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Garden Grove Unified School District

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Presentation on theme: "Garden Grove Unified School District"— Presentation transcript:

1 Garden Grove Unified School District
Health and Welfare Benefits

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

3 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

4 Eligible Dependents Legally Married Spouse Registered Domestic Partner
Marriage Certificate required Registered Domestic Partner Proof of state registration required Children Under Age 26 Birth Certificate required

5 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

6 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

7 Medical Plans GGUSD Self-Insured PPO GGUSD Self-Insured EPO
United Healthcare HMO

8 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

9 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

10 Finding In-Network Providers on the PPO and EPO plan
Access the Anthem Blue Cross provider search at or call EBA&M at 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.

11 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

12 Comparison Chart PPO EPO HMO 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 Office visit co-pay = $25 ER co-pay = $100 Deductible = $300/person $900/family Network only = 100% Pharmacy co-pay $5, $10, or $35 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

13 Dental Garden Grove Self-Insured Dental United Concordia

14 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 – $2,000 Coverage – 90% / 10% Orthodontia Plan pays 50% $2,800 lifetime max

15 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

16 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.

17 Life Insurance Death Benefit Limited coverage for dependents:
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

18 125 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

19 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.

20 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

21 Questions? Please feel free to contact us with any questions regarding your coverage Crystal Qualls Sylvia McMillen District Insurance website

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