2014 Open Enrollment – COBRA & ED Code Participants

This year’s annual Open Enrollment for 2014 benefits occurs from October 1 to December 2, 2013. If you wish to make any changes to your existing coverage, you must complete the Enrollment Form and return it to the District Benefits Office no later than December 2, 2013. All changes will be effective January 1, 2014. Please review the following brief highlights to understand changes that may affect you in 2014.
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New Prescription Benefit Manager: On January 1, 2014, Citizens Rx will replace EnvisionRx as the Prescription Benefits Manager (PBM) for the two PPO Plans. However, this change does not affect participants in the EnvisionRX Plus Medicare Part D plan (see details below).

The JHMB has made this change for 2014 to curb the rising cost of healthcare and maintain existing copays. There will not be any changes in benefits or a reduction in your current pharmacy network as a result of this change. This move is intended to mirror your current plan design with minimal disruption. In addition, any of your current, active prescriptions on file with a participating network pharmacy will remain in effect.

The JHMB is proud that this change will provide participants with enhanced customer service. Citizens Rx is dedicated to delivering safe, high-quality pharmacy care at optimal cost and offers participant-centered service features such as:

– A dedicated call center line with extended hours, live call support and operations
– Mobile Virtual Pharmacy Card App that provides dosage reminders, refill alerts, and GPS functions to locate the nearest pharmacies
– Mail order pharmacy where 99% of all prescriptions ship out within 24 hours
– Acceptance at more than 63,000 retail pharmacies nationwide

In December, you will receive new ID cards and detailed information about Citizensā€™ network, mail order pharmacy, and other services.

This PBM change does not affect participants in the EnvisionRx Plus Medicare Part D plan. If you currently have an EnvisionRx Plus ID card (as shown below), you will not be affected by this change. If you still have questions regarding your enrollment, please feel free to contact EnvisionRx at (800) 361-4542 for assistance.


$1,000 Cap for Non-Network Outpatient Surgical Facilities: In addition, as of January 1, 2014, the maximum benefit for non-network outpatient surgical facilities will be $1,000 per incident. This means, if you wish to receive an outpatient surgery from a non-network ambulatory surgical center, hospital or other facility on or after January 1, 2014, you will be responsible for facility charges above the $1,000 benefit. If you currently have surgeries scheduled on or after January 1, 2014, be sure to check whether the surgery will be performed at a network facility. Delta Health Systems is available to assist you in determining whether a particular provider is an Anthem Blue Cross network provider or a non-network provider. You may contact Delta Health Systems at (800) 807-0820.

New 24/7 NurseLine Service: Lastly, the WellPATH Employee Wellness Program is now sponsoring the Anthem Blue Cross 24/7 NurseLine for all Plan participants enrolled in the PPO plans. The 24/7 NurseLine is there for you (at no cost) whenever you need to consult a health professional regarding your health concerns. At home, on vacation, or on a business trip, this service provides you with direct access to a registered nurse (English or Spanish) to answer questions about allergies, fevers, types of preventive care, or any other topic to help you along your path to better health. Be sure to review the flyer enclosed in the packet sent to your home for more details on this new program. This service becomes available on October 1, 2013, so if you are an existing PPO participant, you can start to use this service at that time.[/togg]
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You can only enroll in Kaiser Permanente Health Plan if you live or work in a zip code on the attached Kaiser zip code range list. Also, Kaiser Permanente Health Plan coverage is only available to participants not eligible for Medicare (under age 65). If you are a retiree eligible for Medicare, effective January 1, 2014, you have the option to enroll in the Kaiser Permanente Senior Advantage Plan. Please contact the District Benefits Office for more information on the Senior Advantage Plan.

To enroll in Kaiser, you must complete the Kaiser enrollment form along with the FUSD benefits enrollment form. For more information about Kaiser Permanente plan benefits and service areas, review the supplemental information enclosed in Open Enrollment packet sent to your home.[/togg]

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If you do not wish to make any changes to your existing coverage for the upcoming year, no action is required on your part during this Open Enrollment period. However, if you wish to make changes to your existing coverage you must complete the Benefits Open Enrollment form.[/togg]

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To assist you in making the best decisions for you and your family, the following information is available for your review:

Summary of Benefits & Coverage (Plan A | Plan B | Plan C)

Anthem 24/7 NurseLine Flyer

Summary of Medical, Dental, and Vision Rates

Benefits Enrollment Forms

Summary of Zip Code Ranges For Kaiser Permanente Service Areas

For additional plan information and/or provider contact information view the following pages:




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