For eligibility, claims or customer service, call Delta Health Systems at 800-807-0820.
The following information about your medical benefits comes directly from the FUSD’s Employee Benefits Book. A full copy of the Employee Benefits Book can be downloaded by clicking here.
Please read your Plan Booklet and familiarize yourself with the benefits provided through the Fresno Unified School District Health Care Plan. The Table of Contents is designed to help you find information quickly and assist you in understanding the Plan’s benefits, provisions, and eligibility requirements. There is also an Index in the back of this Plan Booklet to assist you as a quick reference. Becoming familiar with your Plan prior to accessing health care services will assist you in receiving maximum benefits payable under the Plan.
As a quick reference, should you require Medical Care follow the procedures outlined below:
1. Call Patient’s Network Provider Physician or 911 as appropriate, OR
2. Go directly to emergency room, Outpatient clinic or similar provider for needed service.
If you are admitted to the Hospital as an Inpatient — Within 72 hours of admission, someone MUST CALL either of the following numbers to obtain authorization.
Medical Conditions: Anthem Blue Cross (800) 274 7767
Mental Health Conditions: Avante Health (800) 498-9055 or (559) 261-9060
If ongoing care (follow up visit) is required, you may be required to obtain authorization for certain Non-Emergency services (outlined below). Failure to obtain necessary pre-authorization will result in a $250 penalty if you use a Non-Network provider.
1. Obtain Routine Care from Patient’s Network Provider Physician. You may use Anthem Blue Cross Specialists for Outpatient services without obtaining prior-authorization except for the following services or treatments:
* All Inpatient Admissions
* All Outpatient Surgeries
* Skilled Nursing Facility
* Home Health Care
* Diagnostic Services over $2,000
* All Durable Medical Equipment, expected to exceed $2,000
* Physical Therapy over six visits
2. Inpatient or Outpatient Hospital Services require pre-authorization by Anthem Blue Cross.
3. Chiropractic – please refer to page 28.
4. Mental Health – page 25, please call Avante Health for routine Mental Health Care – (800) 498-9055 or (559) 261-9060.