurance Portability and Accountability Act of 1996 (HIPAA) The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that affects your rights to obtain health benefits and to safeguard your privacy regarding Protected Health Information (PHI). Specifically, HIPAA includes, but is not limited to, the following: Limitations on pre-existing condition exclusions; Prohibitions against discriminating against individual participants and beneficiaries based on health status; Special enrollment periods under certain conditions for qualified individuals; or Privacy standards COBRA Rights Once an employee and/or dependent lose coverage, SISC prepares and mails the COBRA 14-day notification to the qualified beneficiary s last known address. It includes information and rates on all of the products the qualified beneficiary is enrolled in through SISC immediately preceding the qualifying event (loss of coverage). How to Enroll Go to: Click Employee Resources 3. Click Benefits 4. Click LETA/Certificated Information 5. Review all topics, summaries and plans and once your choice is made: 6. Click Enroll in Benefits 7. Complete the proper enrollment forms and bring to Safety & Risk services with proper documentation for spouse, dependents or opting out of medical before the 30 day deadline expires. This booklet is intended to provide highlights of your benefits only; it is not an Evidence of Coverage (EOC) plan document. Official plan and insurance documents govern your right and benefits under each plan. For more details about your benefits, including a complete list of exclusion and limitations, please refer to each carrier s EOC. The EOC s are available on the District Website under Employee Benefits.

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21 Don t miss your opportunity to save. You do not have to be a Costco member to use their prescription pharmacy services. Just tell the associate at the front door you are going to their pharmacy. (excluding some narcotic pain medications and some cough medications) p Get your generic medication with a $0 co-payment. o Present the pharmacist with your insurance card. n Take your prescription for a generic medication to a Costco Pharmacy. TO OBTAIN FREE GENERICS AT COSTCO: TAKE ADVANTAGE OF FREE GENERIC MEDICATIONS AT COSTCO 1 (800) and dial 1 To locate a Costco near you, call Costco at Are You Saving Money on Your Prescription Medications? This Program is available to SISC members on participating drug plans.

22 What keeps you in step? Stay on your toes with immunizations and other preventive care. By taking simple steps when you re well, you boost your chances of staying that way. Make sure you re up-to-date on immunizations they re not just for kids. Get a tetanus shot and, if you re over 65, get a pneumonia shot. Wash your hands often and avoid touching your nose and mouth to help prevent colds and flu. Eating right, getting enough rest, and exercising all help keep your immune system strong. Start small by taking a brisk walk. One study found that even moderate exercise an average of 15 minutes a day can extend your life by three years. Stay on point Here are some ways to help yourself stay well: Find balance. Take breaks from work to go outside or take deep, cleansing breaths to reduce stress. Give it weight. Go out dancing or do other weightbearing exercises like running to help strengthen your bones. take a shot. Get an annual flu shot to protect yourself and others. Visit kp.org/prevention or kp.org/flu for more tips on staying healthy. Kaiser Permanente health plans around the country: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii Kaiser Foundation Health Plan of Colorado Kaiser Foundation Health Plan of Ohio Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR please recycle January 2012

23 Employee Assistance Program Have questions about home, work or family? Maybe you re a few months behind on bills and want to get back on track. Or you re new to town and looking for a daycare center. Whatever your concern, a call to the Employee Assistance Program (EAP) can help you through it. What is EAP anyway? You may have heard about EAP but aren t sure what it is. EAP is a service available to you and members of your household at no extra cost. It s designed to help you with everyday problems and questions, big or small. No need to fill out paperwork or make an appointment to speak with an EAP staff member. Just call or visit anthemeap.com. You ll be connected in an instant, and we re here 24 hours a day, every day, to help you. How we can help When you or a household member contacts us, we ll work with you to figure out the next steps. If you need counseling, we can arrange several free visits with a licensed professional. If you have money or legal questions, we can put you in touch with a financial advisor or a lawyer. If online help is more your style, visit anthemeap.com. You ll find articles, checklists, quizzes and other helpful tools. You can browse resources, attend a webinar or take an online class right at your own desk. Here are just some of the topics covered: Have there been a few bumps in the road? EAP can help smooth it out. Call or go to anthemeap.com and enter SISC. }} Workplace safety }} Child and elder care resources }} Tobacco cessation }} Grief and loss }} Family health }} Home improvement }} Addiction and recovery }} Dealing with identity theft Remember, EAP is here for you 24/7, so you can call at the time and place that are right for you. Your privacy is important to us. No one will know you ve called EAP unless you give them permission in writing. * *In accordance with federal and state law, and professional ethical standards. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. MCASH3151ABC 2/12