This year’s annual Open Enrollment for 2016 benefits occurs from October 1 to November 30, 2015. If you wish to make any changes to your existing coverage, you must complete the enclosed Enrollment Form and return it to the District Benefits Office no later than November 30, 2015. All changes will be effective January 1, 2016. Please review the following brief highlights to understand changes that may affect you in 2016.
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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 enclosed in this packet.[/togg]
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New Telehealth Offering from PlushCare: The Joint Health Management Board (JHMB) is pleased to announce that effective January 1, 2016 the PlushCare network of telehealth physicians will be available to all PPO medical plan participants and covered family members. For both PPO Plans, Plan Options A and B, the Plan will cover all but $5 of the cost for each appointment, and no deductible applies when using PlushCare!
Telehealth is a convenient service for the diagnosis and treatment of many non-acute medical conditions. This service will be offered through PlushCare, and provides you with on-demand access to U.S. Board certified physicians via secure video or by phone. PlushCare physicians provide the same level of care as in-person visits, including electronic prescriptions to your pharmacy in seconds. Appointments are available 24 hours a day, 7 days a week.
Over the coming weeks, you’ll be provided with more information regarding PlushCare and the telehealth service. In addition, be sure to attend a Benefits Workshop this Fall, as the JHMB will be providing more detailed information and answering questions regarding this new offering.
Introducing a Prescription Drug Formulary: EnvisionRx Options and the JHMB are always working together to find ways to provide better prescription coverage while managing the rising costs of prescription medications. Currently, the Plan offers co-pays at $10 and $35 for generic and brand name drugs, respectively. Effective January 1, 2016, Plan Options A and B will begin using a prescription drug formulary list, which creates a new “Non-preferred Brand-name Drugs” tier and co-pay.
As a result of this plan change, brand-name drugs that have a generic alternative or an equivalent acting brand name available will be placed on the non-preferred brand tier with a $50 copayment, while their generic alternative will be available on the generic tier at a $10 copayment. Brand-name drugs without a generic alternative or an equivalent acting brand name available will continue to be available as preferred brand-name drugs with a $35 copayment.
- Generic Drugs: $10
- Preferred Brand-name Drugs: $35
- Non-preferred Brand-name drugs: $50
NOTE: These changes in tier level may impact your current copay if you choose to continue to receive a Non-preferred Brand-name medication.
Over the coming weeks, you’ll be provided with more information regarding this prescription drug benefit change. In addition, be sure to attend a Benefits Workshop this fall, as the JHMB will be providing more detailed information and answering questions regarding this plan change.
Attend a Benefits Workshop: The JHMB, in collaboration with Delta Health Systems and EnvisionRx, will conduct two 1.5-hour benefits workshops specifically to provide information and address your questions regarding the new PlushCare telehealth offering and prescription drug formulary change. Review the dates below and mark your calendars.
- Wednesday, October 28, 2015 at 5:00 PM – 6:30 PM
Bullard High School | Theatre
5445 N. Palm Ave
Fresno, CA 93704
- Wednesday, November 4, 2015 at 5:00 PM – 6:30 PM
Sunnyside High School | Theater
1019 S. Peach Ave
Fresno, CA 93727
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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, 2016, 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 this Open Enrollment packet.[/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:
Benefits Enrollment Form – which must be completed and returned to the Benefits Office no later than November 30, 2015.
Summary of Zip Code Ranges For Kaiser Permanente Service Areas
For additional plan information and/or provider contact information view the following pages: