Full Plan Booklet
Understand your healthcare coverage.
Using Your Plan
Your benefits are explained in the Fresno Unified School District Employee Health Care Plan Booklet. The full plan booklet is very detailed, so in the interest of making it easier for you to get the information you need, the Joint Health Management Board (JHMB) has also compiled a Benefits Information Guide for full-time employees, amendments for changes to the plans, and important excerpts from the booklet to help you navigate your plan.
Benefits Information Guide
For full-time employees, the Benefits Information Guide is your initial resource to understanding and selecting the best benefit options for you and your family. We encourage you to review this booklet in its entirety. The guide reflects the plan information from the date it was published. Please review the “Plan Amendments” section below for the latest updates.
Do you still have questions? You may contact the Benefits Department at (559) 457-3520.
Plan Excerpts
Along with the Benefits Information Guide, the following excerpts from the Full Plan Booklet may help you with specific questions.
If you are a Plan C enrollee, review the Kaiser Permanente® Evidence of Coverage brochure below.
Annual Participant Notices
Appeals
Delta Health Electronic EOBs
Delta Health Systems gives you the option to receive electronic Explanation of Benefits (EOB). Follow the instructions in the directions below to opt-in to receive electronic copies only. Delta Health Systems also provides a guide to understanding your EOBs.
HIPAA Notice of Privacy Protection
Important Information and Contact Numbers
Summary of Benefits & Coverage
As part of the health care reform law, the government established a health plan information document called the Summary of Benefits and Coverage (SBC). The SBC will help you understand and compare different medical plan options. It provides an easy-to-understand overview of each medical plan in a standard format.
Each SBC is based on the plan option that you are currently enrolled in, i.e., Plan Option A (PPO), Plan Option B (PPO), or Plan Option C (Kaiser Permanente HMO). If you would like to review the SBC for a different plan option, you may request one from Delta Health Systems, Kaiser Permanente or the District’s Benefits Office, or you can download all three SBCs below. You will also receive a SBC with your open enrollment materials each year and can request a SBC at any time.
The Summary of Benefits and Coverage includes two parts:
- Benefits and coverage information
- Coverage examples
- 2023 Summary of Benefits and Coverage – PPO Plan A (Aetna)
- 2023 Summary of Benefits and Coverage – PPO Plan B (Aetna)
- 2023 Summary of Benefits and Coverage – HMO Plan C (Kaiser)
- 2023 Summary of Benefits – Medicare Advantage PPO Plan (Aetna)
- 2023 Summary of Benefits - Open Choice PPO Plan (Aetna)
- 2023 Summary of Benefits - Senior Advantage HMO Plan (Kaiser)
- 2023 Summary of Dental Benefits and Coverage – UnitedHealthCare DHMO
- 2023 Summary of Dental Benefits and Coverage – Delta Dental PPO
- Evidence of Coverage – Delta Dental PPO
- Summary of Vision Benefits – VSP Vision
Kaiser Permanente® Evidence of Coverage
If you are enrolled in Plan Option C, the following Kaiser Evidence of Coverage booklets provide detailed plan information for the Kaiser Permanente® Deductible HMO Plan. As a plan participant, you should review these booklets in addition to the Full Plan Booklet to familiarize yourself with all of the provisions offered through the District.
Full Plan Booklet
If you want more clarification into your benefits after reading through the Benefits Information Guide, we suggest reading through the official healthcare plan booklet.
Plan Amendments
2022
2020
- Covered Medical Benefits for Plan Options A and B – Non-Emergency Ambulance Services (Effective October 15, 2020)
- Dependent Eligibility – Mentally or Physically Disabled Child Clarification & Voluntary Termination of Covered Dependents Outside of Open Enrollment (Effective September 17, 2020)
- Behavioral Health Benefits for Plan Options A and B (Effective September 17, 2020)
- COVID-19 Testing and Related Items/Services and Telehealth Visits (Effective March 18, 2020)
- Dependent Eligibility – Disabled Child Clarification (Effective January 28, 2020)
- Dependent Eligibility – Domestic Partner Clarification (Effective January 1, 2020)
2019
2018
- Coinsurance and Out-of-Pocket Expenses for Plan Option ‘A’ (Effective 6/1/2018)
- Chiropractic Care Plan Schedule of Benefits for Plan Options ‘A’, ‘B’, and ‘C’ (Effective 1/1/2018)
- Medical Plan Schedule of Benefits for Plan Options ‘A’ and ‘B’ – Planned Surgery Benefit Program through BridgeHealth (Effective 1/1/2018)
- Prescription Drug Plan of Schedule Benefits for Plan Options ‘A’ and ‘B’ – Select Formulary (Effective 1/1/2018)
- Covered Medical Benefits for Plan Options ‘A’ and ‘B’ Medical Expenses – Transplant Travel and Lodging (Effective 1/1/2018)
- Behavioral Health Benefits for Plan Options ‘A’ and ‘B’ (Effective 1/1/2018)
2017
- Market Reform Regulations Issued Under the Patient Protection and Affordability Act of 2010 (Effective 7/1/2017)
- Changes to Medical & Prescription Drug Benefits for Plan Options A and Plan B (Effective 7/1/2017)
- Prescription Drug Tiers and Available Day Supplies for Plan Options A and Plan B (Effective 1/1/2017)
Frequently Asked Questions
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nunc volutpat ante vel fermentum ullamcorper. Nunc ultrices lorem nibh, id commodo erat ullamcorper eu. Nunc erat odio, sollicitudin vel ornare eget, fermentum eget neque. Duis finibus ex urna, et laoreet leo efficitur non. Ut neque metus, vestibulum vitae congue dictum, pellentesque et enim.
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nunc volutpat ante vel fermentum ullamcorper. Nunc ultrices lorem nibh, id commodo erat ullamcorper eu. Nunc erat odio, sollicitudin vel ornare eget, fermentum eget neque. Duis finibus ex urna, et laoreet leo efficitur non. Ut neque metus, vestibulum vitae congue dictum, pellentesque et enim.
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nunc volutpat ante vel fermentum ullamcorper. Nunc ultrices lorem nibh, id commodo erat ullamcorper eu. Nunc erat odio, sollicitudin vel ornare eget, fermentum eget neque. Duis finibus ex urna, et laoreet leo efficitur non. Ut neque metus, vestibulum vitae congue dictum, pellentesque et enim.
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nunc volutpat ante vel fermentum ullamcorper. Nunc ultrices lorem nibh, id commodo erat ullamcorper eu. Nunc erat odio, sollicitudin vel ornare eget, fermentum eget neque. Duis finibus ex urna, et laoreet leo efficitur non. Ut neque metus, vestibulum vitae congue dictum, pellentesque et enim.
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nunc volutpat ante vel fermentum ullamcorper. Nunc ultrices lorem nibh, id commodo erat ullamcorper eu. Nunc erat odio, sollicitudin vel ornare eget, fermentum eget neque. Duis finibus ex urna, et laoreet leo efficitur non. Ut neque metus, vestibulum vitae congue dictum, pellentesque et enim.
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nunc volutpat ante vel fermentum ullamcorper. Nunc ultrices lorem nibh, id commodo erat ullamcorper eu. Nunc erat odio, sollicitudin vel ornare eget, fermentum eget neque. Duis finibus ex urna, et laoreet leo efficitur non. Ut neque metus, vestibulum vitae congue dictum, pellentesque et enim.
