This year’s annual Open Enrollment for 2017 benefits occurs from October 3 to December 2, 2016. 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 December 2, 2016. All changes will be effective January 1, 2017. Please review the following brief highlights to understand changes that may affect you in 2017.
If you do not wish to make any changes to your benefit elections for the upcoming year, no action is required on your part during this Open Enrollment period.
[button href=”https://www.jhmbhealthconnect.com/6440″ bg_color=”#59969B” text_color=”#fff”]COBRA & ED Code Participants – Click Here For Your Open Enrollment Information [/button]
[tabs tab1=”Actives” tab2=”Non-Medicare Retirees” tab3=”Part-Time Employees” tab4=”Medicare Retirees”]
[tab]
[togg title=”Introducing the New Benefit Information Guide”]
The Joint Health Management Board strives to ensure its members are informed and responsible health care consumers, in the most cost-effective and efficient manner. To that end, we have streamlined the benefits information we provide to both active employees and new hires to the District. In this packet, you’ll find the 2017 Open Enrollment Benefit Information Guide, which replaces the numerous documents you may have received in the past during the annual enrollment period.
The Benefit Information Guide is your supplemental Open Enrollment resource to understanding and selecting the best benefit options for you and your family. In the guide, you’ll find information about:
[checklist]
- Eligibility and Enrollment Requirements
- Benefit Summaries, Cost Information, and Comparison Charts
- Vendor Information (including contact details)
- Annual Notices & Legal Information
[/checklist]
We encourage you to reference this new resource as you review your benefit options for 2017.
[/togg]
[togg title=”Plan Option A and Option B (PPO) Updates”]
NEW: Prescription Drug Copay Tiers in 2017
EnvisionRxOptions and the Fresno Unified School District are always working together to find ways to provide better prescription coverage while managing the rising costs of prescription medications. Effective January 1, 2017, the copay tier structure and the amount of days for which you can receive supplies will change.
New Copay Tier Structure
On January 1, 2017, there will be a new tier for specific generic medications that are covered with no copayment required. This new tier (tier 1) will cover generic medications that are used for treating hyperlipidemia, hypertension, diabetes, and depression with a $0 copay for 30-day and 90-day orders. The 30-day copay amounts for all existing tiers (tiers 2, 3, and 4) will not change, however the copay amount for the 90-day retail and mail order supplies will increase. Please review the following chart for more details.
| TIERS | 30-DAY RETAIL COPAY | 90-DAY RETAIL AND MAIL ORDER COPAY |
30-DAY SPECIALTY MEDICATION COPAY |
| Tier 1 Generic: Medications that are used for treating hyperlipidemia, hypertension, diabetes, and depression |
$0 |
$0 |
$10 |
| Tier 2 Generic: All other categories of covered, generic medications. |
$10 |
$20 |
|
| Tier 3 Preferred Brand: Preferred Brand Name medications |
$35 |
$70 |
$35 |
| Tier 4 Non-Preferred Brand: Non-Preferred Brand Name medications |
$50 |
$100 |
$50 |
180-day Supplies Will No Longer Be Available
On January 1, 2017, members will still be able to obtain 30-day supplies, as well as 90-day supplies of medications at retail pharmacies. In addition, members will be able to fill 90-day supplies of medication at mail order.
However, beginning January 1, 2017, 180-day supplies of medications will no longer be covered under the prescription benefit at retail pharmacies and mail order. Please contact your physician as a new prescription may be required for shorter day supplies of medications.
Always talk to your doctor before discontinuing or changing any medication. If you have medical questions please contact your health care provider. We encourage you to work with your physician to determine which medication options are best for you.
For More Information
Should you have additional questions on any of these updates within your prescription drug benefit, please contact the EnvisionRxOptions Customer Service Help Desk at (800) 361-4542. The Help Desk is here to assist you with prescription questions 24 hours a day/7 days a week.
[/togg]
[togg title=”Pacific Union Dental Plan: Name Change and New ID Cards”]
Effective January 1, 2017, the Pacific Union Dental (PUD) plan will become UHC Dental Direct Compensation plan. As a result, any participants currently on the PUD plan will receive new ID cards and information regarding plan enhancements in December 2016. Until then, if you have any questions regarding your coverage, please contact UHC Dental Direct at (877) 844-4999 Monday-Friday from 8:00 AM – 10:00 PM (ET) or visit www.myuhc.com.[/togg]
[togg title=”Rate Contribution Changes for 2017″]
The Joint Health Management Board (JHMB) continuously strives to manage and maintain the highest quality and most cost-effective benefits for our active employees and retirees. While there are no changes to your Vision provider or plan benefits in 2017, there will be increases of approximately $2-$6 for dental PPO premiums. Please review the rates included on the enclosed Benefits Enrollment form for more details.
Thanks to the improved program usage by our employees and retirees, and the efforts of the Fresno Unified School District and the JHMB, these rate changes are not as large as the healthcare industry average increases in recent years. However, it will require continued efforts by all of us to manage our overall healthcare expenses to help minimize increases in the coming years.
[/togg]
[togg title=”No Rate Contribution Increases for 2017″]
The Joint Health Management Board (JHMB) is pleased to announce that, thanks to the improved program usage by our employees and retirees, and the efforts of the Fresno Unified School District and the JHMB, there are no rate contribution increases for any of the benefits for the fifth straight year. In addition, there are no changes to your Vision providers or plan benefits in 2017. It will require continued efforts by all of us to manage our overall healthcare expenses to help minimize increases in the coming years.
[/togg]
[togg title=”Telehealth Services at Your Fingertips”]
In 2016, the Joint Health Management Board (JHMB) launched a new service offering from PlushCare to provide with you with access to a network of telehealth physicians available to you and your covered family members. For both PPO Plans, Plan Options A and B, the Plan covers all but $5 of the cost for each appointment, and no deductible applies when using PlushCare! As a reminder, Plan Option A has a $250 deductible and $15 copayment, and Plan Option B has a $1,000 deductible and $25 copayment. But when you use the PlushCare telehealth service, you only pay a $5 copayment!
When selecting a physician, what matters most to you? Availability, education, experience, and personality are all important considerations. PlushCare, a leading provider of healthcare over the phone or by videoconference, agrees with all of the above. Their physician network consists of board-certified physicians in internal medicine or pediatrics that trained at a top-25 medical school in the United States. Appointments are available 24 hours a day, 7 days a week.
PlushCare physicians provide the same level of care as in-person visits, including electronic prescriptions to your pharmacy in seconds. Their physicians are experts in telemedicine and devote, on average, nearly all their practice to PlushCare. You call or video chat with a physician and he or she will diagnose you or your family member’s health issue. Your PlushCare physician will then provide recommended treatments based on your symptoms. If appropriate, the physician can write a prescription and have it sent immediately to the pharmacy of your choice (prescription copay applies).
To access this benefit, call PlushCare at (866) 460-6205, download the app on your smartphone, or go online at www.plushcare.com. You will select “Book Appointment”, then select the physician you want to talk with, and a time that is convenient for you. First time users will be required to register, which is just a few simple steps. To register, you will need to enter your name and birthdate, along with a valid email address, password and payment information for the $5 copayment. Currently, credit and debit cards are acceptable forms of payment, and you will only be charged your $5 copayment.
If you’re not one of the hundreds of plan participants that have begun to use this service this year, we recommend it as your first option the next time you need access to a physician. For more information, visit www.JHMBHealthConnect.com/telehealth-at-your-fingertips.
[/togg]
[togg title=”WellPATH Program Update”]
A Special Reward for Your Commitment to Wellbeing
The WellPATH Program continues to search for ways to support you along your path to better health. Starting this fall, if you commit to improving your overall wellbeing, we will commit to making it easier for you. Complete ALL of your Behavior Modification Coaching and/or Personal Training Program sessions and you may be eligible to have WellPATH REIMBURSE YOUR PROGRAM FEES. Review the program details below and contact a Pinnacle Training Systems Wellness Coach at (559) 515-3578 for more details about this special offer.
Behavior Modification Coaching
This program focuses on sustainable nutrition and healthy lifestyle behaviors. Participants learn the skills and tools they need to incorporate life-long changes to undesirable habits and how to adopt healthy behaviors to reduce their risk of chronic disease.
During the initial consultation, participants work with the Pinnacle Training Systems Behavior Modification Coaches to establish their customized wellness goals. Thereafter, participants have 8, 30-minute sessions (in-person or by phone) to address barriers and achievements to meeting their goals. The coaching program also consists of 8 educational webinars, a nutritional workbook, nutritional analysis, and body composition tracking.
Personal Training Program
This program provides accountability to individuals having a hard time committing to a regular exercise program. Sessions focus on teaching individuals proper techniques and exercise regimes that can be mimicked at home or another facility.
During the initial consultation, participants work with Pinnacle Training Systems to determine goals and current level of fitness, assessment of strengths and weaknesses, and body composition tracking, as well as the design of a custom workout based on principles of exercise science.
For more information about these programs and other WellPATH offerings, visit www.JHMBHealthConnect.com/wellpath.
[/togg]
[togg title=”Tax Savings Opportunities Through Section 125 Plans”]
If you enrolled in the Section 125 flexible spending account (FSA) administered by American Fidelity Assurance Company (AFA) for the 2016 plan year, be sure to review your medical spending throughout the year to ensure you are maximizing your benefits. You may reimburse yourself for eligible healthcare expenses incurred by you, your spouse, eligible dependents, and/or adult children up to age 26. You may also reimburse yourself for eligible dependent day care expenses provided that they fall within the special rules outlined by the plan.
The JHMB recommends that you review your FSA on a quarterly basis to ensure that you are maximizing your benefits and reimbursements. Remember, if you don’t use your money by the end of the calendar year, you lose it. Use it, don’t lose it!
As reminder, if you wish to utilize the Section 125 flexible spending account in 2017, you must re-enroll with AFA. Please review the AFA information enclosed in this open enrollment packet for more details regarding AFA’s on-site enrollment sessions this fall and their Section 125 plan offerings.
[/togg]
[togg title=”Take a Healthy Minute and Schedule a Preventive Cancer Screening”]
Under the District’s health plan, all participants are eligible for FREE preventive cancer screenings. Take a Healthy Minute and schedule an appointment with your physician TODAY to get up-to-date with your routine cancer screenings. If you need assistance with locating a physician, visit our Locating Network Providers page.
[/togg]
[togg title=”Employee Assistance Program (EAP) Reminder”]
The Employee Assistance Program, offered through Claremont EAP, helps you resolve personal issues before they become more serious and difficult to manage. Claremont EAP will support you quickly and confidentially in dealing with the stresses and challenges of everyday life. You and your family members can receive the following professional, confidential counseling services:
- – 5 Free Counseling Visits per Incident
- – Legal Consultations
- – Financial Services
- – Child/Elder Care Referrals
- – School/College Assistance
- – Adoption Assistance
- – Pet Care Referrals
- – Daily Living/Convenience Referrals
- – Wellness Referrals
The EAP also provides access to resources that can help you address virtually any personal concern or question. Visit www.ClaremontEAP.com for more information or call Claremont EAP at (800) 834-3773 to discuss your question or issue with an experienced counselor who will refer you to the resources most appropriate for your needs.[/togg]
[togg title=”Review/Download the Materials”]
To assist you in making the best decisions for you and your family, the following information is available for your review:
[checklist]
- 2017 Open Enrollment Benefits Information Guide
- American Fidelity Section 125 Open Enrollment Announcement including a list of scheduled sites and dates
- Annual Participants Notices
- Benefits Enrollment Form – which must be completed and returned to the Benefits Office no later than December 2, 2016.
- California Region Group (Kaiser) Enrollment/Change Form
[/checklist]
For additional plan information and/or provider contact information view the following pages:
www.JHMBHealthConnect.com/your-benefits
www.JHMBHealthConnect.com/using-plans[/togg]
[/tab]
[tab]
[togg title=”Plan Option A and Option B (PPO) Updates”]
NEW: Prescription Drug Copay Tiers in 2017
This does NOT apply to the EnvisionRx Plus Medicare Part D Prescription Plan. If you are enrolled in the EnvisionRx Plus Medicare Part D Prescription Plan, Envision will mail you a summary of benefits outlining changes, if any, to the EnvisionRx Plus plan.
EnvisionRxOptions and the Fresno Unified School District are always working together to find ways to provide better prescription coverage while managing the rising costs of prescription medications. Effective January 1, 2017, the copay tier structure and the amount of days for which you can receive supplies will change.
New Copay Tier Structure
On January 1, 2017, there will be a new tier for specific generic medications that are covered with no copayment required. This new tier (tier 1) will cover generic medications that are used for treating hyperlipidemia, hypertension, diabetes, and depression with a $0 copay for 30-day and 90-day orders. The 30-day copay amounts for all existing tiers (tiers 2, 3, and 4) will not change, however the copay amount for the 90-day retail and mail order supplies will increase. Please review the following chart for more details.
| TIERS | 30-DAY RETAIL COPAY | 90-DAY RETAIL AND MAIL ORDER COPAY |
30-DAY SPECIALTY MEDICATION COPAY |
| Tier 1 Generic: Medications that are used for treating hyperlipidemia, hypertension, diabetes, and depression |
$0 |
$0 |
$10 |
| Tier 2 Generic: All other categories of covered, generic medications. |
$10 |
$20 |
|
| Tier 3 Preferred Brand: Preferred Brand Name medications |
$35 |
$70 |
$35 |
| Tier 4 Non-Preferred Brand: Non-Preferred Brand Name medications |
$50 |
$100 |
$50 |
180-day Supplies Will No Longer Be Available
On January 1, 2017, members will still be able to obtain 30-day supplies, as well as 90-day supplies of medications at retail pharmacies. In addition, members will be able to fill 90-day supplies of medication at mail order.
However, beginning January 1, 2017, 180-day supplies of medications will no longer be covered under the prescription benefit at retail pharmacies and mail order. Please contact your physician as a new prescription may be required for shorter day supplies of medications.
Always talk to your doctor before discontinuing or changing any medication. If you have medical questions please contact your health care provider. We encourage you to work with your physician to determine which medication options are best for you.
For More Information
Should you have additional questions on any of these updates within your prescription drug benefit, please contact the EnvisionRxOptions Customer Service Help Desk at (800) 361-4542. The Help Desk is here to assist you with prescription questions 24 hours a day/7 days a week.
[/togg]
[togg title=”Pacific Union Dental Plan: Name Change and New ID Cards”]
Effective January 1, 2017, the Pacific Union Dental (PUD) plan will become UHC Dental Direct Compensation plan. As a result, any participants currently on the PUD plan will receive new ID cards and information regarding plan enhancements in December 2016. Until then, if you have any questions regarding your coverage, please contact UHC Dental Direct at (877) 844-4999 Monday-Friday from 8:00 AM – 10:00 PM (ET) or visit www.myuhc.com.[/togg]
[togg title=”Rate Contribution Changes for 2017″]
The Joint Health Management Board (JHMB) continuously strives to manage and maintain the highest quality and most cost-effective benefits for our active employees and retirees. While there are no changes to your Vision provider or plan benefits in 2017, there will be increases of approximately $2-$6 for dental PPO premiums. Please review the rates included on the enclosed Benefits Enrollment form for more details.
Thanks to the improved program usage by our employees and retirees, and the efforts of the Fresno Unified School District and the JHMB, these rate changes are not as large as the healthcare industry average increases in recent years. However, it will require continued efforts by all of us to manage our overall healthcare expenses to help minimize increases in the coming years.
[/togg]
[togg title=”Telehealth Services at Your Fingertips”]
In 2016, the Joint Health Management Board (JHMB) launched a new service offering from PlushCare to provide with you with access to a network of telehealth physicians available to you and your covered family members. For both PPO Plans, Plan Options A and B, the Plan covers all but $5 of the cost for each appointment, and no deductible applies when using PlushCare! As a reminder, Plan Option A has a $250 deductible and $15 copayment, and Plan Option B has a $1,000 deductible and $25 copayment. But when you use the PlushCare telehealth service, you only pay a $5 copayment!
When selecting a physician, what matters most to you? Availability, education, experience, and personality are all important considerations. PlushCare, a leading provider of healthcare over the phone or by videoconference, agrees with all of the above. Their physician network consists of board-certified physicians in internal medicine or pediatrics that trained at a top-25 medical school in the United States. Appointments are available 24 hours a day, 7 days a week.
PlushCare physicians provide the same level of care as in-person visits, including electronic prescriptions to your pharmacy in seconds. Their physicians are experts in telemedicine and devote, on average, nearly all their practice to PlushCare. You call or video chat with a physician and he or she will diagnose you or your family member’s health issue. Your PlushCare physician will then provide recommended treatments based on your symptoms. If appropriate, the physician can write a prescription and have it sent immediately to the pharmacy of your choice (prescription copay applies).
To access this benefit, call PlushCare at (866) 460-6205, download the app on your smartphone, or go online at www.plushcare.com. You will select “Book Appointment”, then select the physician you want to talk with, and a time that is convenient for you. First time users will be required to register, which is just a few simple steps. To register, you will need to enter your name and birthdate, along with a valid email address, password and payment information for the $5 copayment. Currently, credit and debit cards are acceptable forms of payment, and you will only be charged your $5 copayment.
If you’re not one of the hundreds of plan participants that have begun to use this service this year, we recommend it as your first option the next time you need access to a physician. For more information, visit www.JHMBHealthConnect.com/telehealth-at-your-fingertips.
[/togg]
[togg title=”WellPATH Program Update”]
A Special Reward for Your Commitment to Wellbeing
The WellPATH Program continues to search for ways to support you along your path to better health. Starting this fall, if you commit to improving your overall wellbeing, we will commit to making it easier for you. Complete ALL of your Behavior Modification Coaching and/or Personal Training Program sessions and you may be eligible to have WellPATH REIMBURSE YOUR PROGRAM FEES. Review the program details below and contact a Pinnacle Training Systems Wellness Coach at (559) 515-3578 for more details about this special offer.
Behavior Modification Coaching
This program focuses on sustainable nutrition and healthy lifestyle behaviors. Participants learn the skills and tools they need to incorporate life-long changes to undesirable habits and how to adopt healthy behaviors to reduce their risk of chronic disease.
During the initial consultation, participants work with the Pinnacle Training Systems Behavior Modification Coaches to establish their customized wellness goals. Thereafter, participants have 8, 30-minute sessions (in-person or by phone) to address barriers and achievements to meeting their goals. The coaching program also consists of 8 educational webinars, a nutritional workbook, nutritional analysis, and body composition tracking.
Personal Training Program
This program provides accountability to individuals having a hard time committing to a regular exercise program. Sessions focus on teaching individuals proper techniques and exercise regimes that can be mimicked at home or another facility.
During the initial consultation, participants work with Pinnacle Training Systems to determine goals and current level of fitness, assessment of strengths and weaknesses, and body composition tracking, as well as the design of a custom workout based on principles of exercise science.
For more information about these programs and other WellPATH offerings, visit www.JHMBHealthConnect.com/wellpath.
[/togg]
[togg title=”Take a Healthy Minute and Schedule a Preventive Cancer Screening”]
Under the District’s health plan, all participants are eligible for FREE preventive cancer screenings. Take a Healthy Minute and schedule an appointment with your physician TODAY to get up-to-date with your routine cancer screenings. If you need assistance with locating a physician, visit our Locating Network Providers page.
[/togg]
[togg title=”Employee Assistance Program (EAP) Reminder”]
The Employee Assistance Program, offered through Claremont EAP, helps you resolve personal issues before they become more serious and difficult to manage. Claremont EAP will support you quickly and confidentially in dealing with the stresses and challenges of everyday life. You and your family members can receive the following professional, confidential counseling services:
- – 5 Free Counseling Visits per Incident
- – Legal Consultations
- – Financial Services
- – Child/Elder Care Referrals
- – School/College Assistance
- – Adoption Assistance
- – Pet Care Referrals
- – Daily Living/Convenience Referrals
- – Wellness Referrals
The EAP also provides access to resources that can help you address virtually any personal concern or question. Visit www.ClaremontEAP.com for more information or call Claremont EAP at (800) 834-3773 to discuss your question or issue with an experienced counselor who will refer you to the resources most appropriate for your needs.[/togg]
[togg title=”Review/Download the Materials”]
To assist you in making the best decisions for you and your family, the following information is available for your review:
[checklist]
- Annual Participants Notices
- Benefits Enrollment Form – which must be completed and returned to the Benefits Office no later than December 2, 2016.
[/checklist]
For additional plan information and/or provider contact information view the following pages:
www.JHMBHealthConnect.com/your-benefits
www.JHMBHealthConnect.com/using-plans[/togg]
[/tab]
[tab]
[togg title=”No Benefit Changes/Employee Rate Contribution Increases for 2017″]
The Joint Health Management Board (JHMB) is pleased to announce that, thanks to the efforts of the Fresno Unified School District, the JHMB, and the improved program usage by our employees and retirees, there are no employee rate contribution increases for any of the benefits for the fifth straight year. In addition, there are no changes to your Vision plan benefits in 2017. It will require continued efforts by all of us to manage our overall healthcare expenses to help minimize increases in the coming years. [/togg]
[togg title=”Tax Savings Opportunities Through Section 125 Plans”]
If you enrolled in the Section 125 flexible spending account (FSA) administered by American Fidelity Assurance Company (AFA) for the 2016 plan year, be sure to review your medical spending throughout the year to ensure you are maximizing your benefits. You may reimburse yourself for eligible healthcare expenses incurred by you, your spouse, eligible dependents, and/or adult children up to age 26. You may also reimburse yourself for eligible dependent day care expenses provided that they fall within the special rules outlined by the plan.
The JHMB recommends that you review your FSA on a quarterly basis to ensure that you are maximizing your benefits and reimbursements. Remember, if you don’t use your money by the end of the calendar year, you lose it. Use it, don’t lose it!
As reminder, if you wish to utilize the Section 125 flexible spending account in 2017, you must re-enroll with AFA. Please review the AFA information enclosed in this open enrollment packet for more details regarding AFA’s on-site enrollment sessions this fall and their Section 125 plan offerings.[/togg]
[togg title=”Pacific Union Dental Plan: Name Change and New ID Cards”]
Effective January 1, 2017, the Pacific Union Dental (PUD) plan will become UHC Dental Direct Compensation plan. As a result, any participants currently on the PUD plan will receive new ID cards and information regarding plan enhancements in December 2016. Until then, if you have any questions regarding your coverage, please contact UHC Dental Direct at (877) 844-4999 Monday-Friday from 8:00 AM – 10:00 PM (ET) or visit www.myuhc.com.[/togg]
[togg title=”Review/Download the Materials”]
To assist you in making the best decisions for you and your family, the following information is available for your review:
[checklist]
- American Fidelity Section 125 Open Enrollment Announcement including a list of scheduled sites and dates
- Annual Participant Notices
- Benefits Open Enrollment Form – which must be completed and returned to the Benefits Office no later than December 2, 2016.
[/checklist]
For additional plan information and/or provider contact information view the following pages:
www.JHMBHealthConnect.com/your-benefits
www.JHMBHealthConnect.com/using-plans[/togg]
[/tab]
[tab]
[togg title=”No Action Required”]
This year’s annual Open Enrollment for 2017 benefits occurs from October 3 to December 2, 2016. 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 December 2, 2016 (or November 8, 2016 if you wish to enroll in Kaiser Senior Advantage, see page 4). All changes will be effective January 1, 2017. Please review the following brief highlights to understand changes that may affect you in 2017.
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]
[togg title=”Plan Option A and Option B (PPO) Updates”]
NEW: Prescription Drug Copay Tiers in 2017
This does NOT apply to the EnvisionRx Plus Medicare Part D Prescription Plan. If you are enrolled in the EnvisionRx Plus Medicare Part D Prescription Plan, Envision will mail you a summary of benefits outlining changes, if any, to the EnvisionRx Plus plan.
EnvisionRxOptions and the Fresno Unified School District are always working together to find ways to provide better prescription coverage while managing the rising costs of prescription medications. Effective January 1, 2017, the copay tier structure and the amount of days for which you can receive supplies will change.
New Copay Tier Structure
On January 1, 2017, there will be a new tier for specific generic medications that are covered with no copayment required. This new tier (tier 1) will cover generic medications that are used for treating hyperlipidemia, hypertension, diabetes, and depression with a $0 copay for 30-day and 90-day orders. The 30-day copay amounts for all existing tiers (tiers 2, 3, and 4) will not change, however the copay amount for the 90-day retail and mail order supplies will increase. Please review the following chart for more details.
| TIERS | 30-DAY RETAIL COPAY | 90-DAY RETAIL AND MAIL ORDER COPAY |
30-DAY SPECIALTY MEDICATION COPAY |
| Tier 1 Generic: Medications that are used for treating hyperlipidemia, hypertension, diabetes, and depression |
$0 |
$0 |
$10 |
| Tier 2 Generic: All other categories of covered, generic medications. |
$10 |
$20 |
|
| Tier 3 Preferred Brand: Preferred Brand Name medications |
$35 |
$70 |
$35 |
| Tier 4 Non-Preferred Brand: Non-Preferred Brand Name medications |
$50 |
$100 |
$50 |
180-day Supplies Will No Longer Be Available
On January 1, 2017, members will still be able to obtain 30-day supplies, as well as 90-day supplies of medications at retail pharmacies. In addition, members will be able to fill 90-day supplies of medication at mail order.
However, beginning January 1, 2017, 180-day supplies of medications will no longer be covered under the prescription benefit at retail pharmacies and mail order. Please contact your physician as a new prescription may be required for shorter day supplies of medications.
Always talk to your doctor before discontinuing or changing any medication. If you have medical questions please contact your health care provider. We encourage you to work with your physician to determine which medication options are best for you.
For More Information
Should you have additional questions on any of these updates within your prescription drug benefit, please contact the EnvisionRxOptions Customer Service Help Desk at (800) 361-4542. The Help Desk is here to assist you with prescription questions 24 hours a day/7 days a week.
[/togg]
[togg title=”Pacific Union Dental Plan: Name Change and New ID Cards”]
Effective January 1, 2017, the Pacific Union Dental (PUD) plan will become UHC Dental Direct Compensation plan. As a result, any participants currently on the PUD plan will receive new ID cards and information regarding plan enhancements in December 2016. Until then, if you have any questions regarding your coverage, please contact UHC Dental Direct at (877) 844-4999 Monday-Friday from 8:00 AM – 10:00 PM (ET) or visit www.myuhc.com.[/togg]
[togg title=”Rate Contribution Changes for 2017″]
The Joint Health Management Board (JHMB) continuously strives to manage and maintain the highest quality and most cost-effective benefits for our active employees and retirees. While there are no changes to your Vision provider or plan benefits in 2017, there will be increases of approximately $2-$6 for dental PPO premiums. Please review the rates included on the enclosed Benefits Enrollment form for more details.
Thanks to the improved program usage by our employees and retirees, and the efforts of the Fresno Unified School District and the JHMB, these rate changes are not as large as the healthcare industry average increases in recent years. However, it will require continued efforts by all of us to manage our overall healthcare expenses to help minimize increases in the coming years.
[/togg]
[togg title=”Telehealth Services at Your Fingertips”]
In 2016, the Joint Health Management Board (JHMB) launched a new service offering from PlushCare to provide with you with access to a network of telehealth physicians available to you and your covered family members. For both PPO Plans, Plan Options A and B, the Plan covers all but $5 of the cost for each appointment, and no deductible applies when using PlushCare! As a reminder, Plan Option A has a $250 deductible and $15 copayment, and Plan Option B has a $1,000 deductible and $25 copayment. But when you use the PlushCare telehealth service, you only pay a $5 copayment!
When selecting a physician, what matters most to you? Availability, education, experience, and personality are all important considerations. PlushCare, a leading provider of healthcare over the phone or by videoconference, agrees with all of the above. Their physician network consists of board-certified physicians in internal medicine or pediatrics that trained at a top-25 medical school in the United States. Appointments are available 24 hours a day, 7 days a week.
PlushCare physicians provide the same level of care as in-person visits, including electronic prescriptions to your pharmacy in seconds. Their physicians are experts in telemedicine and devote, on average, nearly all their practice to PlushCare. You call or video chat with a physician and he or she will diagnose you or your family member’s health issue. Your PlushCare physician will then provide recommended treatments based on your symptoms. If appropriate, the physician can write a prescription and have it sent immediately to the pharmacy of your choice (prescription copay applies).
To access this benefit, call PlushCare at (866) 460-6205, download the app on your smartphone, or go online at www.plushcare.com. You will select “Book Appointment”, then select the physician you want to talk with, and a time that is convenient for you. First time users will be required to register, which is just a few simple steps. To register, you will need to enter your name and birthdate, along with a valid email address, password and payment information for the $5 copayment. Currently, credit and debit cards are acceptable forms of payment, and you will only be charged your $5 copayment.
If you’re not one of the hundreds of plan participants that have begun to use this service this year, we recommend it as your first option the next time you need access to a physician. For more information, visit www.JHMBHealthConnect.com/telehealth-at-your-fingertips.
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[togg title=”Attend a Benefits Workshop”]
The JHMB, in collaboration with Kaiser Permanente, EnvisionRx, and the District’s Benefits Office will conduct a 1.5-hour benefits workshop specifically to provide information and address your questions regarding Kaiser Permanente Senior Advantage, the EnvisionRx Plus Medicare Part D prescription drug plan, and changes to how your premiums will be billed. Mark your calendars!
- Friday, October 14, 2016
9:30 – 11:00 AM
Center for Professional Development
Room 100
1833 E Street
Fresno, CA 93706
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Special Enrollment Ends November 8, 2016
As a reminder, from October 3 – November 8, 2016, Fresno Unified School District is offering a Special Enrollment for the Kaiser Permanente Senior Advantage plan. This employer-sponsored group coverage is being offered to Medicare-eligible retirees and spouses.
Participation in the Senior Advantage plan is not mandatory and is being offered in addition to the current PPO plans. However, if you wish to change to Senior Advantage effective January 1, 2017, you will have to make this change during the Special Enrollment period and return your election forms to the District’s Benefit Department by November 8, 2016. Any other changes you wish to make to your existing coverage can be made during the Annual Open Enrollment period from October 3 – December 2, 2016.
To learn more about the Kaiser Permanente Senior Advantage plan, please attend the Benefits Workshop noted above or contact Kaiser Permanente at the information provided below. Enrollment forms will be provided at the Benefits Workshop or available for pick up at the District Benefits Office. You may contact Kaiser Permanente to have an enrollment form mailed to you.
Questions about the Senior Advantage (HMO) Plan
Kaiser Permanente
(855) 843-8390
(TTY 711 for the deaf, hard of hearing, or speech impaired)
Seven days a week, 8 a.m. to 8 p.m.
As a reminder, if you wish to change to Senior Advantage effective January 1, 2017, you will have to make this change by November 8, 2016. Any other changes you wish to make to your current health plan offerings can be made during the Annual Open Enrollment period from October 3 – December 2, 2016.
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A Special Reward for Your Commitment to Wellbeing
The WellPATH Program continues to search for ways to support you along your path to better health. Starting this fall, if you commit to improving your overall wellbeing, we will commit to making it easier for you. Complete ALL of your Behavior Modification Coaching and/or Personal Training Program sessions and you may be eligible to have WellPATH REIMBURSE YOUR PROGRAM FEES. Review the program details below and contact a Pinnacle Training Systems Wellness Coach at (559) 515-3578 for more details about this special offer.
Behavior Modification Coaching
This program focuses on sustainable nutrition and healthy lifestyle behaviors. Participants learn the skills and tools they need to incorporate life-long changes to undesirable habits and how to adopt healthy behaviors to reduce their risk of chronic disease.
During the initial consultation, participants work with the Pinnacle Training Systems Behavior Modification Coaches to establish their customized wellness goals. Thereafter, participants have 8, 30-minute sessions (in-person or by phone) to address barriers and achievements to meeting their goals. The coaching program also consists of 8 educational webinars, a nutritional workbook, nutritional analysis, and body composition tracking.
Personal Training Program
This program provides accountability to individuals having a hard time committing to a regular exercise program. Sessions focus on teaching individuals proper techniques and exercise regimes that can be mimicked at home or another facility.
During the initial consultation, participants work with Pinnacle Training Systems to determine goals and current level of fitness, assessment of strengths and weaknesses, and body composition tracking, as well as the design of a custom workout based on principles of exercise science.
For more information about these programs and other WellPATH offerings, visit www.JHMBHealthConnect.com/wellpath.
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[togg title=”Take a Healthy Minute and Schedule a Preventive Cancer Screening”]
Under the District’s health plan, all participants are eligible for FREE preventive cancer screenings. Take a Healthy Minute and schedule an appointment with your physician TODAY to get up-to-date with your routine cancer screenings. If you need assistance with locating a physician, visit our Locating Network Providers page.
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[togg title=”Employee Assistance Program (EAP) Reminder”]
The Employee Assistance Program, offered through Claremont EAP, helps you resolve personal issues before they become more serious and difficult to manage. Claremont EAP will support you quickly and confidentially in dealing with the stresses and challenges of everyday life. You and your family members can receive the following professional, confidential counseling services:
- – 5 Free Counseling Visits per Incident
- – Legal Consultations
- – Financial Services
- – Child/Elder Care Referrals
- – School/College Assistance
- – Adoption Assistance
- – Pet Care Referrals
- – Daily Living/Convenience Referrals
- – Wellness Referrals
The EAP also provides access to resources that can help you address virtually any personal concern or question. Visit www.ClaremontEAP.com for more information or call Claremont EAP at (800) 834-3773 to discuss your question or issue with an experienced counselor who will refer you to the resources most appropriate for your needs.[/togg]
[togg title=”Review/Download the Materials”]
To assist you in making the best decisions for you and your family, the following information is available for your review:
[checklist]
- Annual Participant Notices
- Benefits Plan Comparison Chart
- Benefits Enrollment Form – which must be completed and returned to the Benefits Office no later than December 2, 2016. As a reminder, if you wish to change to the Kaiser Senior Advantage plan, you will have to make this change by November 8, 2016.
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For additional plan information and/or provider contact information view the following pages:
www.JHMBHealthConnect.com/your-benefits
www.JHMBHealthConnect.com/using-plans[/togg]
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