Notice to Enrollees in the Fresno Unified School District Employee Health Care Plan

Group health plans sponsored by State and local governmental employers must generally comply with Federal law requirements in title XXVII of the Public Health Service Act (the “PHSA”). However, self-funded group health plans sponsored by state and local governments, including school districts, are permitted to elect to be exempt from some of the PHSA requirements. The benefits provided by Anthem Blue Cross, Avante, EnvisionRx, Claremont EAP, Chirometrics, and Delta Dental constitute the self-insured portions of the Fresno Unified School District Employee Health Care Plan (the “Plan”).

The Plan is administered by the Joint Health Management Board (“JHMB”). The JHMB has elected to exempt the self-insured portion of the Plan from the PHSA requirement to have the same financial requirements and treatment limitations for mental health or substance abuse benefits as for medical and surgical benefits. This exemption will be in effect for the plan year beginning July 1, 2013 and ending June 30, 2014. The election may be renewed for subsequent plan years.

PLEASE NOTE: Even though the JHMB is opting out of the mental health parity protections, the JHMB is not making any changes to your current mental health or substance abuse benefits. If you have questions regarding your mental health or substance abuse coverage, please contact Avante Health at (800) 498-9055.

The JHMB is not opting out of other applicable HIPAA requirements. It is not opting out of the provisions regarding standards relating to benefits for mothers and newborns, coverage for reconstructive surgery following mastectomies, and coverage of dependent students on medically necessary leaves of absence.

The PHSA also requires the Plan to provide covered employees and dependents with a “certificate of creditable coverage” when they cease to be covered under the Plan. There is no exemption from this requirement. The certificate provides evidence that you were covered under this Plan, because if you can establish your prior coverage, you may be entitled to certain rights to reduce or eliminate a preexisting condition exclusion if you join another employer’s health plan, or if you wish to purchase an individual health insurance policy.

If you have any questions about this notice, please contact Franceen Hanley at Delta Fund Administrators at (209) 940-5140.

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