Presentation on theme: "Self-Insured Schools of California: Schools Helping Schools SISC Health Benefits Program Information for Peralta Community College District Presented."— Presentation transcript:
1 Self-Insured Schools of California: Schools Helping Schools SISC Health Benefits Program Information for Peralta Community College DistrictPresented October 11, 2012 by Lola Nickell, SISC Account Manager
2 Self-Insured Schools of California SISC - Who We Are Not-For-Profit Joint Powers Authority (JPA) established in 1979, administered by the Kern County Office of Education.SISC administrative personnel are employees of the public school system.SISC III is one of the largest school focused health care purchasing pools in California.Current statewide membership is over 200,000 lives from over 380 school districts in 39 countiesA JPA governed by a Board of DirectorsLike school districts, SISC is subject to the Brown Act.Our Board of Directors are employees of school districts and are elected by member districts.Our Philosophy – “Schools Helping Schools”
3 The SISC AdvantageUnder SISC, districts may select from a wide range of medical, dental, vision, and life plan product offerings to customize a comprehensive benefit package for employees.Strong financial standing with stabilization reserves. Claims liability fully funded.Long term health benefits solution: 220+ districts in SISC III for at least 10 years.Continued growth: 150+ school districts have joined in the last 10 years.
4 SISC: Carriers & Products We offer a wide range of health benefits through major carriers; PPO’s, HMO’s, Rx, Dental, Vision and Life.Anthem Blue Cross (Self-funded PPO and fully insured HMO)Blue Shield (Self-funded PPO and fully insured HMO)Pharmacy Benefits through Express Scripts (Non-HSA plans)Kaiser PermanenteDelta Dental (Premier and PPO Plans)Vision – VSP and MESLife - Mutual of Omaha
5 SISC Medical Plan Options HMO Plan OptionsKaiser Permanente, Anthem Blue Cross, Blue ShieldMust live/work within defined service areaSelf Funded PPO19 Medical + 2 HSA Compatible OptionsSISC Plan Design with Anthem Blue Cross or Blue Shield of CaliforniaOut of Network services paid at Non-Par Fee Schedule (except emergencies)No annual Out of Pocket maximum on OON expensesBlue on Blue RulesOutside California: BlueCard network (BCBSA)General InformationNo waiting periods, no pre-existing limitationsDeductibles run January to December4th Quarter Deductible Carryover on non-HSA PPO plans
6 Outpatient Rx: Anthem & Blue Shield PPO & HMO Plans Outpatient prescription drug coverage through Express Scripts (Except HSA Plans)SISC Express Scripts Rx Plan Enhancements:Costco $0 Co-Pay Program for Generic DrugsCostco Membership is not required; Excludes some categories: narcotic pain and some cough medicationsGeneric Co-Pays for Diabetic SuppliesThe generic co-payment will be charged on brand only Diabetic supplies (lancets, test strips and syringes)Maximum 30 Days Supply at Retail Pharmacies. Most pharmacies are in-network EXCEPT Walgreens90 Days supply available with Mail-Order through Express Scripts
7 Dental & Vision Plans Delta Dental Plan Can offer dual choice to include a Premier (Incentive) Plan and a PPO PlanAll medical plan options must include same dental plan(s)Those employees enrolling in medical must enroll in dentalImplants are covered benefitVision Service PlanAll medical plan options must include same vision planAll employees enrolling in medical must enroll in vision
8 Value Added Services For Members: Health Smarts- A robust Health Improvement ProgramIncludes: Periodic on site biometric screenings and on site flu shot clinic at no charge to member or districtMost Recent Program: Awards up to $150 for participation in online health improvement program; all SISC members age 18+ eligibleSISC Employee Assistance Program (EAP)Resources for Managers and SupervisorsVoluntary, No cost to use EAP, Available 24 hours /7 days per weekConfidential service by Licensed ProfessionalsSISC Section 125 PlanNo participation fees for Employee or District
9 Value Added Services For Districts: No-Cost Administration Services include:COBRASection 125 Flex PlanSelf-pay Individual Retiree Direct Bill programLow Cost Administration ServicesRetiree Drug Subsidy (RDS) - OptionalSISC has collected $7 million for districts since 2006SISC charges $30 per member for annual applicationApplication fees not charged until subsidy receivedOther Administrative Services May Be OfferedExample: Early Retiree Reinsurance Program (ERRP)SISC filed for ERRP monies on behalf of member districtsFunds paid as of January 2012 totaled $27.5 million (29th largest)ERRP funds applied to offset renewal increases
10 Program Options and Eligibility Plan Choices – Work with SISC to select a maximum of 6 plans for each employee group (plan options subject to underwriting approval)Benefit selections may be unique to three groups: Confidential & Management, Classified, CertificatedEligibility for domestic partners is as stated under AB205 unless the district requests that eligibility be extended to opposite sex domestic partners (a negotiated benefit)Eligible Dependents include: legal spouse, DP; Child/Child of DP: natural child, step-child, legally adopted child to age 26; a child for whom the member has legal guardianship to age 18. Disabled overage child who is a dependent for federal income tax purposes and who has been accepted through carrier application process.
11 Participation Requirements WHO MUST ENROLL IN COVERAGEAll employees who work 90% or more of the full-time equivalent for the applicable job classification are required to participate in all health benefits offered by the districtWHO MAY DECLINE COVERAGE An eligible employee who works less than 90% of the full-time equivalent for the applicable job classification or receives less than 90% of the amount that is contributed towards an eight-hour full-time employee may enroll when first eligible or decline coverage. If they enroll, they must enroll in all coverage offered through SISC.Any deviation from SISC Underwriting Guidelines must be requested in writing by the school district and approved in writing by SISC prior to joining.
12 RetireesMust enroll at initial enrollment, no re-entry once coverage terminatesMay select from medical plans offered to active employees of bargaining unit from which they retiredAll Retirees must be enrolled in Medicare Parts A&B, otherwise costly monthly surcharges will apply.Retirees with Medicare A&B may choose instead to enroll SISC Individual Retiree Medical Plan OptionsAll include Medicare Part D Rx with no donut holeKaiser Permanente Senior Advantage Plan $324 SingleBlue Shield Mediare Advantage Plan $354 SingleRetiree must reside in Advantage Plan Service AreaCompanionCare – SISC Medicare Supplement $373 SinglePlan is claim free when services are received from providers who accept Medicare Assignment. No residence limits.
13 Joining SISC: Timing & Action Items SISC Rates are effective October 1-September 30Renewing districts receive rates by early MayDistricts may join SISC with a the first of the month effective date, with 60 days advance noticeDepending on effective date, initial rate period maybe short or long.Example 1: Joining SISC January 1, 2013: Rates quoted will remain in effect to September 30, 2013Example 2: Joining SISC July 1, 2013:Rates quoted will remain in effect to September 30, 2014SISC Underwriting will provide list of items required for quote, and quote delivery timeline. Quote delivery typically takes place after district receives KP renewal.Initial commitment is 3 years per JPA agreementWithdrawal from program – written notice must be received by August 15 for October 1 effective date
14 Joining SISC: Timing & Action Items Signed SISC JPA Agreement & Bylaws, Plan choice selections will be required 60 days in advanceSISC will coordinate with District and Carriers to provides Open Enrollment meetings for Active and Retiree membersRequired: Submission of signed, completed enrollment forms (fillable pdf)Dependent eligibility documentation required (copies of birth & marriage certificates, DP registration forms, legal custody docs, etc.)Support available for members currently in course of care at time of transition
15 Peralta CCD Committee Members: Thank you for your interest in SISC. Questions?Peralta CCD Committee Members:Thank you for your interest in SISC.Lola NickellSISC Account Manager