Health & Voluntary Benefits

With the Kaiser Permanente Health Maintenance Organization (HMO) plans, you must obtain services at a Kaiser Permanente facility, except in the case of emergency. All of your care must be directed through your selected doctor, but you can choose and change your doctor at any time, for any reason. Kaiser Permanente integrates all elements of healthcare such as physicians, medical centers, pharmacy, and administration in one convenient facility. In addition, Kaiser Permanente offers online tools so you can email your doctor’s office, make appointments, refill prescriptions, and more.  VIEW KAISER HMO PLANS

With the Anthem Blue Cross Health Maintenance Organization (HMO) plans, you must choose a primary care physician (PCP) or medical group within the Select and Vivity networks. All of your care must be directed through your PCP or medical group. Any specialty care you need will be coordinated through your PCP and will generally require a referral or authorization. You will receive benefits only if you use the doctors, clinics, and hospitals that belong to the medical group in which you are enrolled, except in the case of an emergency.  VIEW ANTHEM HMO PLANS

The Anthem Blue Cross Preferred Provider Organization (PPO) plans allows you to direct your own care. If you receive care from a physician who is a member of the Prudent Buyer PPO network, a greater percentage of the entire cost will be paid by the insurance plan. However, you are not limited to the physicians within the network and you may self-refer to specialists. If you obtain services using a non‐network provider, please note that you will be responsible for the difference between the covered amount and the actual charges, and you may be responsible for filing claims.  VIEW ANTHEM PPO PLANS

With the Delta Dental Preferred Provider Organization (PPO) dental plan, you may visit a PPO dentist and benefit from the negotiated rate or visit a non‐network dentist. When you utilize a Delta Dental dentist, your out-of-pocket expenses will be less. You may also obtain services using a non-network dentist; however, you will be responsible for the difference between the covered amount and the actual charges and you may be responsible for filing claims.  VIEW DELTA DENTAL PPO PLAN

The VSP vision plan provides professional vision care and high-quality lenses and frames through a broad network of optical specialists. You will receive richer benefits if you utilize a network provider. If you use a non‐network provider, you will be responsible for paying all charges at the time of your appointment and will be required to file an itemized claim with VSP.  VIEW VSP PPO PLAN

• Marriage, divorce, legal separation or annulment
• Birth or adoption of a child
• A qualified medical child support order
• Death of a spouse or child
• A change in your dependent’s eligibility status
• Change in your residence or workplace (if your benefit options change)
• Loss of coverage through Medicaid or Children’s Health Insurance Program (CHIP)
• Loss of coverage from another health plan

• Effective October 1, 2018, the maximum District annual contribution for District medical insurance for each eligible full-time unit member shall be equivalent to 100% of each tier (1 party, 2 party, 3 or more) of the District’s lowest cost HMO medical health benefit plan.
• The maximum District annual contribution for District medical insurance shall be prorated for unit members working less than full-time.
  • Employees working less than full-time, but at least four (4) hours per day, five days per week, will have a proportionate amount (same proportion as their working time to full time) contributed to the premium under the same conditions applicable to full-time employees if the balance is paid by the employee.
  • Employees working less than four (4) hours per day, five (5) days per week shall not be eligible to participate in the medical care insurance plan.
• The District’s annual medical contribution may not be combined or applied to any other employee’s selection of medical benefits.
• A current District employee cannot be added as a dependent on a parent’s selected District medical plan.
• Unit members selecting coverage with a higher premium shall authorize payroll deductions for the amounts in excess of the District contribution as a condition of receipt of coverage.
• Premium payments for service less than a full school year shall be prorated.
• District paid coverage terminates on the last day of the unit member's final month of employment.
• Employees will be personally responsible for payment of the difference, if any, between the amount contributed by the District and the full amount of the premium.
  • The employee may authorize salary warrant deductions for the purpose of paying that portion of the premium for which the employee is responsible.

• The District will pay the full premium costs of the existing dental care plan for each eligible employee and dependents where applicable.
  • Employees working less than full-time, but at least four (4) hours per day, five (5) days per week, will have a proportionate amount (same proportion as their working full-time) contributed to the premium under the same conditions applicable to full-time employees, if the balance is paid by the employee.
  • Employees working less than four (4) hours per day, five (5) days per week, shall not be eligible to participate in the dental care insurance plan.
• Employees will be personally responsible for payment of the difference, if any, between the amount contributed by the District and the full amount of the premium.
  • The employee may authorize salary warrant deductions for the purpose of paying that portion of the premium for which the employee is responsible.

• The District will pay the full premium costs of the existing vision care plan for each eligible employee, and dependents where applicable.
  • Employees working less than full-time, but at least four (4) hours per day, five (5) days per week, will have a proportionate amount (same proportion as their working full-time) contributed to the premium under the same conditions applicable to full-time employees if the balance is paid by the employee.
  • Employees working less than four (4) hour per day, five (5) days per week, shall not be eligible to participate in the vision care insurance plan.
• Employees will be personally responsible for payment of the difference, if any, between the amount contributed by the District and the full amount of the premium.
  • The employee may authorize salary warrant deduction for the purpose of paying that portion of the premium for which the employee is responsible.

• The District shall pay the full premium costs for a life insurance policy for each eligible employee not to exceed a minimum face value of $25,000 or and a maximum District cost not to exceed premium value of $100 per member.
  • Employees working less than full-time, but at least four (4) hours per day, five (5) days per week, will have a proportionate amount (same proportion as their working full-time) contributed to the premium under the same conditions applicable to full-time employees if the balance is paid by the employees.
  • Employees working less than four (4) hours per day, five (5) days per week, shall not be eligible to participate in the life insurance plan.
• Employees will be personally responsible for payment of the difference, if any, between the amount contributed by the District and the full amount of the premium.
  • The employee may authorize salary warrant deductions for the purpose of paying that portion of the premium for which the employee is responsible.

Health Insurance

• Unit members who retire prior to January 1, 2016, shall be eligible for a District annual contribution toward District medical insurance equal to active employees in accordance subject to all of the following conditions:

  • He/she is enrolled in a district approved medical plan at the time his/her retirement becomes effective.

  • The employee has retired from District service in accordance with the regulations then in effect with the applicable retirement system (either STRS or PERS of which he/she is a member).

  • He/she has completed twenty (20) years of credited service with the District immediately prior to retirement.

  • He/she is at least fifty-five (55) years of age and is receiving retirement allowance from either STRS or PERS.

  • Any out of pocket costs will be reimbursed to the district by the retiree as a condition of continued eligibility.

  • Eligible retirees shall be covered for twelve (12) months annually.

  • Medical coverage for retirees shall terminate when the employee reaches age 65 or becomes Medicare eligible, whichever comes later.

• Eligible full time unit members who retire from the District after January 1, 2016, shall be eligible for a District contribution for retiree only medical coverage equal to active employees subject to the conditions listed above.