In an effort to make it simpler to access the specific information you need, the Joint Health Management Board (JHMB) provides you with excerpts from the Official Plan Booklet regarding how to use the Plan. The Plan Booklet became effective April 1, 2012 and includes Plan clarifications up to August 1, 2012.
Access the Full Official Health Care Plan Booklet
Participants in Plan Option C, Kaiser Permanente option, should review a separate Evidence of Coverage brochure (available below) describing benefits offered through Kaiser Permanente and applicable sections of this Plan Booklet to familiarize yourself with all provisions of the plan of benefits offered through the District.
2022 Participant Notice – Mental Health Parity Opt-Out (PDF)
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, 2022 and ending June 30, 2023. The election may be renewed for subsequent plan years.
2019 Participant Notice – Mental Health Parity Opt-Out (PDF)
The JHMB has elected to exempt the self-insured portion of the Plan from the Public Health Service Act (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, 2019 and ending June 30, 2020. The election may be renewed for subsequent plan years.
2018 Participant Notice – Privacy Practices for Protected Health Information (PDF)
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
2018 Participant Notice – Mental Health Parity Opt-Out (PDF)
The JHMB has elected to exempt the self-insured portion of the Plan from the Public Health Service Act 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, 2018 and ending June 30, 2019. The election may be renewed for subsequent plan years.
2017 Certificate of Creditable Prescription Drug Coverage (PDF)
This notice (available on page 3 of the PDF download above) has information about your current prescription drug coverage with the Fresno Unified School District and about your options under Medicare’s prescription drug coverage. This information can help you decide whether or not you want to join a Medicare drug plan. If you are considering joining, you should compare your current coverage, including which drugs are covered at what cost, with the coverage and costs of the plans offering Medicare prescription drug coverage in your area. Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice.
2016 Annual Participant Notices (PDF)
Each year, the Joint Health Management Board distributes Annual Participant Notices for participants and dependents in the Fresno Unified School District Health Plan. The 2016 Annual Participant Notices specifically relate to the following topics:
- Certificate of Creditable Prescription Drug Coverage
- Mental Health Parity and Public Health Service Act
- New Mother’s Health Protection Act
- Notice of Privacy Practices for Protected Health Information
- Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
- Women’s Health and Cancer Rights Act
Download the Appeals Section (PDF)
Download the Coverage Interruptions Section (PDF)
How to Access Your EOBs Online
Delta Health Systems has the option for you to receive electronic Explanation of Benefits (EOBs). By following the simple instructions in the flyers provided below, you can choose to opt-in to receive electronic copies only.
How to Access Your EOBs Online (PDF)
Once this change is made, you will receive an email every 7 days if you or a family member has received care. You will still be able to view and print EOBs via the Delta Health Systems website once a claim is processed.
NOTE: Dependents over the age of 18 must log in and select their option separately.
If you do not login and select this option, you will continue to receive episodic EOBs paper copies in the mail every 7 days. Please download and review the flyer below for more information.
Understanding Your EOBs Online
Delta Health Systems also provides a helpful guide for understanding how to read your EOBs. We invite you review the guide for descriptions of the fields that correspond to the sample EOB provided in the download below.
Understanding Your EOBs Online (PDF)
Download the Eligibility Section (PDF)
Plan Amendment – Dependent and Disabled Child Definitions (PDF)
The definitions for Dependent and Disabled Child were amended effective 12/1/2013.Download the HIPAA Notice of Privacy Protection (PDF)
Download the If You Leave Section (PDF)
Download the COBRA RATES and ED CODE 7000 – Effective April 1, 2013 through December 31, 2014 (PDF)
Download the Important Information and Contact Numbers (PDF)
The Joint Health Management Board (JHMB) is pleased to provide you with direct access to the Kaiser Permanente Evidence of Coverage (EOC) booklets. These EOC booklets provide detailed plan information for the Kaiser Permanente Deductible HMO Plan.
Participants in Plan Option C, Kaiser Permanente option, should review the separate Evidence of Coverage booklets describing benefits offered through Kaiser Permanente and applicable sections of the District’s Official Plan Booklet to familiarize yourself with all provisions of the plan of benefits offered through the District.
Download the Kaiser EOC – Actives Employees (PDF)
Download the Kaiser EOC – Early Retirees (PDF)
As part of the health care reform law, the government established a new 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 overview of each medical plan in a standard format and is written in easy-to-understand language.
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). 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 three parts:
- Benefits and coverage information
- Coverage examples
- A link to a Uniform Glossary
Benefits and Coverage Information
This section includes a chart that lists the main features of your medical plan option(s). It answers fundamental questions about the coverage levels of the plan options. It also provides specific information about coverage for different services, such as office visits, prescription drugs and emergency room services.
Coverage Examples
The coverage examples on the last two pages of the document show how the plan might cover medical care for two specific scenarios – “Having a Baby” and “Managing Type 2 Diabetes.” The examples show what the plan would pay and what the patient would pay based on a common set of assumptions. It is important to note that these are examples only. They should not be used to estimate your actual costs under the plan.
Uniform Glossary
The SBC explains how to access or request a glossary with definitions for common health insurance and medical terms, such as copayment and deductible. There may be differences between terms found in the Uniform Glossary and those in your health plan documents. In these instances, you should go by the terms in your health plan document.
Download the Uniform Glossary of Health Coverage & Medical Terms (PDF)
Call Delta Health Systems or Kaiser Permanente Customer Services if you have questions about your plan. Use the toll-free number on your Delta Health Systems or Kaiser Permanente medical ID card for any questions you may have.
Please keep in mind the SBC is an summary illustration of your benefits plan. The Benefits Plan Booklet is the official governing document for your benefits plan. Review the Benefits Plan Booklet for specific details about your benefits plan.
2022 Summaries of Benefits and Coverage
Download the 2022 Summary of Benefits and Coverage – Healthcare Plan A (PDF)
Download the 2022 Summary of Benefits and Coverage – Healthcare Plan B (PDF)
Download the Notice: Your Rights and Protections Against Surprise Medical Bills – Affects Healthcare Plans A & B (PDF)
Download the 2022 Summary of Benefits and Coverage – Healthcare Plan C (Kaiser) (PDF)
Download the 2022 Summary of Dental Benefits and Coverage – UnitedHealthCare DHMO (PDF)
2021 Summaries of Benefits and Coverage
Download the 2021 Summary of Benefits and Coverage – Healthcare Plan A (PDF)
Download the 2021 Summary of Benefits and Coverage – Healthcare Plan B (PDF)
Download the 2021 Summary of Benefits and Coverage – Healthcare Plan C (Kaiser) (PDF)
2020 Summaries of Benefits and Coverage
Download the 2020 Summary of Benefits and Coverage – Healthcare Plan A (PDF)
Download the 2020 Summary of Benefits and Coverage – Healthcare Plan B (PDF)
Download the 2020 Summary of Benefits and Coverage – Healthcare Plan C (Kaiser) (PDF)
2019 Summaries of Benefits and Coverage
Download the 2019 Summary of Benefits and Coverage – Healthcare Plan A (PDF)
Download the 2019 Summary of Benefits and Coverage – Healthcare Plan B (PDF)
Download the 2019 Summary of Benefits and Coverage – Healthcare Plan C (PDF)
2018 Summaries of Benefits and Coverage
Download the 2018 Summary of Benefits and Coverage – Healthcare Plan A (PDF)
(effective January 1, 2018)
(effective June 1, 2018)
Download the 2018 Summary of Benefits and Coverage – Healthcare Plan B (PDF)
(effective January 1, 2018)
Download the 2018 Summary of Benefits and Coverage – Healthcare Plan C (PDF)
(effective January 1, 2018)
(effective June 1, 2018)