Presentation on theme: "Garden Grove Unified School District"— Presentation transcript:
1 Garden Grove Unified School District Health and Welfare Benefits
2 Benefit PackageAs a benefited employee, you are entitled to a comprehensive benefits package including:MedicalDentalVisionLife Insurance
3 Employee Contributions--Premium Taken directly from your paycheck tenthlyEmployee Only – $50Employee + I Dependent – $100Employee + 2 or More Dependents – $150Note: Sign both lines of your Election and Authorization form for tax exempt participation
4 Eligible Dependents Legally Married Spouse Registered Domestic Partner Marriage Certificate requiredRegistered Domestic PartnerProof of state registration requiredChildren Under Age 26Birth Certificate required
5 Qualifying EventCertain changes in your status allow you to change the dependents on your plan.New marriage / Domestic partnershipNew birth / AdoptionLoss of other coverage in certain circumstancesDivorce 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 planAdd dependents (outside of a qualifying event)Change health or dental coverageChanges become effective October 1st
7 Medical Plans GGUSD Self-Insured PPO GGUSD Self-Insured EPO United Healthcare HMO
9 Exclusive Provider Organization (EPO) Office Visit Co-Pay – $25Emergency Room Co-Pay – $100Deductible $300 per personMax $900 per family100% coverage after co-pays & deductibleMust use only Participating Network ProvidersPharmacy 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 atCheck 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 – $100Hospital Admission Charge – $100 per day$300 max per admission$2,000 out of pocket max per calendar yearPer memberMust use only United Healthcare providersMust choose a primary care physicianMust see only doctors within a chosen groupMust get referrals to see most specialistsPharmacy Co-Pays – $5, $15, $30
12 Comparison Chart PPO EPO HMO Office visit co-pay = $25 ER co-pay = $100Deductible = $300/person $900/familyNetwork80% / 20%Out of network70% / 30% of allowablePharmacy co-pay$5, $10, or $35Office visit co-pay = $25ER co-pay = $100Deductible = $300/person $900/familyNetwork only = 100%Pharmacy co-pay$5, $10, or $35Office visit co-pay = $25ER co-pay = $100Hospital Admission Charge $300HMO 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 DentalGarden Grove Self-Insured DentalUnited Concordia
14 Garden Grove Self-Insured Dental Plan (Fee for Service) Choose your own dentistUse network for additional savings!Annual deductibles$25 individual$75 family maximumAnnual limit – $2,000Coverage – 90% / 10%OrthodontiaPlan pays 50%$2,800 lifetime max
15 United Concordia (HMO) Must use United Concordia dentists100% coverage for most covered servicesOrthodontic 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 monthsFrames every 24 months$120 AllowanceSecond Pair Benefit – $200Allowance toward 2nd pair ofcontacts or glasses.
17 Life Insurance Death Benefit Limited coverage for dependents: Class 1 Employees – $50,000Class 2 Employees (management) – $70,000Limited coverage for dependents:Spouse – $1,000Unmarried ChildrenBirth to 6 months – $1006 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 ExemptMedical$2,500 maximum per year$200 minimum per yearDependent 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 roomPharmaceutical- generic vs. brand name prescriptionsCall Insurance Department first if unsureAsk questions of your doctor and pharmacistKeep your EOBs for your recordsStay in network- includes doctor, hospital, lab, anesthesiologist, etc.
20 Conclusion Forms to be completed Insurance Election and Authorization FormNote: Pre-tax deduction authorization is for insurance premium, not flex accountLife Insurance Beneficiary Designation FormPlease hand in this form before you leaveMedical Enrollment FormDental Enrollment Form
21 Questions?Please feel free to contact us with any questions regarding your coverageCrystal QuallsSylvia McMillenDistrict Insurance website