This year's annual Open Enrollment for 2024 benefits occurs from October 1 to November 30, 2023. If you wish to make any changes to your existing coverage, you must complete your Enrollment Form and return it to the District Benefits Office by no later than Thursday, November 30, 2023. All changes will be effective January 1, 2024. Please review the following brief highlights to understand changes that may affect you in 2024.
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.
New, Employee-Centered Website
JHMBHealthConnect.com is your go-to resource on your benefits. As a District employee or retiree, you are entitled to certain benefits, and the new Joint Health Management Board website is designed to help you understand and use those benefits. Whether you have questions about your plan, your specific benefits, or your healthcare, HealthConnect will point you in the right direction, supporting you on your journey to better health and wellness.
Additional Coverage for Co-insurance
The Joint Health Management Board and Fresno Unified School District have eliminated the percentage co-insurance that you would pay for medical benefits after your deductible has been met if you are enrolled in Plan Option A (PPO) or Plan Option C (Kaiser Permanente®). If you are a Plan Option B (PPO) participant, the percentage co-insurance that you would pay after the deductible has been met has been reduced to 20%.
Waiver of Annual Deductible for Dual-Covered PPO Plan Participants
Effective January 1, 2024, the annual deductible will be waived for all covered family members of a dual-covered member enrolled in PPO Plan Option A or PPO Plan Option B. To be eligible for this waiver, two District employees or retirees married to one another or in a domestic partnership must each enroll their spouse/domestic partner as a dependent under their plan.
Vision: New Provider and Plan
Vision coverage is now provided by VSP Vision as a (PPO) plan. The switch to a new provider also comes with additional in-network benefits, including an increased in-network frame allowance to $175 (up from $130), added calendar year allowance for glasses and contact lenses, and added full coverage for progressive and transition lenses.
To locate an in-network VSP Vision provider, go to www.vsp.com, click on “Find a Doctor.” You can search by location, office or doctor. Any questions pertaining to your vision coverage can be directed to VSP Vision by calling (800) 877-7195, or by visiting the website at www.vsp.com.
Dental Plan Changes
Delta Dental Premier® Incentive Plan
If selecting the Delta Dental Premier Incentive Plan, you will receive additional benefits including up to 100% coverage for many dental services through in-network and out-of-network providers. The plan is on a new tiered structure designed to increase your benefits as you continue receiving dental care every year. This plan is an enhancement of the existing Delta Dental Dental PPO™ plan.
The new incentive-tiered structure applies to preventive services, restorative services, periodontics, endodontics, oral surgery, and crowns & inlays. There is 100% benefits coverage for participants covered by the plan as of December 31, 2023. Otherwise:
- 70% coverage when receiving dental care for the first year enrolled
- 80% coverage when receiving dental care for the second straight year while enrolled
- 90% coverage when receiving dental care for the third straight year while enrolled
- 100% coverage when receiving dental care for the fourth straight year (or longer) while enrolled
Note: Benefits will decrease by 10% if you do not receive dental care each year.
For further assistance or to find an in-network dentist, contact Delta Dental® at (866) 499-3001 or visit www.deltadentalins.com.
UnitedHealthcare Dental HMO Updates
Benefits have been increased for the existing UnitedHealthcare Dental HMO plan:
- Composite fillings and root canals are now no charge.
- All oral surgery, crowns & inlays, and prosthetics & bridges are now no charge.
- The maximum out-of-pocket expense for 24-month orthodontia services have been reduced to $1,250.
You can contact UnitedHealthcare at (800) 999-3367 or find an in-network dentist at www.myuhc.com.
2024 COBRA/ED CODE 7000 Dental and Vision Rate Change
Effective January 1, 2024, retirees on automatic premium deduction for Dental and/or Vision through CalPERS/CalSTRS, premiums will update automatically. No action is needed. You will receive a separate notice regarding the rate change.
Retirees who are on a monthly bill pay through the bank/bank transfer/writing checks to FUSD, premium payments must be adjusted accordingly.
Retiree Workshop Dates
Have questions about your benefits as a District retiree? We are holding two workshop days to assist you in what you need to do to maximize your plan.
We will hold two sessions per day on Tuesday, October 17, 2023, and Wednesday, October 18, 2023, at DoubleTree by Hilton, Fresno Convention Center, located at 2233 Ventura St. in Fresno. The first session each day will start at 9 a.m. and end at 11 a.m., and the second session will be held from 1 to 3 p.m.
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:
- Arthritic Pain
- Colds and Flu
- Insect Bites
- Conjunctivitis (Pink Eye)
- Respiratory Infection
- Skin Inflammation
- Sore Throat
- Sprains & Strains
- Urinary Tract Infection
- Sports Injuries
Telehealth services are available at $0 cost and no deductible applies when using Teladoc. For more information regarding this service, please visit our telehealth information page.
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 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 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
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.
Plan Option C (Kaiser Permanente®)
You can only enroll in the 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 group enrollment form along with the District’s benefits enrollment form. For more information. review their online informational portal, along with additional details about Kaiser’s services and resources available on our Plan Option C (Kaiser Permanente) page.
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 Healthy Aging Corner for our age 55+ plan participants. If you are not currently receiving these healthful email updates,
Dependents Eligibility Reminder
Notify the District when your ex-spouses and 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 required time period may cause you to be responsible for the reimbursement of any claims paid for ineligible dependents.
Medicare Enrollment Reminder
Enroll in Medicare when you and/or your spouse or dependent 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 or dependent 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 patient responsibilities 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.
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.
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 six to eight 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 $50 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. These are offered at various District locations throughout the year. Visit our wellness screenings page for the current schedule.
Additional Services Offered by WellPATH
WellPATH offers many additional services, including:
- Annual preventative wellness screenings ($50 gift card for participating)
- Wellness challenges (Gift Card Prizes for qualifying participants)
- Free onsite group fitness classes
- Annual flu shot clinics (NEW – $25 gift card for receiving your flu shot at a WellPATH event)
- Monthly health education
- Wellness coaching
- Personal training (member must qualify)
- Behavior modification (member must qualify)
Take a Healthy Minute and Schedule a Preventative 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.
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
- Financial Services
- School/College Assistance
- Pet Care Referrals
- Wellness Referrals
- Legal Consultations
- Child/Elder Care Referrals
- Adoption Assistance
- Daily Living/Convenience 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.