TO: All Fresno Unified School District Health Plan Participants with Enrolled Dependents
DATE: March 2, 2018
**This only applies to District health plan participants with enrolled dependents**
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.
One of the ways we ensure that our plan is sustainable is by conducting a routine dependent verification review. This ensures 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.
HMS Employer Solutions to Conduct Dependent Verification Review
The JHMB has retained the services of a highly recommended independent auditor, HMS Employer Solutions (HMS), to assist us with completing a dependent verification of our plans. HMS is known for their professionalism, confidentiality and sensitivity to employee needs and concerns. The JHMB is confident that this process will ensure we are covering eligible dependents in a fair and equitable manner.
When you receive any correspondence from HMS, please read it carefully as there are specific due dates when certain information needs to be returned. Failure to follow the instructions could results in loss of coverage for your dependents.
How the Verification Process Works
If you have dependents enrolled in a Fresno Unified School District health plan, you will receive a letter addressed to your home from HMS in the coming weeks. The letter will detail the steps and information required to keep coverage on your enrolled dependents. You will also be asked to submit evidence of eligibility directly to HMS. Once the proof is received, a confirmation postcard will be mailed to you.
What Happens if You Do Not Respond or Have Ineligible Dependents?
If HMS does not hear from health plan participants within certain time frames, second and third letters will be sent. If health plan participants fail to respond after several opportunities to do so, the health care coverage for enrolled dependents will be terminated. In addition, if you have enrolled ineligible dependents, you should notify HMS.
Privacy and Personal Data
It’s important to know that neither HMS nor the JHMB is interested in personal details. The documents are used solely to verify dependent eligibility, so we can be assured that only those who are eligible for coverage under the terms of the District’s health plans are receiving those benefits. Further details regarding proper documentation, privacy, and security will be provided in the letter from HMS.
THIS IS NOT AN OPEN ENROLLMENT OPPORTUNITY
Please note that this process is only an eligibility verification review. Although the JHMB will be conducting a Special Enrollment during the same period this year, you may not use the dependent verification process to make changes to your health coverage. HMS will not be able to assist you in making changes, instead please consult the information provided by the JHMB specifically regarding the Special Enrollment period.
For Questions & More Information
If you have dependents (that is, your husband, wife, children, or domestic partner) enrolled in a District health plan, you will receive correspondence from HMS in the coming weeks. Detailed eligibility information, a FAQ, and HMS contact information will be included in the upcoming correspondence.
Feel free to contact HMS if you have any questions or need additional information. Please do not contact the District Benefit Department or Delta Health Systems, as HMS will be conducting the review on behalf of the District.
Thank you for helping to manage our plan expenses, so that we may continue to provide health care at a reasonable cost!