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