Santa Ana Unified School District

Transcription

1 Santa Ana Unified School District Employee Benefits Office (714) SAUSD Open Enrollment Information for Post Eligible Retirees It s time for you to make decisions about your health care benefits. Open Enrollment is your once-a-year opportunity to make changes to your current health care benefits, including electing new plans. During this period, you are allowed to: Enroll in medical/vision and dental coverage, Make changes to your current plans or level of coverage, and Add eligible dependents or drop dependents. What s Changing for ? Here s a look at what s changing for the coming plan year: Due to new mental health parity legislation the current behavioral health benefits for Blue Shild (through UBH) will be changing in order to be as generous as the current medical benefits. Copays will remain the same howevever the following changes will take effect 7/1/2010: o Remove Inpatient limits out-of-network from 30 days to unlimited o Remove Outpatient limits out-of-network from 20 visits to unlimited o Remove substance abuse lifetime max out-of-network from 60 days to unlimited o Behavioral health plan will now be subject to shared out-of-pocket maximum and deductible in place on the medical plan o Changing out-of-network coinsurance from 50% to 30% (PPO only) See pages 4 and 5 for your design comparison for detailed changes. Review page 8 for employee contribution amounts the percentage of the total premium that employees pay for health care benefits will change. Open Enrollment is Monday, May 17 through Friday, May 28, If you are making any changes, you must return your Open Enrollment/Change forms to the Employee Benefits Office no later than 4:30 pm on May 29, Any changes you make will be effective July 1, 2010 through June 30, You do not need to submit forms if you do not wish to make changes for the plan year. Your current elections will continue and your benefits will remain the same. Post Eligible Retirees 1

2 What You Need to Do Here are the steps you need to take to enroll for your benefits: 1. Review this announcement and the retiree premiums. 2. Attend an employee or retiree meeting, if you wish, where you will be able to speak directly with representatives from Blue Shield, Kaiser, Delta Dental, and American Fidelity. Here is the meeting schedule: DATE TIME LOCATION ADDRESS May 19, :00 pm 4:00 pm Board Room 1601 E. Chestnut Ave Santa Ana May 28, :00 pm 4:00 pm Board Room 1601 E. Chestnut Ave Santa Ana Remember, you must submit your completed SAUSD Open Enrollment/Change form by 4:30 pm on May 28, If you mail your form through the District mail or U.S. postal mail, it is your responsibility to confirm that it was received by the Employee Benefits office before the deadline by calling (714) Post Eligible Retirees 2

3 Tools & Resources for Retirees Before you make any decisions for the upcoming plan year, there is some important information you need to know about your benefits. Below is a list of tools and resources that will give you the information you need to make informed decisions during this year s Open Enrollment. Retiree Memo This document includes information that retirees need to consider when selecting your benefits for : o Prescription Drug Coverage considerations See page 5 for important information about your prescription drug coverage. Retiree Agreement Your Retiree Agreement (that you signed when you retired) gives you an overview of the benefits you are eligible for and how long. Be sure to read all of the information provided to you carefully. If your questions are not answered by the materials listed above, please call the benefits office at (714) Wellness Resources Blue Shield has comprehensive online health and wellness tools available for members. For example, you ll have access to Blue Shield s LifePath decision guides which provide comparative data on hospitals as well as different treatment options so you can make informed decisions regarding your health care. You ll also have access to a 24/7 nurse advice line where you can talk to a nurse anytime day or night at (877) See the Blue Shield enrollment booklet for details on wellness resources. Post Eligible Retirees 3

4 What You Need to Know About Medicare It is important to remember that the District requires that you and/or your spouse enroll in Medicare Part A (hospitalization) and Medicare Part B (medical) at age 65. You will be responsible for paying any premiums associated with the Medicare plans. Beginning in 2007, Medicare Part B premiums were based on income. For example, if you are single and your annual income is less than $85,000 annually (or $170,000 if you are married), the monthly premium for 2010 is $ The 2010 monthly premium increases with your annual income up to a maximum of $ per month. Once you and/or your spouse enroll in Medicare, these plans become your primary medical insurance. This means that all of your medical claims must be submitted to Medicare first and your benefits through the District become your secondary insurance plan. Because you have two insurance carriers, it s important to remind your provider that Medicare is your primary insurance. What About Medicare Part D? You should not enroll in Medicare Part D (prescription drug coverage) because the District s prescription drug coverage is, on average, expected to pay as much as the standard Medicare prescription drug plan. For more information about Medicare Part D, refer to your Notice of Creditable Coverage included with this package. If you are eligible for Medicare and do not enroll, your rates for medical coverage may be higher. Post Eligible Retirees 4

5 Your Medical Benefits High-quality medical care is very important for maintaining overall health and wellness. SAUSD offers comprehensive medical coverage that gives you your choice of the following plans: Kaiser HMO Blue Shield HMO Blue Shield PPO HMO and PPO Medical Plans Here is a brief overview of the differences in your medical plan options: HMO Plan A managed care plan that offers a range of medical services at low, predictable costs called copays. Pays benefits only if you seek care from HMO network providers. If you use out-of-network providers, you ll pay 100% of the cost of the medical care you receive, except for medical emergencies. If you enroll in Blue Shield, you must choose a primary care physician (PCP) from their provider network. This PCP will direct all of your care. PPO Plan A medical plan with a network of health care providers, who have contracts with the insurance company to provide their services at discounted rates. Pays in and out-of-network benefits. If you go to an in-network provider, you receive a higher level of benefits. For most network and out-of-network benefits, you must meet a deductible before the plan pays benefits and then you pay a percentage of the cost of all covered services. Blue Shield members will still receive UBH and VSP benefits If you are a Blue Shield member you will still receive mental health and substance abuse benefits from United Behavioral Health and vision benefits from VSP. If you are a Kaiser HMO member you will receive your mental health and substance abuse benefits as well as your vision benefits through Kaiser. Post Eligible Retirees 5

6 Medical Benefits at a Glance RETIREES WITHOUT MEDICARE ONLY Kaiser HMO Blue Shield HMO Blue Shield PPO In- Network Out-of-Network¹ Lifetime Maximum Unlimited Unlimited $6 million First, you may be required to meet a calendar-year deductible before the plan pays benefits Annual Deductible None None $300/individual $600/family Next, you ll pay either a copay or coinsurance for covered services Office Visits You pay $15 copay You pay $15 copay You pay $20 copay (deductible does not apply) amount after deductible Specialist Visits You pay $15 copay You pay $15 copay with referral Self referrals to specialist in s participating medical group $30 You pay $20 copay (deductible does not apply) amount after deductible Lab and X-rays You pay $0 You pay $0 You pay 20% after deductible Routine Physical Exams You pay $15 copay You pay $15 copay You pay $20 copay (deductible does not apply) OB/GYN (well-woman exams ) Prenatal Office Visits (maternity care, tests and procedures) Well-Baby/Well-Child Visits You pay $15 copay You pay $15 copay You pay $20 office visit copay For lab work, you pay 20% not subject to deductible You pay $15 copay You pay $0 You pay 10% after deductible You pay $15 copay You pay $15 copay You pay $0 copay, not subject to deductible amount after deductible amount after deductible; amount after deductible amount after deductible amount after deductible, Hospitalization Inpatient You pay $0 You pay $0 You pay 10% after deductible Outpatient Surgery You pay $15/procedure You pay $0 You pay 10% after deductible Emergency Room (copay waived if admitted) You pay $50 copay You pay $50 $50 copay $50 copay Mental Health (For Blue Shield HMO and PPO plans, benefits are provided through United Behavioral Health) Inpatient You pay $0; Kaiser facilities only In-network: You pay $0 Out-of-Network: Not Covered You pay $0 amount after deductible 2 amount after deductible You pay 30% of R&C after deductible; Outpatient (office visit) You pay $15 copay/ individual therapy In-network: You pay $10 copay You pay $10 copay You pay 30% of R&C after deductible; You pay $7 copay/ group therapy Out-of-Network: Not Covered Kaiser facilities only Post Eligible Retirees 6

7 Substance Abuse Inpatient You pay $0; Outpatient (office visit) RETIREES WITHOUT MEDICARE ONLY Kaiser HMO Blue Shield HMO Blue Shield PPO Kaiser facilities only You pay $15 copay/ individual therapy You pay $7 copay/group therapy Kaiser facilities only In network: You pay $0 Out-of-Network: Not Covered In-network: You pay $10 copay Out-of-Network: Not Covered Retail Prescription Drugs (Blue Shield: 30-day supply/kaiser: 100-day supply) You pay $0 In- Network You pay $10 copay Out-of-Network¹ You pay 30% of R&C after deductible; You pay 30% of R&C after deductible; Generic You pay $10 copay You pay $10 copay You pay $10 copay You pay $10 copay plus 25% of allowable amount Brand You pay $20 copay You pay $20 copay You pay $20 copay You pay $20 copay plus 25% of allowable amount Non-formulary N/A You pay $40 copay You pay $40 copay You pay $40 copay plus 25% of allowable amount Mail Order Prescription Drugs (Blue Shield: 90-day supply/kaiser: 100-day supply) Generic You pay $10 copay You pay $20 copay You pay $20 copay Not covered Brand You pay $20 copay You pay $40 copay You pay $40 copay Not covered Non-formulary N/A You pay $80 copay You pay $80 copay Not covered Then, if you meet the annual out-of-pocket maximum, the plan will pay 100% of the cost of covered services for the remainder of the year. Annual Out-of-Pocket Maximum $1,500/individual $3,000/family $1,000/individual $2,000/two party $3,000/family $1,000/individual $2,000/family 1 If your out-of-network provider charges more than the allowable amount, you will pay the difference. If you choose to seek care outside of the network, Blue Shield pays only a portion of those charges and it is your responsibility to pay the remainder. The amount you are required to pay does not apply to the out-of-pocket maximum. It s recommended that you ask the out-of-network physician or health care professional about their billed amount. 2 For out of network hospitalization, Blue Shield pays up to $600 per day, members are responsible for 30% of this amount plus any amount over $600 per day. Note: The benefits above do not represent the complete benefit schedule. Please refer to the Summary Plan Descriptions for a complete description of benefits and plan exclusions. Post Eligible Retirees 7

8 RETIREES WITH MEDICARE ONLY Kaiser Senior Advantage HMO Plan Blue Shield 65 Plus HMO Plan Lifetime Maximum Unlimited Unlimited First, you may be required to meet a calendar-year deductible before the plan pays benefits Annual Deductible None None Next, you ll pay either a copay or coinsurance for covered services Office Visits You pay $15 copay You pay $15 copay Specialist Visits You pay $15 copay You pay $15 copay with referral Lab and X-rays You pay $0 You pay $15 copay Routine Physical Exams You pay $15 copay You pay $15 copay for one time exam within the first 12 months OB/GYN (well-woman exams ) You pay $15 copay You pay $15 copay Hospitalization Inpatient You pay $0 You pay $0 Outpatient Surgery You pay $15/procedure You pay $0 Emergency Room (copay waived if admitted) You pay $50 copay You pay $50 copay Mental Health Inpatient You pay $0; Kaiser facilities only You pay $0 Blue Shield contracted facilities only Outpatient (office visit) You pay $15 copay/ individual therapy You pay $7 copay/ group therapy Kaiser facilities only You pay $15 copay individual and group therapy Blue Shield contracted providers only Substance Abuse Inpatient You pay $0; Kaiser facilities only You pay $0 Blue Shield contracted facilities only Outpatient (office visit) You pay $15 copay/ individual therapy You pay $7 copay/group therapy Kaiser facilities only Retail Prescription Drugs (Blue Shield: 30-day supply/kaiser: 100-day supply) Generic You pay $10 copay You pay $10 copay Brand You pay $20 copay You pay $20 copay Non-formulary N/A You pay $40 copay Mail Order Prescription Drugs (Blue Shield: 90-day supply/kaiser: 100-day supply) Generic You pay $10 copay You pay $20 copay Brand You pay $20 copay You pay $40 copay Non-formulary N/A You pay $80 copay You pay $15 copay individual and group therapy Blue Shield contracted providers only Then, if you meet the annual out-of-pocket maximum, the plan will pay 100% of the cost of covered services for the remainder of the year. Annual Out-of-Pocket Maximum $1,500/individual / $3,000/family None Note: The benefits above do not represent the complete benefit schedule. Please refer to the Summary Plan Descriptions for a complete description of benefits and plan exclusions. Post Eligible Retirees 8

9 Your Dental Benefits How the Delta Dental DHMO Plan Works The DeltaCare USA DHMO works the same way as other DHMO plans when you enroll in the DHMO, you select a Primary Care Dentist (PCD) from the DeltaCare USA DHMO network for yourself and any eligible dependents you wish to enroll. To receive benefits, you must see your PCD, who will take care of most of your dental care needs. If you require treatment from a specialist, your PCD will refer you to another dentist in the DeltaCare USA DHMO network. How the Delta Dental Network and Incentive DPPO Plans Work The Delta Network and Incentive DPPO plans provide coverage for similar types of dental care; however, your costs for enrolling your dependents will be less with the Delta Network DPPO and you will be required to pay more out-of-pocket when you see an out-ofnetwork dentist. Locating a Delta Dental Dentist If you want to find out if your current dentist is a Delta Dental PPO or DeltaCare USA DHMO dentist, or if you want to select a new dentist, here is what you need to do: 1. Log on to from any computer. 2. Select Find a Dentist in the left navigation bar. 3. Click on National Online Directory. 4. Select your plan and location. 5. Select how you want to search for a dentist (by name or dental office). If you do not have online access, call (800) for the DHMO plan or (866) for the DPPO plan to request a list of providers in your area. With the Incentive DPPO plan (former Delta Dental Indemnity plans), you will pay more for covering your eligible dependents, but will receive richer benefits when you visit an out-ofnetwork provider than you would under the Network DPPO. Both Delta Dental DPPO plans work a little differently than other dental PPO plans because Delta Dental has two network levels, plus out-of-network coverage. Again, before your next dentist appointment, be sure to check with Delta Dental to find out which of the DPPO networks your dentist belongs to. Level Delta Dental DPPO Network Delta Dental Premier Network (Considered an out-of-network provider) Out-of-Network Description You will receive the highest level of benefits when you see a Delta Dental DPPO network dentist. That s because DPPO network dentists have agreed to charge lower, negotiated rates. Plus, you will pay a lower percentage of these lower rates. When you see a Premier network provider, you will receive the lower out of network benefit compared to the higher network DPPO benefit. That s because you will pay a higher percentage of the reasonable and customary (R&C) charge. However, Delta Dental has negotiated with Premier providers so that you will not be required to pay more than the R&C charge for the care you receive. The out of network deductible also applies to these providers. When you see an out-of-network provider, you will be required to pay the deductible, applicable coinsurance percentage of the R&C, plus any amount over the R&C charge for the care you receive. For more details about your Delta Dental benefits, see Dental Benefits at a Glance on page 13 of this announcement or visit Post Eligible Retirees 9

10 Dental Benefits at a Glance DeltaCare USA DHMO Delta Dental Network DPPO Delta Dental Incentive DPPO In-Network Out-of-Network 1 In-Network Out-of-Network 1 First, you may be required to meet a calendar-year deductible before the plan pays benefits Calendar-Year Deductible None None None None $25/individual $75/family (waived on diagnostic and preventive care) Next, your care will be covered at no charge, or you ll pay a percentage of the cost for covered services Includes teeth cleaning, panoramic or full mouth X-rays and fluoride treatment 1 cleaning every 6 months Extractions, simple (single tooth) Fillings (amalgam) Fillings (composite for molars) Preventive Services You pay $0 You pay $0 You pay 50% of R&C You pay 0 30% You pay 0 30% of R&C 2 cleanings per year combined in- and out-ofnetwork 2 cleanings per year combined in- and outof-network Basic Services You pay $0 You pay $0 You pay 50% of R&C You pay 0 30% You pay 0 30% of R&C after deductible You pay $0 You pay $0 You pay 50% of R&C You pay 0 30% You pay 0 30% of R&C after deductible You pay $0 $75 You pay $0 You pay 50% of R&C You pay 0 30% You pay 0 30% of R&C after deductible Root Canal You pay $45 $205 copay You pay $0 You pay 50% of R&C You pay 0 30% You pay 0 30% of R&C after deductible Periodontics (scaling and root You pay $0 You pay $0 You pay 50% of R&C You pay 0 30% You pay 0 30% of R&C after deductible planing; per quadrant) Major Services Crown You pay $35 $195 copay (includes all lab and metal fees) You pay $0 You pay 50% of R&C You pay 0 30% You pay 0 30% of R&C after deductible Complete denture (upper or lower) You pay $100 copay You pay 50% You pay 50% of R&C You pay 50% You pay 50% of R&C after deductible Orthodontia (24- month treatment plan) Children (up to age 19) You pay 50%; $500 lifetime maximum You pay $1,700 copay for comprehensive treatment Adults You pay $1,900 copay for comprehensive treatment You pay 50%; $1,000 lifetime maximum You pay 50%; $1,000 lifetime maximum You pay 50% of R&C; $1,000 lifetime maximum You pay 50%; $1,000 lifetime maximum You pay 50%; $500 lifetime maximum You pay 50%of R&C; $500 lifetime maximum You pay 50%; $500 lifetime maximum Additional Benefits Covered General Anesthesia You pay $165 copay You pay $0 You pay 50% of R&C You pay 0 30% You pay 0 30% of R&C after deductible External You pay $125 copay Not covered Not covered Not covered Not covered Bleaching (per arch) Occlusal Guards You pay $95 copay Not covered Not covered Not covered Not covered Then, if you meet the maximum annual benefit, you ll be responsible for 100% of the cost for the remainder of the plan year. Maximum Annual None $2,000 $1,200 $2,000 $1,500 Benefit 1 If your out-of-network dentist charges more than the reasonable and customary (R&C) amount, you will pay the difference. However, if you visit an out-of-network Delta Premier dentist and the dentist charges more than the fee agreed upon with Delta Dental, then you will not be required to pay the difference between the dentist s R&C amount and the amount agreed upon with Delta Dental. Note: The benefits above do not represent the complete benefit schedule. Please refer to the Summary Plan Descriptions for a complete description of benefits and plan exclusions. Post Eligible Retirees 10

11 Summary of Your Contributions for Coverage Certificated and Management The table below summarizes the monthly retiree contribution amounts that will be effective July 1, If you are eligible for Medicare and do not enroll, your rates for medical coverage may be higher. Kaiser Sr. Advantage HMO* Total Monthly Premium What the District Pays Monthly Employee-only $ $0 = $ Two-party $ $0 = $ Kaiser HMO Employee-only $ $0 = $ Two-party $1, $0 = $1, Family $2, $0 = $2, Blue Shield 65 Plus HMO* ** Employee-only $ $0 = $ Two-party $ $0 = $ Blue Shield HMO (with or without Medicare)*** Employee-only $ $0 = $ Two-party $1, $0 = $1, Family $2, $0 = $2, Blue Shield PPO (with or without Medicare)*** Employee-only $1, $0 = $1, Two-party $2, $0 = $2, Family $3, $0 = $3, DeltaCare USA DHMO Employee-only $23.42 $0 = $23.42 Two-party $41.44 $0 = $41.44 Family $45.05 $0 = $45.05 Delta Dental Network DPPO Employee-only $0 = Two-party $0 = Family $0 = Delta Dental Incentive DPPO Employee-only $0 = Two-party $0 = What You Pay Monthly Family $0 = *You and your spouse must be enrolled in Medicare to be eligible for the Kaiser Sr. Advantage or Blue Shield 65 Plus plans. Medicare-eligible retirees are responsible for continuing to pay Part B premiums. ** Blue Shield 65 Plus plan rates include UBH EAP and VSP (Vision) costs. Behavioral health and substance abuse benefits are provided by Blue Shield for this plan only. ***Blue Shield HMO rates include UBH (Behavioral Health and EAP) and VSP (Vision) costs. Post Eligible Retirees 11

12 Summary of Your Contributions for Coverage Classified The table below summarizes the monthly retiree contribution amounts that will be effective July 1, If you are eligible for Medicare and do not enroll, your rates for medical coverage may be higher. Kaiser Sr. Advantage HMO* Total Monthly Premium What the District Pays Monthly Employee-only $ $0 = $ Two-party $ $0 = $ Blue Shield 65 Plus HMO* ** Employee-only $ $0 = $ Two-party $ $0 = $ Blue Shield HMO (with or without Medicare)*** Employee-only $ $0 = $ Two-party $1, $0 = $1, Family $2, $0 = $2, Blue Shield PPO (with or without Medicare)*** Employee-only $1, $0 = $1, Two-party $2, $0 = $2, Family $3, $0 = $3, DeltaCare USA DHMO Employee-only $23.42 $0 = $23.42 Two-party $41.44 $0 = $41.44 Family $45.05 $0 = $45.05 Delta Dental Network DPPO Employee-only $0 = Two-party $0 = Family $0 = Delta Dental Incentive DPPO Employee-only $0 = Two-party $0 = What You Pay Monthly Family $0 = *You and your spouse must be enrolled in Medicare to be eligible for the Kaiser Sr. Advantage or Blue Shield 65 Plus plans. Medicare-eligible retirees are responsible for continuing to pay Part B premiums. ** Blue Shield 65 Plus plan rates include UBH EAP and VSP (Vision) costs. Behavioral health and substance abuse benefits are provided by Blue Shield for this plan only. ***Blue Shield HMO rates include UBH (Behavioral Health and EAP) and VSP (Vision) costs. Post Eligible Retirees 12

13 Your Resources Here are some important phone numbers and websites that you may need in order to locate providers or get answers to your questions. You can also contact the Benefits Office at (714) Benefit Carrier Phone Website Blue Shield PPO Number (800) Medical Dental Blue Shield HMO (800) United Behavioral Health (Mental health and substance abuse care and Employee Assistance Program for Blue Shield HMO and PPO members.) (800) Kaiser HMO (800) Delta Dental DPPO (Network and Incentive Plans) (866) DeltaCare USA DHMO (800) Vision Vision Service Plan (VSP) (800) Section 125 Plan Supplemental Insurance American Fidelity (800) American Fidelity (800) Conseco (800) The information presented in this announcement contains only highlights of the District s benefit plans. Plan documents and the insurance contracts contain full provisions. If there is a discrepancy between the material in these charts and the plan documents or insurance contracts, the plan documents or insurance contracts will govern. Post Eligible Retirees 13

14 Glossary Below are some definitions that will help you better understand your benefits. Term Annual deductible Allowable amount Brand-name drug Coinsurance Copay Covered service Explanation of Benefits (EOB) Generic drug Network provider Out-of-network provider Out-of-pocket maximum Plan year Pre-tax basis Primary care dentist (PCD) Primary care physician (PCP) Qualifying event Reasonable and customary (R&C) charges Definition The amount you pay for covered services in a calendar year before the plan begins to pay benefits. Since the deductible is on a calendar-year basis, it starts over every January 1, not July 1 when the new plan year begins. The maximum amount the plan will pay for a service, based on what is reimbursed to network providers A drug that is patented by the FDA and subject to an exclusivity agreement that allows the company to be the sole manufacturer of the drug for a certain number of years. The percentage of the cost for a covered service that you pay. A fixed dollar amount that you pay for a covered service at the time the service is provided. The health care services that a plan will cover in part or in full based on plan documents. The statement from the insurance company defining each procedure billed by your provider, the exact amount paid to your provider and the amount you owe (if any). HMO members do not receive an EOB. A prescription drug that has the same active ingredients as a brand-name drug and is subject to the same FDA standards for quality, strength and purity as its brand-name counterpart but typically costs less. Not all brand-name drugs have generic equivalents. Any licensed doctor, hospital, lab or other health care provider that has contracted to provide members with wide-ranging services at discounted rates. Any licensed doctor, hospital, lab or other health care provider that is not part of a provider network. The maximum amount you pay each calendar year for covered services. Once you reach your out-of-pocket maximum, the plan pays 100% for additional covered services. Since the out-of-pocket maximum is on a calendar-year basis, it starts over every January 1, not July 1 when the new plan year begins. July 1 through June 30 of each year. Not included in your W-2 income or subject to income taxes. A doctor within an HMO network whom you have selected to handle your medical care. He/she will treat you directly or refer you to specialists, as necessary. A doctor within an HMO network whom you have selected to handle your medical care. He/she will treat you directly or refer you to specialists, as necessary. A life event that may allow you to make certain changes to your health coverage or FSA participation. This includes marriage, legal separation or divorce; birth, adoption, legal guardianship, or change in custody of dependent child(ren); the ineligibility or death of a dependent; a move to an area where your current plan is not offered; a change in your or your spouse s employment or a major change in health coverage. The maximum amount the plan will pay for a service, based on what providers in that geographic area charge for similar services or supplies. Post Eligible Retirees 14

15 FAQs Here are some quick answers to some of our most frequently asked benefits questions. Question Which of my dependents are eligible for coverage? Who qualifies for benefits as a domestic partner? Answer The following dependents are eligible for benefits: Legal spouse. Unmarried children from birth to age 19. Adopted children or children under legal guardianship. Unmarried children from age 19 to 25, if they are claimed as a dependent as defined by Internal Revenue Service regulations and are a full-time student. Verification of full-time status will be requested. Dependent children over age 19 who are mentally or physically handicapped and incapable of self-sustaining employment. Verification of handicapped status will be requested. Domestic partner (see the definition of domestic partner below) and his or her children (same as above). To qualify for benefits, a domestic partner must be registered with the California Secretary of State by filing a notarized Declaration of Domestic Partnership form. To qualify for registration, the partnership must include two people who meet all of the following requirements: Are the same sex (or opposite sex if at least one of the partners is over age 62 and eligible for Social Security pension benefits or Supplemental Security Income (SSI) based on age), Are 18 years or older, Share a common residence, Are jointly responsible for each other s basic living expenses, Are capable of consenting to the partnership, Are neither married nor a member of another domestic partnership, Are not related by blood in a way that would prevent them from being married in the State of California, and Consent to the jurisdiction of the California courts for dissolution, nullity, legal separation, or any other proceeding related to the partners rights and obligations. If a legal union (other than marriage) of two persons of the same sex was validly formed in another jurisdiction and that union is considered comparable to a domestic partnership registered in California, California will allow the persons in that union to register as domestic partners with the California Secretary of State. Such unions include civil unions in Connecticut and Vermont and partnerships registered in New Jersey. How do I make a change to my benefits during Open Enrollment? You must provide proof that your domestic partnership is registered with the state of California before you can enroll your domestic partner for benefits. Complete and return an Open Enrollment /Change form to the Employee Benefits Office no later than 4:30 pm on Friday, May 28, When do the changes I make during Open Enrollment take effect? The changes take effect on July 1, 2010 and are in place the entire plan year July 1, 2010 through June 30, Post Eligible Retirees 15

16 Question Will I be able to make a change after open enrollment? Are any contribution amounts changing? How can I find out if my current dentist is a member of the Delta Dental network? What are reasonable and customary (R &C) charges? If I currently have a flexible spending account (FSA), what do I need to do? Answer Not unless a qualifying event occurs. See page 14 for the definition of a qualifying event. Note: For any change, an Open Enrollment/Change form must be completed and returned to the Employee Benefits Office. Contribution percentage has not changed however contribution amounts will be increasing due to an increase in premium rates. Kaiser HMO will still remain the no cost option. By logging on to you can find out if your dentist is in the Delta Dental network (see page 10 for details). You can also call Delta Dental and request a directory of network dentists in your area (see page 13 of the Open Enrollment announcement for phone numbers). Reasonable and customary (R&C) charges are the maximum amount the plan will pay for a service, based on what providers in that geographic area charge for similar services or supplies. If you are currently enrolled in an FSA, you should: Submit your receipts and claim forms to American Fidelity no later than June 30, Re-enroll for your FSA(s) if you want to participate for the coming plan year your current FSA elections will not carry over. Contact American Fidelity, if you will not be returning to the District next year. Where do I get more information about my benefits? You can attend an employee meeting during Open Enrollment (see page 2 of the Open Enrollment announcement for a meeting schedule), you can call the carriers directly or visit their website. Contact information is listed under Your Resources. Post Eligible Retirees 16