Special Open Enrollment for Medical Benefits
(Changes to Plan Options A and B and
Addition of New Plan Option C – Kaiser Permanente)
TO: Active and Non-Medicare (under Age 65) Retired Employees Eligible for Benefits under the Fresno Unified School District’s Employee Health Care Plan
RE: Rate Increases – Medical Benefit Modifications and Employee Monthly Premium
Effective April 1, 2012
DATE: January 27, 2012
_____________________________________________________________________________
In October, 2011, Open Enrollment material mailed to all Plan participants of the Health Care Plan announced that additional changes to the Medical Plans would be forthcoming in order to bring health care spending in line with available income. After careful review, the Joint Health Management Board adopted the medical plan changes noted, in bold, on the attached side-by-side comparison for Plan Options A and B effective April 1, 2012 for Active Employees and for Non-Medicare Early Retirees (under age 65). In addition, you will also note that a new Kaiser Permanente Plan, Option C, has been added to the comparison as an option effective April 1, 2012.
Based on the Plan’s financial projections, the medical plan also requires an increase to Active Employee Monthly Premium Rates in order to move the Plan toward a financially sound position. A separate exhibit is enclosed outlining Active Employee Monthly Premium Rates effective April 1, 2012.
Kaiser Permanente has been added as a Plan option. The Joint Health Management Board believes that offering more options to the participants improves the Plan and your health care. Kaiser Permanente was chosen because of their superior record for providing good, integrated care and because their patient satisfaction rating is very high.
A special Open Enrollment will take place during the period January 27, 2012 through March 9, 2012 as a result of the medical plan changes. In addition to reviewing the enclosed material, you and your family are encouraged to attend an informational meeting where representatives from the Plan (District’s Benefit Office and Delta Health Systems), Anthem Blue Cross (relating Plan Options A and B), and Kaiser Permanente Health Plan (relating Plan Option C) will be available to talk about the available options and to answer your questions concerning coverage differences, coordination of benefits, premium increases, and your Out-Of-Pocket maximums. Beverages, light snacks, and promotional giveaways, will be provided. The meeting dates can be expanded if demand is high.
While it is not required in order to attend a meeting, you may sign up for one of the following meetings by logging on to FUSDSpecialOE.org and reserve a place. By signing up, each health care vendor will be better able to provide you with information, food, and sufficient giveaways!!
| February 9
6:00-7:30 p.m. |
Hoover High School Auditorium | 5550 N. First, Fresno 93710 |
| February 16
4:00-5:30 p.m. |
Sunnyside High School Auditorium | 1019 S. Peach, Fresno 93727 |
| February 23
4:00–5:30 p.m. |
Fresno High School Auditorium | 1839 N. Echo, Fresno 93704 |
If you are considering enrolling in Plan Option C, Kaiser Permanente Health Plan,
Please be advised that:
- 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.
- Presently, Kaiser Permanente Health Plan coverage is only available to Active Employees and Retirees not eligible for Medicare (under age 65). If you are a Retiree eligible for Medicare, or have a dependent that is eligible for Medicare, you will not be eligible to enroll in Plan Option C. Also, if you are a Retiree or a Dependent of Retiree and you expect to become Medicare eligible within the next year, you may not want to enroll in the Kaiser Permanente Health Plan, because you would have to change to Plan Option A or B once you become eligible for Medicare.
- Kaiser Permanente enrolled participants will continue to use the Plan’s Chiropractic benefits provided through ChiroMetrics and the Plan’s Employee Assistance Program (EAP) benefits provided through Claremont EAP. The Kaiser Permanente Health Plan will include Mental Health service benefits as noted on the comparison.
- In addition, Vision benefits under the Kaiser Permanente Health Plan will be covered for employees and dependents without additional premiums for vision coverage as follows: Preventative eye exams at no charge and not subject to the deductible; diagnostic eye exams to diagnose or treat disease and injuries to the eye at $15 copayment and not subject to the deductible; lenses every 12 months if prescription changes by more than 50 diopters; and frames at an allowance of $175 plus 20% of any out of pocket over $175 every 24 months.
Note: If you enroll in Kaiser Permanente, you and your dependents will not be able to access benefits from the Plan’s vision care providers, Vision Service Plan or Safeguard Vision Services, and must use the vision benefits provided by Kaiser Permanente.
If you are considering changing Medical Plan Options (to A, B, or C) effective April 1, 2012, please complete the enclosed District Election Form and return it to the District Office via intra-district mail or regular mail no later than March 9, 2012. If you are electing Kaiser Permanente, in addition to completing the District Election Form, please complete Sections B, C, and D and sign and date the enclosed Kaiser Permanente Enrollment Form as well. Please be advised that any Deductible applied during the January 1, 2012 through March 31, 2012 period under your current Medical Plan Option will be accrued toward the Deductible under any Plan Option (A, B, or C) you enroll in effective April 1, 2012.
If you do not wish to change medical plans, NO action is required on your part and you will automatically remain in your existing Plan A or Plan B. However, since the Medical Plan benefits and Active Employee Monthly Premium Rates will change effective April 1, 2012, please review the side-by-side comparison and Monthly Premium Rates that will be applicable to you based on your current family status election.
This Special Medical Plan Open Enrollment election does not allow you to change your Dental or Vision benefits; however, if you enroll in Option C, Kaiser Permanente, you will be disenrolled from either Vision Service Plan or Safeguard (if you are currently enrolled in one of these vision plans) and can only use the Kaiser Permanente Vision Program.
Active Employees: Please be advised that according to Flexible Spending Account Regulations, there can be no change to your FSA withholding election until next January 1, 2013 and, therefore, American Fidelity will not be involved in this Special Open Enrollment. However, the Active Employee Monthly Premium Rate increase can automatically change and will continue to be on a pre-tax basis. This means that you will automatically have deducted pre-tax from your paycheck the new Employee Monthly Premium rate that applies to the Plan selected.
Please be aware that the changes for this Special Open Enrollment are noted in bold-type in the enclosed side-by-side Medical Plan comparison and on the Active Employee Monthly Premium Rates.