Certificated Employees Open Enrollment Guide

Transcription

1 San Marcos Unified School District Open Enrollment October 28, 2013 November 18, 2013 Certificated Employees Open Enrollment Guide Questions? Please contact: Kitty Ross Benefits Technician Phone: Fax: PLEASE READ INSIDE FOR FURTHER DETAILS ABOUT THE 2014 BENEFIT CHANGES Important Dates: Site Visits See the Open Enrollment Calendar on page 10 Walk-In Meetings Can t make it to your site visit? Get your questions answered at the walk-in meetings at the District Office (walk-in basis). 11/6/13 2:00 P.M. to 5:00 P.M. 11/13/13 2:00 P.M. to 5:00 P.M. 11/14/13 2:00 P.M. to 5:00 P.M. 11/15/13 2:00 P.M. to 5:00 P.M. 11/18/13 3:00 P.M. to 5:00 P.M.(last day of Open Enrollment) Flu Shots 10/28/13 at San Marcos MS from 3:30 P.M. 5:30 P.M. 11/18/13 at the District Office from 3:00 P.M. 5:00 P.M. Health Fair 10/28/13 at San Marcos MS Gym 3:30 PM to 5:30 PM

2 OPEN ENROLLMENT FOR CERTIFICATED EMPLOYEES Open enrollment will begin on October 28, 2013 and will end on November 18, Open Enrollment is the time of year employees can change their health plan selection, an opportunity to add/drop eligible dependents, enroll/re-enroll in the Flex 125 plan (FSA), and enroll in other voluntary benefits. Summary of 2014 Plan Changes Certificated employees will be offered the Kaiser $20, UnitedHealthcare HMO Package D and UnitedHealthcare Alliance HMO with HRA, and the UnitedHealthcare PPO with HRA. Optum Health Chiropractic and Acupuncture Kaiser Office visit ment increase from $15 to $20. New Prescription Drug Copay Structure 30-day supply at retail/100-day supply at mail order UnitedHealthcare HMO Network 1 Package D Primary Care Office Visit Copayment increase from $10 to $20. (Specialist visits $20) Other Copayment Changes - Inpatient Hospital Care, Complex Radiology(MRI/PET), Physical Therapy, Emergency Room and Prescription Drugs UnitedHealthcare HMO Network 2 Package D Primary Care Office Visit Copayment increase from $20 to $30. (Specialist visits $40) Other Copayment Changes - Inpatient Hospital Care, Complex Radiology(MRI/PET), Physical Therapy, Emergency Room and Prescription Drugs UnitedHealthcare HMO Network 3 Package D Primary Care Office Visit Copayments remain the same at $40. (Specialist visits $60) Other Copayment Changes - Inpatient Hospital Care, Complex Radiology(MRI/PET), Physical Therapy, Emergency Room and Prescription Drugs 2014 Open Enrollment - Certificated 1

3 Summary of 2014 Plan Changes (continued) Alliance HMO with HRA Primary Care Office Visits remain the same $35 (Specialists $50). Scripps Clinic/Scripps Coastal medical groups. ($500 Health Reimbursement Account (HRA), included with Alliance HMO plan). UnitedHealthcare PPO-SD2 with HRA Primary Care Office Visits remain the same at $30 In-Network 50% Out-of-Network - Employees who access Scripps Clinic or Scripps Coastal medical groups may want to look at the Alliance HMO plan as a more cost-effective option. ($500 Health Reimbursement Account (HRA), included with PPO plan). Optum Health for Chiropractic Care Effective January 1, 2014, Optum Health will replace American Specialty for Chiropractic Care. Copays will stay the same ($10, $20, or $30) Depending on your Primary Care Physician. The majority of the ASH providers are in the Optum Network. New Acupuncture services. You need to confirm that your chiropractor is in the Optum network before continuing services (if your chiropractor is NOT in the network, please contact Optum who will reach out to the provider to join the network). At or complete a Provider Nomination Form located on the smusd website and follow directors for where to send. The provider can complete an online form Interested in Becoming a Provider at Or call your medical provider customer service at: Kaiser Members: UHC HMO Members: UHC PPO Members: Optum Member Services: Delta Dental No Premium or plan benefit changes on Delta PPO or Delta Premier. Enrollees can change from the Delta Premier plan to the Delta PPO plan effective 1/1/2014. Enrollees cannot change to Delta Premier Plan from the Delta PPO Plan since the Premier Plan is closed to new enrollment. Employees can change to Delta PPO by completing an enrollment form. Go to click on Departments, Benefits, Open Enrollment to download the Delta enrollment form. Employees can verify which Delta Dental plan they have by calling Delta Dental or by registering on their website. Delta Dental website, Dental phone number Open Enrollment - Certificated 2

4 FLEXIBLE SPENDING ACCOUNTS/SECTION 125 PLAN Enrollment is not continuous - employees that wish to enroll in this plan must re-enroll every year. This is the time to enroll (or re-enroll if you currently participate in the program) in the flexible spending account program. This plan allows you to pre-tax income for dependent care reimbursement and medical expenses. To enroll or re-enroll in the plan, employees must meet with a representative from American Fidelity. Representatives will be available at every Open Enrollment site visit, the walk-in meeting at the District Office and at the Health/Benefit Fair. VOLUNTARY PLAN ENROLLMENTS The following plans are available for enrollment during Open Enrollment. If you are interested in these plans, please request additional information or visit the SMUSD website*. Legal Aid Plan Long Term Care Insurance Voluntary Life Insurance Critical Illness Insurance Liberty Mutual Home, Renters, and Auto Insurance American Fidelity Plans Please see an American Fidelity representative Accident Insurance Disability Insurance Cancer Insurance Life Insurance Getting Your Questions Answered Please visit the SMUSD website for additional information. The website includes supplementary information regarding all of the plans. Go to click on Departments, Benefits, Open Enrollment. Come to your Site Visit: Please see the Open Enrollment calendar for the date and time. Walk-In Meetings at the District Office: Can t make it to your site visit? Get your questions answered at the walk-in basis meetings at the District Office. The meeting will be in the Human Resources Conference room (2 nd floor) on the following dates: November 6 th 2:00 PM to 5:00 PM November 13 th 2:00 PM to 5:00 PM November 14 th 2:00 PM to 5:00 PM November 15 th 2:00 PM to 5:00 PM November 18 th 3:00 PM to 5:00 PM (Last day of Open Enrollment) 2014 Open Enrollment - Certificated 3

5 How to Make Changes Employees do not have to complete an enrollment form if they are not making any changes. ONLINE ENROLLMENT: Employees can enroll in any of the health plans (health plans only) by using the VEBA online enrollment tool. Be prepared with your primary care doctor choice and your dependents doctor choice. 1. Go to 2. Click on the Online Enrollment link. The link says, For information about 2014 Open Enrollment and to Enroll Online, please click here. 3. Click on #2, Online Enrollment. 4. Enter your Pin and Password. If you forgot your pin and password or don t have one, click on the link that says New to Online Enrollment or forgot your Login Information? 5. Then follow the instructions on the screen PAPER ENROLLMENT FORM: Print a paper enrollment form from the SMUSD website or pick one up at your Open Enrollment site visit. CHANGING YOUR DENTAL PLAN: The Delta Dental Premier plan has been closed to all new enrollments since Employees cannot switch to this plan. (Additional Delta Dental plan information is available on the SMUSD website*) Employees can change to the Delta PPO plan. Please print an enrollment form from the SMUSD website or pick one up from your site visit. ADDING NEW DEPENDENTS: Dependent Eligibility Verification Documents: To add a new dependent to your benefits employees must submit a dependent eligibility verification document with the enrollment and/or change form(s). Please visit the SMUSD website to view a list of acceptable documents. Health Plan To add an eligible dependent to your health plan, please use the Online Open Enrollment Tool or print a paper enrollment form from the SMUSD website. Delta Plan - Please complete a Delta Dental Change form. Employees can print the form from the SMUSD website. Dependent children age must be unmarried full time students to be eligible to be enrolled in the dental, vision or group life insurance plans. Dependent children age 25+ are not eligible for the dental, vision or group life insurance. Health Care Reform - Affordable Care Act: The Affordable Care Act allows young adults to stay on their parent s health plan until age 26. The dependent does not have to be a full-time student and marital status does not prohibit the dependent s eligibility. Dependents that are not currently enrolled in the employee s health plan can be added to the plan for coverage effective 01/01/14. The Affordable Care Act rule only applies to health care coverage. Dependents age who are not full time students or are married, are not eligible to enroll in the employee s dental, vision, or group life insurance plans. ALL ENROLLMENT FORMS MUST BE RECEIVED BY NOVEMBER 18, NO EXCEPTIONS! Enrollment forms are to be turned in to Kitty Ross in the Benefits Department 2014 Open Enrollment - Certificated 4

6 Certificated Employee Premiums 2014 Plan Year Health Plan/Benefit Packages Kaiser Permanente HMO Kaiser Kaiser (includes Delta PPO, VSP, and Group Life) (includes Delta Premier, VSP, and Group Life) Payroll Deduction Monthly $65.00 $ UnitedHealthcare HMO (Package D) Network 1 Network 1 (includes Delta PPO, VSP, and Group Life) (includes Delta Premier, VSP, and Group Life) $ $ Network 2 Network 2 Network 3 Network 3 (includes Delta PPO, VSP, and Group Life) $ (includes Delta Premier, VSP, and Group Life) $ (includes Delta PPO, VSP, and Group Life) $ (includes Delta Premier, VSP, and Group Life) $ Alliance HMO (with HRA) Alliance Alliance (includes Delta PPO, VSP, and Group Life) (includes Delta Premier, VSP, and Group Life) $ $ UnitedHealthcare Choice Plus PPO (with HRA) PPO (includes Delta PPO, VSP, and Group Life) PPO $1, (includes Delta Premier, VSP, and Group Life) $1, Open Enrollment - Certificated 5

7 ur 20 ur 20 San Marcos Unified School District Making Health Care Better for Everyone 2014 Benefit Changes Welcome to the California Schools Voluntary Employee Benefits Association (VEBA). VEBA is a benefits trust that was formed by a collaboration of labor and management representatives to give education employees, like you, the highest quality benefits at the lowest cost. This flyer describes benefit changes that will take place January 1, 2014, and provides a summary of your benefits. Changes for ALL Members New Chiropractic & Acupuncture Plan Carrier OptumHealth (Optum) will replace American Specialty Health (ASH) for chiropractic and acupuncture services. Here s what you need to know: Kaiser members will receive an OptumHealth ID card for chiropractic and acupuncture plan benefits. UHC members will not receive an OptumHealth ID card as Optum chiropractic and acupuncture services are included in UHC s health care benefits. Office visit s will stay the same. The majority of ASH providers are in the Optum network. You need to confirm your chiropractor and/or acupuncturist is in the Optum network before receiving services. (Optum is reaching out to ASH providers who are not currently participating, to join the Optum network). To find a provider, please visit: or call Customer Service: - Kaiser Members: UHC HMO Members: UHC PPO Members: CaféWell Program Starting October 1, 2013, all employees can sign up for CaféWell. CaféWell will connect you with a VEBA Health Coach and provide health and fitness activities. It also uses social networking to provide you with tools to help you make meaningful lifestyle changes along with the chance to win prizes. You simply create a profile; find friends to participate in the activities and share tips and information; reach out to health experts; and have the potential to be rewarded for your efforts. Get all your friends, family members, and coworkers to sign up. It s easy! Visit: Changes for KAISER Members New Prescription Drug Copay Structure Kaiser members will be encouraged to use clinically-proven generic drugs and mail order service to receive maintenance medications. What s Changing Current Kaiser Plans Kaiser Plans starting January 1, 2014 Retail & Mail Order Pharmacy Generic & Brand Name Medications You may be paying one for up to 100 days of medication either through Retail Pharmacy or Mail Order You may be paying the same for both Generic and Brand Name medications You will pay different s for Retail and Mail Order medications: Retail: Pay one for up to 30 days of medication Mail Order: Pay two s for up to 100 days of medication You will pay different s for Generic and Brand medications Generic medications will have lower s than Brand medications Changes for UHC Performance HMO Members Members in Mid-County Physicians Medical Group MUST TAKE ACTION Effective January 1, 2014, the Mid-County Physicians Medical Group, which is currently in Network 1 (with highest performance ratings) in the Performance HMO health plan will move to Network 2 (with fair performance ratings). This change is because the California Office of the Patient Advocate recently lowered Mid-County Physicians Medical Group s quality score from good to fair. The Performance HMO Plan was designed to reward members like you with lower cost benefits when you select the highest performing providers. That s why if you or any of your dependents are in Mid-County Physicians Medical Group, you must TAKE ACTION regarding your health plan. Here s what you need to do: 1. If you want to stay with Mid-County Physicians, you must ENROLL yourself and any family members in the Performance HMO Plan Network 2. (Note: If you select Network 2 you will pay higher s.) 2. If you want to stay in Network 1 and find a new PCP you must SELECT A NEW PCP for you and any family members. You can find the VEBA Performance HMO provider directory online at Click on Find a Doctor, then select your state and the VEBA Performance HMO network from the dropdown list to view the physicians in Network 1. (Note: You can use this information to complete your online enrollment at: or contact your district benefits office for assistance.) 8885 Rio San Diego Drive, Suite 327, San Diego, CA vebaonline.com 2014 Open Enrollment - Certificated 6

8 Changes for UHC Performance HMO Members (continued) New Copays for Services Please see summary of benefits on page three of this flyer. To compare 2013 and 2014 plan benefits, please visit: Members BENEFITS Changes for UnitedHealthcare PPO Members Medical Necessity Reviews for Out-Of-Network Services UHC requires PPO members to receive Medical Necessity reviews for the following services when they are received Out-Of-Network: BRCA genetic test Diagnostic cardiac catheterization Electrophysiology implants Sleep apnea surgery Intensity modulated radiation therapy MR-guided focused ultrasound Carrier Contact Information Plan Name Phone Number Website Best Doctors OptumHealth Chiropractic Kaiser Members: UHC HMO Members: UHC PPO Members: Employee Assistance Program access code: VEBA Kaiser Express Scripts UnitedHealthcare HMO UnitedHealthcare PPO VEBA Advocacy Programs Rio San Diego Drive, Suite 327, San Diego, CA vebaonline.com 2014 Open Enrollment - Certificated 7

9 Benefits Summary & Contact Information For more details about your benefits or to see the Summary of Benefits Coverage (SBC) document please visit: Visit: Members BENEFITS (Please note: 2014 benefit changes are shown in red.) Benefits Summary Kaiser $20 Performance HMO D Network 1 Performance HMO D Network 2 Performance HMO D Network 3 Alliance HMO PPO SD2 (with HRA) In Network Outside Network Deductible (individual/family) None None None None $2,000/$2,000 $2,500/$2,500 $2,500/$2,500 Annual Out-of-Pocket Maximum (individual/family) $1,500/$3,000 $5,000/$10,000 $5,000/$10,000 $5,000/$10,000 $5,000/$5,000 $5,000/$5,000 $5,000/$5,000 Health Reimbursement Account None None None None $500 $500 $500 PCP Office Visit $20 $20 $30 $40 $35 $30 Specialist Office Visit $20 $20 $40 $60 $50 $30 Preventive Care No charge No charge No charge No charge No charge No charge Inpatient Hospital Care Mental Health Services (outpatient/inpatient) Substance Abuse Services(outpatient/inpatient) No charge $20 /No charge $20 /No charge $250 admit $20 / $250 $500 admit $30 / $500 50% $40 / 50% No charge No charge No charge 20% $40 /20% $40 / 20% 20% coinsurace $30 / $30 / No coverage for nonnetwork services Infertility $20 Not covered Not covered Not covered Not covered Not covered Not covered Outpatient Diagnostic Laboratory and Radiology (standard procedures) No charge No charge No charge No charge Complex Radiology (PET & MRI) No charge $100 $200 $200 Outpatient Surgery $20 No charge $250 50% Outpatient Physical/Rehabilitation Therapy(PCP/Specialist) $20 $20 / $20 $30 / $40 $40 / $60 20% (after deductible) $35/$50 No charge $30 50% Urgent Care (your medical group/other medical group) $20 $20 / $75 $30 / $100 $40 / $100 $35 / $50 Emergency Room (Copay waived if admitted) $50 $150 $200 $300 20% (after deductible) $100 $100 Retail Prescription Drugs 1 (generic/preferred/non-preferred) $15 /$30 $5/$20/50% $10/$30/50% $10/$30/50% $5/$25/50% $10/$30/50% No coverage for nonnetwork pharmacy Mail Order Prescription Drugs 2 (generic/preferred/non-preferred) $30 /$60 (up to a 100-day $10/$40/50% (90-day $20/$60/50% (90-day $20/$60/50% (90-day $10/$50/50% (90-day $20/$60/50% (90-day No coverage for nonnetwork pharmacy Chiropractor & Acupuncture Services 3 $20 $20 $30 $30 $30 $30 1 Non-Preferred Brand drugs through Express Scripts Retail Pharmacy are subject to a $30 minimum and $125 maximum 2 Non-Preferred Brand drugs through Express Scripts Mail Order are subject to $60 minimum and $250 maximum 3 Chiropractor & Acupuncture Services must be Medically Necessary Disclaimer: This summary is merely a brief description of the major benefits of the plan(s) and is not intended to alter or expand benefits, rights or liabilities as set forth in the official plan documents and contracts. Limitations may apply. See the Certificate/Evidence of Coverage for details. No coverage for nonnetwork services 8885 Rio San Diego Drive, Suite 327, San Diego, CA vebaonline.com 2014 Open Enrollment - Certificated 8

10 Alliance Plan Network Mercy Physicians Medical Group Primary Care Associated Medical Group Scripps Clinic Scripps Coastal Medical Center 2014 Open Enrollment - Certificated 9

11 SMUSD Open Enrollment Calendar October 28, November 18, 2013 October 2013 Monday Tuesday Wednesday Thursday Friday Health Woodland Park MS San Elijo Middle Twin Oaks Elem. San Marcos Middle 11:00 A.M. - 3:30 P.M. 10:00 A.M. - 4:30 P.M. 11:30 A.M. - 4:00 P.M. 3:30 P.M. - 5:30 P.M. FLU SHOTS 3:30 P.M - 5:30 P.M November 2013 Monday Tuesday Wednesday Thursday Friday 1-Nov Mission Hills High 10:00 A.M. - 3:30 P.M Transportation Paloma Elem District Office Walk-In San Marcos High Carrillo 8:30 A.M. - 10:30 A.M 11:30 A.M. - 4:00 P.M. 2:00 P.M. - 5:00 P.M. 10:00 A.M.-3:30 P.M. 11:30 A.M - 4:00 P.M. M&O 11:30 A.M. - 2:30 P.M JAL District Office Walk-In District Office Walk-In District Office Walk-In Holiday 11:30 A.M. - 4:00 P.M. 2:00 P.M. - 5:00 P.M. 2:00 P.M. - 5:00 P.M. 2:00 P.M. - 5:00 P.M Last Day District Office Walk-In 3:00 P.M. - 5:00 P.M. FLU SHOTS 3PM - 5PM District Thanksgiving Break 2014 Open Enrollment - Certificated 10