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Welcome to stockton unified school district

Welcome to Stockton Unified
School District
This presentation will explain your benefit coverage. Please ask any questions you may have at the end of the program.
Stockton Unified School District
This presentation is not a contract, but only a summary of your benefits. Please refer to the plan brochures for a full disclosure of SUSD Medical Benefit Plans
 Kaiser Permanente (HMO) Plan “A” or “B”  Blue Shield (EPO) Plan “A”, “B”, “C”, or “D” Kaiser Medical Plans
Doctor office visits
Kaiser Permanente
Glasses/Vision Exams
 Kaiser members receive an ophthalmological exam and one pair of lenses and frames every 24 months.
General Information for Kaiser
Subscribers
 All Kaiser subscribers must obtain their benefits at the Kaiser facility and doctors only.
 Stockton Kaiser’s facility is open 7 days week 24 hrs  Dameron hospital is used for emergency treatment Blue Shield EPO
 EPO – stands for “Exclusive Provider Organization”
 Blue Shield EPO offers several other distinct advantages: You are no longer required to select a “primary care physician” All members are entitled to see any of the Blue Shield network providers or specialist without a referral. (You no longer will be restricted to receiving services from any particular medical group.) You have access to the Blue Shield nationwide network. (This may be helpful for those who have dependants who live away from home.) Blue Shield Medical Plans
Blue Shield Medical Plans
 In your packets you’ll find brief summaries of each plan option which includes prescription drug coverage and the copayments for office visits, urgent care, emergency room, etc.
Vision Benefits
Blue Shield Subscribers
 Choose a contracted physician from the  Obtain glasses from listed vendors as noted Vision Benefits
Blue Shield Subscribers
 Annual ophthalmological exam covered at  Frame allowance is $100.00 with contracted SUSD Medical Benefit Plans
 Chiropractic services are provided to Blue Shield and Kaiser subscribers through ACN  The benefit plan allows 20 visits per year with a $5.00 copay per visit. The first 3 visits can be made without prior authorization.
Delta Dental
70% 1st yr – 80% 2nd yr90% 3rd yr – 100% 4th yr  Must go to the dentist each year to increase Delta Dental
 $1,100 lifetime maximum per person for Special Information
 All benefit coverage begins on the first day of the following month after the month which  A newborn or a new spouse must be enrolled Special Information
 Your coverage cannot begin until your first  You have 30 days from your date of hire to enroll. If you do not enroll within this period, you may not enroll until next open enrollment Special Information
 New dependants or spouses are to be enrolled within 31 days of the event date. If you do not enroll within this period, you may not enroll them until next  If a child loses their dependant status, come to Risk Management to delete them off from your coverage.
Special Information
 Verification of dependants must be provided at the Examples: birth certificate, marriage license, or  A dependant can be eligible for up to 25 years of age with a full time student status of 12 units or be listed as a tax dependant on your tax return.
Special Information
 Court order and or adoption decrees must be provided for all non-biological children.
Office at 933-7110 ext 2550 for information.
Spousal Rebate Program
 If you are covered by your spouse’s insurance, the district offers a monthly medical rebate reimbursement in return for waiver of medical and chiropractic benefits.
Spousal Rebate
 The only time you can enroll in the spousal rebate program is during open enrollment or upon your initial hiring with the district.
Spousal Rebate
 You can chose to continue dental and vision.
Spousal Rebate
 The spousal rebate program is valid FOR
ONLY 1 YEAR
 You must re-enroll every year during open enrollment (NO EXCEPTIONS)
Spousal Rebate
 Must provide medical ID card from your alternative health carrier for our records upon enrollment along with proof of marriage ( a marriage certificate or most recent tax return).
 Remember to enroll dependants for vision and dental if they were not originally covered in your medical plan.
Spousal Rebate
 If you do not return to re-enroll during annual open enrollment period, your medical benefits will automatically be reactivated, and contributions will be required for coverage according to health insurance rates set up for that fiscal year.
 Come to the Risk Management office and sign a waiver to drop the medical coverage if you do not want to continue the plan.
SUSD Health Benefits
Your benefits end on the last day of the month in which you: 125 Flex Plan
Administered by American Fidelity Assurance
 The 125 flex plan is structured in three Layer One
This is known as the “POP” or the premium only plan.
The district removes from taxation any monthly benefit buy-up
cost from your monthly gross and levies payroll taxes only on the
remaining salary. The net effect is that your paycheck stays
larger at the end of the month because your benefit contribution
is not taxed. This all happens in the payroll department. No
money is sent to American Fidelity. A designated form must be
signed to activate the option.
125 Flex Plan
Administered by American Fidelity Assurance
Layer Two
This is known as the medical reimbursement area. You
may claim up to an annual maximum of $3,600 of qualified
reimbursable expenses within this provision. Typical eligible
expenses include braces, lasix eye surgery or over the counter
drug expenses. Employee decides on a certain amount to be
deducted tax free from monthly salary. Employee pays the
expenses with regular income, then files a claim with American
Fidelity. American Fidelity then sends the reimbursement check
to the employee within 7-10 days.
125 Flex Plan
Administered by American Fidelity Assurance
Layer Three
This is known as the
child care/elder care reimbursement area.
You may claim up to an annual maximum of $5,000 of qualified
reimbursable expenses with this provision. Eligible expenses
would be child care charges or elder care charges.
Reimbursement works the same way as described in layer two.
125 Flex Plan
Administered by American Fidelity Assurance
American Fidelity also sells annuities, life insurance, and disability insurance.
125 Flex Plan
Administered by American Fidelity Assurance
with a “use it or lose it” provision.
claim expenses for all the money in the American Fidelity trust account, end of the plan year. There is a 70
day grace period after the end of the
Long Term Disability
 This coverage plan is fully paid by SUSD for CSEA 318 members only.
 The disability carrier is American Fidelity Long Term Disability
 Members of all other units who desire to purchase disability insurance should inquire within their collective bargaining units about group disability coverage.
Long Term Disability
 The following disability plan information applies to CSEA 318 members only.
 This plan pays 66 & 2/3 of your monthly Long Term Disability
Management office for CSEA 318 members
only. Return all completed forms including
doctors form to Risk .
 There’s a 30 day waiting period or the expiration of all leaves whichever is greater. This includes vacation and sick leave.
Long Term Disability
 At the end of the month you’ll receive two checks. One for differential pay from the district and the other from LTD carrier. The two checks together equal 2/3rds of your gross pay.
 Risk Management must receive a medical release from you before returning to work.
Workers Compensation
 If you sustain an on the job injury which requires medical treatment you must notify your supervisor immediately.
 To assure payment of benefits, a workers compensation claim form must be completed prior to treatment.
Workers Compensation
 Dameron and Kaiser Occupational Medical Clinics have been selected to treat on the job injuries for SUSD employees.
Initial medical treatment for all on the job
injuries may not be provided by your
personal chiropractor.
Workers Compensation
 Dameron Hospital Occupational Injury Clinic Workers Compensation
 Kaiser Permanente Occupational Injury Workers Compensation
 If you wish to be treated by your own physician for OJI you must submit a letter of
designation (must be signed by your
physician)
naming your Primary Care
Physician prior to the injury.
Workers Compensation
 Your designation may not be a chiropractor.
 Your predesignated physician can only be your primary care physician as assigned through your private health insurance.
Workers Compensation
 You’re required to bring your return to work
status report and/or release to Risk Management prior to returning to work.
 Injured employees with work restrictions must report to Risk prior to work.
Workers Compensation
“Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime, and may be subject to the state prison for up to 5 years or by a fine up Safety Handbook
 Within the packet of information you received is a copy of the SUSD Employee Safety Handbook. It is your responsibility to read and adhere to the safety rules listed. To report a safety concern see your supervisor.
Thank You
Please complete your enrollment at the front counter before leaving.

Source: http://www.stockton.k12.ca.us/risk/documents/Benefit%20Orientation%20Slideshow.pdf

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