This year’s annual Open Enrollment for 2023 benefits occurs from October 1 to November 30, 2022. Please review the following highlights below to understand changes that may affect you in 2023.
[button href=”https://www.jhmbhealthconnect.com/11649″ bg_color=”#59969B” text_color=”#fff”]All Other Plan Participants – Click Here For Your Open Enrollment Information [/button]
[tabs tab1=”COBRA Participants” tab2=”ED Code Participants” ] [tab]
This year’s annual Open Enrollment for 2023 benefits occurs from October 1 to November 30, 2022. 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 Wednesday, November 30, 2022. All changes will be effective January 1, 2023. Please review the following brief highlights in this letter to understand changes that may affect you in 2023.
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 title=”Plan Option A and Option B (PPO) Participants”]
NEW: Annual Coordination of Benefits (COB) Form Required Starting January 2023
Beginning 2023, all Plan Option A and Option B (PPO) participants with one or more covered dependent(s) will be required to complete an annual Coordination of Benefits (COB) Form with Delta Health Systems (DHS). The District’s plans contain a “Coordination of Benefits” provision to ensure coordination of coverage between payors. For billing purposes, when a patient is covered under more than one group plan, one payor becomes the “primary carrier” and the other becomes the “secondary carrier.” The primary carrier must pay benefits before the secondary carrier can determine what benefits it will pay. This applies if you have more than one medical plan, including Medicare coverage.
In January 2023, DHS will mail the annual COB form to all Plan Option A and Option B (PPO) participants with one or more covered dependent(s) – including Medicare-eligible retirees. Be sure to review your form and make any necessary changes to ensure your information is up-to-date. Sign all pages and return the complete COB form to DHS within 90 days of the date of the mailed letter. Failure to complete and/or return the form within the 90-day period may result in any pending claims being denied. For more information, contact DHS Customer Service at (800) 807-0820.
Telehealth: You’ve Got Teladoc – Talk to a Doctor Anywhere, Anytime by Phone or Video
Teladoc provides telehealth services for PPO Plan Options A & B. With Teladoc, you can connect with leading board-certified physicians in your state through the internet or telephone, helping you avoid emergency rooms and urgent care centers. Teladoc can also assist with prescription medications and with many non-emergency illnesses, including:
|
• Allergies • Arthritic pain • Asthma • Bronchitis • Colds and flu • Diarrhea • Insect bites • Pharyngitis • Conjunctivitis (pink eye) |
• Rash • Respiratory infection • Sinusitis • Skin inflammation • Sore throat • Sprains & strains • Urinary tract infection • Sports injuries • Vomiting |
Telehealth services are available at $0 cost and no deductible applies when using Teladoc. For more information regarding this service, please visit www.JHMBHealthConnect.com/telehealth-at-your-fingertips.
Elixir Member Portal – Easier Management of Your Pharmacy Benefits
Have you ever been in your doctor’s office wondering if the drug being prescribed would be covered by your insurance plan? Now, you don’t have to wonder because it is easier than ever to keep an eye on your prescription benefits with the newest release of the Elixir Member Portal and mobile app.
Prescription Benefits at Your Fingertips
Whether or not you have used Elixir’s Member Portal or mobile app, you will gain some helpful
new features that will make managing your prescription benefits much easier. Here’s a quick snapshot of what you can do.
- – Complete benefits information, so you can easily determine copays, accumulated max out of pocket amounts, and more
- – Personalized savings offers that will alert you when there is a savings opportunity, such as a lower cost alternative
- – Dynamic pharmacy search filters that will help you find pharmacies based on specific needs, such as those with drive-thru pick-up windows or those that are open 24 hours a day
- – Ask-a-Pharmacist and enhanced contact options, so you can send messages to ask pharmacists questions about your medications
- – Refill reminders that will alert you when any of your prescriptions are ready to be refilled
- – Complete list of current medications, which can be printed or easily accessed for referencing as needed
- – Biometric sign-on, enabling you to quickly and securely access your information with your unique fingerprint
- – Glossary and forms to help you understand and get the most from your pharmacy benefit
Get Started Today
If you aren’t already using Elixir’s handy Member Portal and/or mobile app to access your prescription benefits, we recommend you start now. Check out the full article online for details on how to get started at www.JHMBHealthConnect.com/11514.
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[togg title=”Elixir Customer Service Survey – Just 9 Quick Questions”]
We Need Your Feedback: Survey Open from October 1 – 31, 2022
One of the JHMB’s core missions is to manage and maintain the highest quality health benefits possible on behalf of active and retired employees. From time to time, we reach out to you (as plan participants) to help us understand and manage the service you receive from our benefits vendors.
For the past four years, we conducted a customer service survey for our prescription drug program and received valuable feedback from hundreds of our plan participants. Your feedback was essential in helping us identify and improve gaps in service. Now it’s time to assess our progress over this past year. If you have used your Elixir prescription drug benefits within the last year, we ask that you take a moment to answer 9 simple questions to help us assess and improve your customer experience. The survey asks brief questions regarding the following aspects of the prescription drug program:
- – Retail Pharmacy – Rite Aid | Walgreens | CVS | Costco
- – Specialty Pharmacy – Elixir Specialty
- – Elixir Website and Member Portal
- – Elixir Overall Customer Service
This is your chance to provide feedback on the services you’ve received from Elixir and its partners over the last year. You may also add written comments to provide more details regarding your experience(s).
Take the Survey & Enter to Win a $50 Gift Card
You may complete the survey online at: www.JHMBHealthConnect.com/rxsurvey. If you wish to enter into a raffle for a $50 Visa Gift Card, please provide your employee/retiree ID number when you complete the survey. It will help us identify you if you win the raffle. We look forward to your feedback and thank you for helping us manage the highest quality benefits for you and your family.
We look forward to your feedback and thank you for helping us manage the highest quality benefits for you and your family.
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[togg title=”Rate Contribution Changes for 2023″]
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. Medical, dental, and vision premiums depend on the plan option(s) you select. 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=”Plan Option C (Kaiser Permanente)”]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. To enroll in Kaiser, you must complete the Kaiser enrollment form along with the District’s benefits enrollment form. For more information about Kaiser Permanente plan benefits and service areas, review the information enclosed in this Open Enrollment packet. We also invite you to review their online informational portal, complete with an overview video and additional details about Kaiser’s services and resources below:
[/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.
[/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
- – EnvisionRx Customer Service Survey – which must be completed online or returned to the District Benefits Office no later than October 31, 2022.
- – Benefits Enrollment and California Kaiser Group Enrollment Form – which must be completed and returned to the Benefits Office no later than November 30, 2022.*
- – Kaiser Commercial Zip Code Master Listing
[/checklist] For additional plan information and/or provider contact information view the following pages: www.JHMBHealthConnect.com/your-benefits | www.JHMBHealthConnect.com/using-plans
* Do not mail original birth or marriage certificates to the District.
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[/tab] [tab]
This year’s annual Open Enrollment for 2023 benefits occurs from October 1 to November 30, 2022. 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 Wednesday, November 30, 2022 (or November 18, 2022 if you wish to enroll in Kaiser Senior Advantage, see page 4). All changes will be effective January 1, 2023. Please review the following brief highlights in this letter to understand changes that may affect you in 2023.
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, or add/remove eligible dependents, you must complete the Benefits Open Enrollment form enclosed in this packet.
[togg title=”Plan Option A and Option B (PPO) Participants”]
NEW: Annual Coordination of Benefits (COB) Form Required Starting January 2023
Beginning 2023, all Plan Option A and Option B (PPO) participants with one or more covered dependent(s) will be required to complete an annual Coordination of Benefits (COB) Form with Delta Health Systems (DHS). The District’s plans contain a “Coordination of Benefits” provision to ensure coordination of coverage between payors. For billing purposes, when a patient is covered under more than one group plan, one payor becomes the “primary carrier” and the other becomes the “secondary carrier.” The primary carrier must pay benefits before the secondary carrier can determine what benefits it will pay. This applies if you have more than one medical plan, including Medicare coverage.
In January 2023, DHS will mail the annual COB form to all Plan Option A and Option B (PPO) participants with one or more covered dependent(s) – including Medicare-eligible retirees. Be sure to review your form and make any necessary changes to ensure your information is up-to-date. Sign all pages and return the complete COB form to DHS within 90 days of the date of the mailed letter. Failure to complete and/or return the form within the 90-day period may result in any pending claims being denied. For more information, contact DHS Customer Service at (800) 807-0820.
Telehealth: You’ve Got Teladoc – Talk to a Doctor Anywhere, Anytime by Phone or Video
Teladoc provides telehealth services for PPO Plan Options A & B. With Teladoc, you can connect with leading board-certified physicians in your state through the internet or telephone, helping you avoid emergency rooms and urgent care centers. Teladoc can also assist with prescription medications and with many non-emergency illnesses, including:
|
• Allergies • Arthritic pain • Asthma • Bronchitis • Colds and flu • Diarrhea • Insect bites • Pharyngitis • Conjunctivitis (pink eye) |
• Rash • Respiratory infection • Sinusitis • Skin inflammation • Sore throat • Sprains & strains • Urinary tract infection • Sports injuries • Vomiting |
Telehealth services are available at $0 cost and no deductible applies when using Teladoc. For more information regarding this service, please visit www.JHMBHealthConnect.com/telehealth-at-your-fingertips.
Elixir Member Portal – Easier Management of Your Pharmacy Benefits
Have you ever been in your doctor’s office wondering if the drug being prescribed would be covered by your insurance plan? Now, you don’t have to wonder because it is easier than ever to keep an eye on your prescription benefits with the newest release of the Elixir Member Portal and mobile app.
Prescription Benefits at Your Fingertips
Whether or not you have used Elixir’s Member Portal or mobile app, you will gain some helpful
new features that will make managing your prescription benefits much easier. Here’s a quick snapshot of what you can do.
- – Complete benefits information, so you can easily determine copays, accumulated max out of pocket amounts, and more
- – Personalized savings offers that will alert you when there is a savings opportunity, such as a lower cost alternative
- – Dynamic pharmacy search filters that will help you find pharmacies based on specific needs, such as those with drive-thru pick-up windows or those that are open 24 hours a day
- – Ask-a-Pharmacist and enhanced contact options, so you can send messages to ask pharmacists questions about your medications
- – Refill reminders that will alert you when any of your prescriptions are ready to be refilled
- – Complete list of current medications, which can be printed or easily accessed for referencing as needed
- – Biometric sign-on, enabling you to quickly and securely access your information with your unique fingerprint
- – Glossary and forms to help you understand and get the most from your pharmacy benefit
Get Started Today
If you aren’t already using Elixir’s handy Member Portal and/or mobile app to access your prescription benefits, we recommend you start now. Check out the full article online for details on how to get started at www.JHMBHealthConnect.com/11514.
[/togg]
[togg title=”Elixir Customer Service Survey – Just 9 Quick Questions”]
We Need Your Feedback: Survey Open from October 1 – 31, 2022
One of the JHMB’s core missions is to manage and maintain the highest quality health benefits possible on behalf of active and retired employees. From time to time, we reach out to you (as plan participants) to help us understand and manage the service you receive from our benefits vendors.
For the past four years, we conducted a customer service survey for our prescription drug program and received valuable feedback from hundreds of our plan participants. Your feedback was essential in helping us identify and improve gaps in service. Now it’s time to assess our progress over this past year. If you have used your Elixir prescription drug benefits within the last year, we ask that you take a moment to answer 9 simple questions to help us assess and improve your customer experience. The survey asks brief questions regarding the following aspects of the prescription drug program:
- – Retail Pharmacy – Rite Aid | Walgreens | CVS | Costco
- – Specialty Pharmacy – Elixir Specialty
- – Elixir Website and Member Portal
- – Elixir Overall Customer Service
This is your chance to provide feedback on the services you’ve received from Elixir and its partners over the last year. You may also add written comments to provide more details regarding your experience(s).
Take the Survey & Enter to Win a $50 Gift Card
You may complete the survey online at: www.JHMBHealthConnect.com/rxsurvey. If you wish to enter into a raffle for a $50 Visa Gift Card, please provide your employee/retiree ID number when you complete the survey. It will help us identify you if you win the raffle. We look forward to your feedback and thank you for helping us manage the highest quality benefits for you and your family.
We look forward to your feedback and thank you for helping us manage the highest quality benefits for you and your family.
[/togg]
[togg title=”Kaiser Permanente Senior Advantage Plan Option”]
Special Enrollment Ends November 18, 2022
As a reminder, from October 1 – November 18, 2022, Fresno Unified School District is offering a Special Enrollment for the Kaiser Permanente Senior Advantage plan. This employer-sponsored group coverage is available 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, 2023, 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 18, 2022. Any other changes you wish to make to your existing coverage can be made during the Annual Open Enrollment period from October 1 – November 30, 2022.
To learn more about the Kaiser Permanente Senior Advantage plan, please contact Kaiser Permanente at the information provided below. Enrollment forms are available for pick up at the District Benefits Office.
Information 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, 2023, you will have to make this change by November 18, 2022. Any other changes you wish to make to your current health plan offerings can be made during the Annual Open Enrollment period from October 1 – November 30, 2022.
[/togg]
[togg title=”2023 Rate Contribution Changes “]
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. Medical, dental, and vision premiums depend on the plan option(s) you select. 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=”Stay Connected – Sign Up for Monthly Updates & Benefit Alerts”]
Every month, the JHMB provides our plan participants with healthful information to help them along their path to better health. This includes benefits alerts and key reminders, upcoming events, healthful news and local activities, wellness offerings, healthy recipes, and even a new Healthy Aging Corner for our age 55+ plan participants. If you are not currently receiving these healthful email updates, visit www.JHMBHealthConnect.com/staying-connected to review past announcements and to sign up for our email list.
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[togg title=”Dependents Eligibility Reminder”]
Notify the District When Your Ex-Spouses & Dependents are No Longer Eligible for Benefits
As a reminder, you are required to notify the District within 60 days following the date on which any dependent no longer meets the eligibility criteria for dependent coverage (including divorce or legal separation; and the termination, dissolution or nullification of Domestic Partnership). Failure to notify the District within the adequate time period may cause you to be responsible for the reimbursement of any claims paid for ineligible dependents.
[/togg]
[togg title=”Medicare Enrollment Reminder”]
Enroll In Medicare When You and/or Your Spouse Become an Eligible Retiree to Minimize Your Payments
The Joint Health Management Board wants to remind you of the importance of enrolling in Medicare once you are eligible. The District’s Health Care Plan indicates that you must enroll in Medicare Parts A & B as soon as you and/or your spouse become eligible for Medicare as a retiree.
Your specific Coordination of Benefits (COB) changes once you become eligible for Medicare as a retiree, which may result in reductions of Plan payments and increases in your payments if you fail to enroll in Medicare. This requirement only applies to retirees in the Fresno Unified School District Employee Health Care Plan. Active employees age 65 or over are not required to enroll in Medicare. For more information, review the JHMB’s notice available at www.JHMBHealthConnect.com/5665.
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[togg title=”WellPATH Program Update”]
WellPATH, the Employee Wellness Program for Fresno Unified School District, is pleased to offer a variety of wellness services throughout the year. Below are some highlights of the WellPATH program. If you have not signed up to receive the monthly newsletter informing you of current program offerings, benefit updates, and educational material for your health, please reach out to WellPATH@delapro.com or visit our Staying Connected page to sign up (www.JHMBHealthConnect.com/staying-connected.)
Participate in Wellness Challenges – Improve Your Health and Win Prizes! Throughout the year, the WellPATH Program serves up wellness challenges to jumpstart and/or cultivate healthy habits among its members. These challenges typically run 6-8 weeks and offer individual and work site incentives based on healthy eating, exercising, and educational activities.
Become a WellPATH Champion! WellPATH Champions are on-site ambassadors for the WellPATH program who are committed to creating a workplace culture of health and wellness. They share wellness-related information with coworkers and help them connect with wellness programs and activities. WellPATH Champions receive program benefits and incentives. Contact WellPATH if you would like to receive information about becoming a WellPATH Champion.
Participate in a WellPATH Wellness Screening – “Know Your Numbers” and Receive a $25 Gift Card! There are important numbers that we all need to know in order to safeguard our health. Cholesterol, blood pressure, waist size, body mass index, and blood sugar are key indicators of our risk for major
illness. By knowing these numbers, we can take action to reduce our chances of developing heart disease, diabetes, and other major illnesses. It is very important to get these numbers checked on a regular basis and you can learn this information by attending a WellPATH Know Your Numbers wellness screening.
Additional Services Offered by WellPATH The suite of free services includes:
- – Annual preventative wellness screenings ($25 gift card for participating)
- – Wellness challenges (Gift Card Prizes for qualifying participants)
- – Group fitness classes
- – Annual flu shot clinics
- – Monthly health education
- – Wellness coaching
- – Personal training (member must qualify)
- – Behavior modification (member must qualify)
For more information about these programs and other WellPATH offerings, visit www.JHMBHealthConnect.com/wellpath or contact the WellPATH Program at (833) Well-PATH.
[/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.
[/togg]
[togg title=”Employee Assistance Program (EAP) – Available to Retirees Too!”]
The Employee Assistance Program, offered through Claremont EAP, helps you resolve personal issues before they become more serious and difficult to manage. Claremont 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
- – EnvisionRx Customer Service Survey – which must be completed online or returned to the District Benefits Office no later than October 31, 2022.
- – Benefits Open Enrollment Form – which must be completed and returned to the Benefits Office no later than November 30, 2022.* As a reminder, if you wish to change to the Kaiser Senior Advantage plan, you will have to make this change by November 18, 2022.
- – Kaiser Commercial Zip Code Master Listing
- – KPSA Zip Code Master Listing
[/checklist] For additional plan information and/or provider contact information view the following pages: www.JHMBHealthConnect.com/your-benefits | www.JHMBHealthConnect.com/using-plans
* Do not mail original birth or marriage certificates to the District.
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