Garden Grove Unified School District

Health and Welfare Benefits

2013-2014

Benefit Package

As a benefited employee, you are entitled to a comprehensive benefits package including: Medical Dental Vision Life Insurance

Employee Contributions--Premium

Taken directly from your paycheck tenthly Employee Only – $50 Employee + I Dependent – $100 Employee + 2 or More Dependents – $150

Note: Sign both lines of your Election and Authorization form for tax exempt participation

Eligible Dependents

Legally Married Spouse Marriage Certificate required

Registered Domestic Partner Proof of state registration required

Children Under Age 26 Birth Certificate required

Qualifying Event

Certain changes in your status allow you to change the dependents on your plan.

New marriage / Domestic partnership New birth / Adoption Loss of other coverage in certain circumstances

Divorce or Legal Separation requires you to remove your spouse/former spouse.

All changes MUST be made within 30 days of the qualifying event

Open Enrollment

The month of September is Open Enrollment Open Enrollment is the time to make changes

to your plan Add dependents (outside of a qualifying event) Change health or dental coverage

Changes become effective October 1st

Medical Plans

GGUSD Self-Insured PPO GGUSD Self-Insured EPO United Healthcare HMO

Preferred Provider Organization (PPO)

Office Visit Co-Pay – $25 Emergency Room Co-Pay – $100 Deductible $300 per person

Max $900 per family Participating Providers – 80% / 20% Non-Participating Providers – 70% / 30%

Plus fees that exceed allowable PPO rates Coinsurance Maximum

$10,000 in billed allowable charges Pharmacy Co-Pays – $5, $10, $35

Exclusive Provider Organization (EPO)

Office Visit Co-Pay – $25 Emergency Room Co-Pay – $100 Deductible $300 per person

Max $900 per family 100% coverage after co-pays & deductible Must use only Participating Network Providers Pharmacy Co-Pays – $5, $10, $35

Finding In-Network Providers on the PPO and EPO plan Access the Anthem Blue Cross provider search at

www.ebam.com or call EBA&M at 855-322-7606. Check before every appointment as changes can

occur throughout the year. Make sure you are seeing the provider at the

address listed. When searching by name, keep your search broad

by not indicating a specialty. If you have trouble finding a provider by name, try

searching by location.

United Healthcare HMO

Office Visit Co-Pay – $25 Emergency Room Co-Pay – $100 Hospital Admission Charge – $100 per day

$300 max per admission $2,000 out of pocket max per calendar year

Per member Must use only United Healthcare providers

Must choose a primary care physician Must see only doctors within a chosen group Must get referrals to see most specialists

Pharmacy Co-Pays – $5, $15, $30

Comparison Chart

PPO Office visit co-pay =

$25 ER co-pay = $100 Deductible =

$300/person $900/family

Network 80% / 20%

Out of network 70% / 30% of

allowable

Pharmacy co-pay $5, $10, or $35

HMO Office visit co-pay =

$25 ER co-pay = $100 Hospital Admission

Charge $300 HMO providers only

= 100% Limited to primary

care physician and group.

Primary physician referral needed for most specialists.

Pharmacy co-pay $5, $15, or $30

EPO Office visit co-pay =

$25 ER co-pay = $100 Deductible =

$300/person $900/family

Network only = 100%

Pharmacy co-pay $5, $10, or $35

Dental

Garden Grove Self-Insured Dental United Concordia

Garden Grove Self-Insured Dental Plan (Fee for Service)

Choose your own dentist Use network for

additional savings!Annual deductibles

$25 individual $75 family maximum

Annual limit – $2,000Coverage – 90% / 10%Orthodontia

Plan pays 50% $2,800 lifetime max

United Concordia (HMO)

Must use United Concordia dentists 100% coverage for most covered services Orthodontic care (limited coverage)

Employee pays $1500 for banding for those under 19 $2000 for banding for those age 19 and older

Vision Service Plan

Eye exam – $25 One eye exam per year Lenses or contact lenses every 12 months Frames every 24 months

$120 Allowance Second Pair Benefit – $200

Allowance toward 2nd pair of contacts or glasses.

Life Insurance

Death Benefit Class 1 Employees – $50,000 Class 2 Employees (management) – $70,000

Limited coverage for dependents: Spouse – $1,000 Unmarried Children

Birth to 6 months – $100 6 months to 19 years – $1000

(Full-time students to 23)

Don’t forget to keep the Insurance Department updated on beneficiaries

125 Flexible Spending Account

Tax Exempt Medical

$2,500 maximum per year $200 minimum per year

Dependent Day Care $5,000 maximum filing jointly $2,500 maximum filing singly

How to be a good consumer...

Use it don’t abuse it- we pay for it! Urgent care vs. emergency room Pharmaceutical- generic vs. brand name

prescriptions Call Insurance Department first if unsure Ask questions of your doctor and pharmacist Keep your EOBs for your records Stay in network- includes doctor, hospital,

lab, anesthesiologist, etc.

Conclusion

Forms to be completed Insurance Election and Authorization Form

Note: Pre-tax deduction authorization is for insurance premium, not flex account

Life Insurance Beneficiary Designation Form Please hand in this form before you leave

Medical Enrollment Form Dental Enrollment Form

Questions?

Please feel free to contact us with any questions regarding your coverage

Crystal Qualls 714-663-6523 cqualls@ggusd.us

Sylvia McMillen 714-663-6523 smcmillen@ggusd.us

District Insurance website www.ggusd.us/departments/insurance/