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 the Enrollment Form you received and return it to the District Benefits Office by no later than Thursday, November 30, 2023 (or November 20, 2023, if you wish to enroll in Kaiser Senior Advantage, see the section below. 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. 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.
Aetna Medicare Advantage Plan Option for Medicare-Eligible Retirees
Effective July 1, 2023, the PPO option for Medicare-eligible ED Code retirees transitioned to the Aetna Medicare Advantage Plan. The new plan offers additional benefits for Medicare-eligible members and Medicare-eligible dependents, including no deductibles, no out-of-pocket charges, and no co-pays in many cases. The Aetna Open Choice PPO plan, for non-Medicare-eligible dependents, resembles PPO Plan A. These plans provide you and your dependents with medical and prescription drug coverage featuring a provider network available in Fresno County and throughout most of the United States.
If you were previously enrolled in the PPO Plan A or B, and you are a retiree, you likely have been enrolled in the new Aetna Medicare Advantage plan (unless you chose Kaiser Senior Advantage or opted out). During this open enrollment period, you are able to review your options and make desired changes on your Open Enrollment form.
If you are requesting to enroll/re-enroll into the Aetna Medicare Advantage plan, you must do so by November 20, 2023. Any other changes you wish to make to your existing Aetna Medicare Advantage plan coverage can be made during the annual Open Enrollment period from October 1, 2023, to November 30, 2023.
Receive more information about the Aetna Medicare Advantage (PPO) Plan by calling Aetna Customer Service at 1-888-267-2637, or visiting aetnaretireeplans.com/.
Vision: New Provider and Plan
Vision coverage for members enrolled in Plan Option A or Option B (PPO) is now provided by VSP Vision as a (PPO) plan. The switch to a new provider also comes with additional in-network benefits, including a higher retail allowance for frames.
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, for 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.
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%.
Note: This may not apply if you are eligible for Medicare.
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 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.
The Elixir Customer Service Survey – Just 10 Quick Questions
We need your feedback through our survey, open for Online Enrollment from October 1, 2023, through January 31, 2024. 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 five years, we conducted a customer service survey for our prescription drug program and received valuable feedback from hundreds of our plan participants. Your feedback has been essential in helping us identify and improve gaps in service and assess our progress over the previous year.
If you have used your Elixir prescription drug benefits within the last year, we ask that you take a moment to answer 10 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 during online enrollment. 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.
Kaiser Permanente® Senior Advantage Plan Option
From October 1, 2023, to November 20, 2023, Fresno Unified School District is offering an enrollment opportunity for the Kaiser Permanente® Senior Advantage plan. This employer-sponsored group coverage is available to Medicare-eligible retirees and spouses. There are no changes in benefits for this plan for 2024.
If you wish to change to Kaiser Permanente Senior Advantage (KPSA) plan effective January 1, 2024, you will have to make this change during this enrollment period and return your election forms to the District’s Benefit Department by November 20, 2023.
To learn more about the Kaiser Permanente Senior Advantage plan, please contact Kaiser Permanente at the information below. Enrollment forms are available for pick up at the District Benefits Office.
For more information about the Kaiser Senior Advantage (HMO) Plan, contact Kaiser Permanente at (855) 843-8390 (TTY 711 for the deaf, hard of hearing, or speech impaired). Phone lines are open seven days a week from 8 a.m. to 8 p.m.
As a reminder, if you wish to change to Kaiser Senior Advantage effective January 1, 2024, you will have to make this change by November 20, 2023. 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, 2023, to November 30, 2023.
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 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, as an ED Code retiree, you are not required to enroll in Medicare Parts A & B as soon as you and/or your spouse become eligible for Medicare, but you may want to so you can avoid penalties by Medicare.
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.
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)
For more information about these programs and other WellPATH offerings, visit our WellPATH page or contact the WellPATH Program at WellPATH@JHMBHealthConnect.com or (833) WELL-PATH.
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.
