Important Notice: Dependent Verification Review Completed

TO:        Fresno Unified School District Employee Health Care Plan Participants in PPO Plan Options A and B

DATE:     August 21, 2018

The District’s Joint Health Management Board (JHMB) continuously strives to build and maintain a cost-effective healthcare program for our employees, retirees, and their families. Each year, the JHMB reviews various aspects of the health plan to manage our health plan costs and ensure that our plan is sustainable for the long-term.

Earlier this year, the JHMB partnered with HMS Employer Solutions to conduct a Dependent Verification Review. This routine practice ensures that all dependents enrolled in our plans meet the eligibility requirements and that the District is not paying for ineligible individuals.

Dependent Verification Review Summary

  • Full Verification Review: Between late March through late May, HMS completed a comprehensive dependent verification of 5,889 employees with 14,008 dependents enrolled in Joint Health Management Board of the Fresno Unified School District’s medical, dental and vision plans.
  • High Response Rate: Ninety-seven percent (97%) of eligible plan participants responded to the dependent verification review.
  • Over $1 Million in Estimated Savings: At the end of the review, a total of 661 dependents were deemed ineligible and removed from the JHMB’s plan. This results in an estimated savings of $1.7 Million in medical plan costs to the Plan.*

* – Total estimated savings (which includes elimination of dental, vision, and life insurance costs) may increase the $1.7 million amount noted above.

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 adequate time period may cause you to be responsible for the reimbursement of any claims paid for ineligible dependents.

Thank You for Helping Us Keep Costs Down

We must continue to make sure that only those dependents that are actually eligible are the ones being provided with coverage. Covering people who are not eligible dependents raises our cost for health coverage, which may ultimately be reflected in higher premiums and out-of-pocket costs.

Thank you for helping to manage our plan expenses, so that we may continue to provide health care at a reasonable cost!

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