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Changes to PPO Benefits Starting July 1, 2024



The Joint Health Management Board is tasked with keeping Fresno Unified School District employees, retirees, and dependents up to date on their health plan benefits.

As of July 1, specific benefits are changing for all non-Medicare PPO plans, including Aetna® PPO Plan A and Plan B members and retiree dependents who are enrolled in Aetna® Open Choice PPO.

These changes include:

  • Enhanced mental health & substance abuse benefits (All non-Medicare PPO plans)
  • Removal of copayment for in-network outpatient surgery (All non-Medicare PPO plans)
  • Reduced copay for thyroid medications (All non-Medicare PPO plans)
  • Increase in coinsurance (Open Choice PPO)

Changes to Mental Health & Substance Abuse Benefits

Prior to the change for non-Medicare PPO plans, mental health and substance abuse benefits:

  • Don’t cover out-of-network care
  • Limit coverage of inpatient or partial-day treatment to 45 days
  • Limit the number of outpatient visits to 60
  • Require prior authorization for all inpatient and outpatient services
Prior authorization is when more details are needed before coverage can be approved. It’s the process of confirming that your services are medically necessary and if your plan will cover those services.

As of July 1, 2024, non-Medicare PPO mental health and substance abuse benefits:

  • Include coverage of out-of-network care
  • Remove limits to the number of days or visits for inpatient, partial-day, or outpatient care
  • Require prior authorization only for inpatient care and certain complex outpatient care

These changes allow non-Medicare PPO plan members to use out-of-network mental health and substance abuse care toward the annual out-of-network deductible and out-of-pocket maximum. Coinsurance for all out-of-network mental health and substance abuse services for PPO Plan A and Open Choice PPO enrollees and dual enrollees is 60% of the customary service cost after the deductible has been met. For PPO Plan B enrollees and dual enrollees, this coinsurance is 50%.

Changes to Outpatient Surgery Benefits

The existing benefits for non-Medicare PPO plans require a copayment for in-network outpatient surgery. As of July 1, 2024, this copayment is removed—there is no charge. Out-of-network outpatient surgery is still not covered under this plan after July 1.

Changes to Thyroid Medication Copays

As of June 1, 2024, generic- and preferred-brand thyroid medications are available for a $0 copay for non-Medicare PPO plan members. To avoid paying more, plan members must try the generic medication (e.g., Levothyroxine) before filling the branded medication (e.g., Synthroid).

Changes to Open Choice PP Coinsurance

Coinsurance benefits for Open Choice PPO plan members are increased from 95% to 100%, effective July 1, 2024. This means that for services for which a plan member was required to pay 5% of the cost after the deductible was met, the member will now pay 0% following the deductible being met.

For more information about these upcoming changes to your coverage and benefits, and on changes in benefits for other FUSD healthcare plans, please subscribe to our email notifications at the bottom of this page.

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