HUMAN RESOURCES
Benefit Summary
Table of Contents
- Introduction
- AFLAC
- Pacificare (HMO Members Only)
- Delta Dental
- VSP (Vision Plan)
- Blue Cross (PPO & HMO)
- Kaiser Permanente HMO
- Express Scripts Inc. (PPO Members Only)
- How Much Things Actually Cost
Introduction
The District provides Medical, Dental, Vision and Life Insurance to employees and their dependents. The Dental, Vision and Life plans require no premium contribution for full time employees. We have a corporate membership account with 24 Hour Fitness where you can enroll on a month-to-month basis with no long term contract involved and no enrollment fees.
Employee premium contribution is required for medical coverage. Currently for the HMO plan it is $52.00 per month and for the PPO plan it is $150.00 per month. Open enrollment will be conducted during the month of September as our policy year begins October 1, 2007. We have not completed our medical plan renewal for the next policy year. The premium contribution may be subject to change; however, we are hopeful that we shall have a favorable renewal.
AFLAC
Julie Kraus, AFLAC Representative
1-805-529-8190
AFLAC offers a variety of supplemental insurance programs.
FLEX ONE Section 125 provides a way to buy a range of supplemental benefits through the workplace on a pre-tax basis that may increase take home pay.
FLEX ONE®
Lets employees use pre-tax dollars to pay for qualified benefits,
like health insurance and child care, through AFLAC’s Section 125 Cafeteria
Plan Program.
AFLAC Administrative Services offers a new direct deposit program called REDI-FLEX. REDI-FLEX is free, you get your payments faster and your banking time is shortened. REDI-FLEX can become effective in as little as 10 business days.
AFLAC believes that preventive medical testing and screenings are just as important to maintaining good health as seeking treatment when you are ill or have been hurt in an accident.
For this reason, we offer the Wellness Benefit to our policyholders. After you have paid your premiums for 12 months and while coverage is in force, AFLAC will pay a benefit for you or any one family member (if family coverage applies) to undergo routine examinations or other preventive tests. Family members include your spouse and the dependent children of you or your spouse.
Pacificare (HMO Members Only)
1-800-999-9585
There may be times in your life when you feel out of control and overwhelmed. Maybe you have a personal or workplace issue, problems or crisis that consumes your thoughts. Or maybe a household member is experiencing problems. Or maybe you need help locating resources to help deal with everyday issues, like locating quality childcare or establishing a budget. Whatever the problem, you do not need to handle it alone. PacifiCare Behavioral Health is here to provide Employee Assistance Program (EAP) services and Mental Health and Chemical Dependency Benefits. PacifiCare Behavioral Health is a leader in providing managed behavioral health benefits to schools. All mental health and EAP services are available for you and your enrolled dependents. All services are strictly confidential and protected at all stages of the programs.
Need to Sharpen Your Focus?
In today's workplace, where multi-tasking and a busy schedule are now part of the landscape, it's a challenge to get organized and stay that way. Commonly, when people are disorganized, they feel overwhelmed and out of control, which eventually hampers their ability to accomplish what needs to be done. Understanding how to get organized is critical to maintaining high productivity, keeping a sharp focus on your most important job responsibilities, and controlling your stress level.
Need a few solid pointers to help you stay on track? Get started with these ideas:
- Plan your Day
- Manage paperwork and mail as received
- Stop Procrastination
Delta Dental
1-866-499-3001
Principal Benefits & Covered Services
Under this plan, Delta pays 70% of the approved fees for covered diagnostic, prevention, basic, cast and crown benefits during the first year you are eligible. This percentage will increase 10% each year (to a maximum of 100%) for each enrollee, provided that person visits the dentist at least once of year. If an enrollee does not use the plan during a calendar year, the percentage remains at the level reached the previous year. If an enrollee becomes ineligible for benefits and later regains eligibility, the percentage will drop back to 70%.
The plan offers an allowance maximum of $1,500 per calendar year, per subscriber and covered dependents.
About Delta Dental
The Delta Dental Premier plan allows you to :
- Visit any licensed dentist of your choice.
- Change dentists at any time
- Go to a dentist specialist of your choice.
- Receive dental care anywhere in the world.
VSP (Vision Plan)
1-800-877-7195
The plan provides full coverage, in excess of a $10.00 calendar year deductible, for covered services when you go to a participating provider of the Eye Care Network. (Allowances are only applicable when utilizing the Medical Eye Services Preferred Providers).
Benefits Provided (after the annual $10 co-payment has been paid)
- The VSP Core plan covers a WellVision Exam that focuses on eye health and overall wellness every 12 months.
- Lenses (every 12 months): Single vision, lined bifocal, and lined trifocal
- Frame (every 24 months): up to $110, 20% off any out-of-pocket costs
or
- -Prescription contact lens material covered-in-full up to the retail allowance of $100 (every 12 months) Allowance is for contacts and the contacts lens fitting evaluation.
- There is a buy-up option available for $4.81 a month; please contact the Insurance Specialist for additional information.
Blue Cross
Blue Cross PPO 1-800-288-2539
If elected, there is a $150.00 monthly premium contribution for the PPO Plan.
The Blue Cross PPO sponsored plan has a deductible of $500 p/person. It covers 90% In-Network and 70% Out-Of– Network.
Blue Cross has kept its networks among the largest and strongest in California, even with recent disruptions in provider networks throughout the state. We know that changes to networks can be a confusing and frustrating experience for employers and employees. Blue Cross works hard to help maintain relationships with providers and to lessen the impact of network changes on employees. Blue Cross has access to one of the largest networks in California and across the United States.
Blue Cross HMO 1-800-227-3771
If elected, there is a $52.00 monthly premium contribution for the Blue Cross HMO Plan.
Blue Cross HMO members must consult with their primary care physician for all services.
Doctor visits have a $10 co-pay and emergency room visits have $50 co-pay. The prescription program includes Generic $10/Brand $20.00.
The best way for you to stay healthy is through maintaining a healthy lifestyle.
Kaiser Permanente HMO
1-800-464-4000
If elected, there is a $52.00 monthly premium contribution for the Kaiser HMO.
Kaiser members must consult with their primary care physician for all services.
There is a $10 co-pay for all office visits and a $50 co-pay for all emergency room visits.
The Kaiser HMO offers a prescription drug program including the following benefits:
- $10 co-pay: generic
- $20 co-pay: brand name
- 100 day supply retail or mail order
- $10 co-pay: generic
- $20 co-pay: brand name
*There is a Kaiser Pharmacy’s located in Oxnard (1851 Lombard Street #105 on Gonzales Rd.) and in Ventura (4020 Main Street #B-8 in the Bed Bath & Beyond Plaza)
Express Scripts Inc. (PPO Members Only)
The Express Scripts Inc., retail Prescription Program allows you to go to any ESI participating pharmacy to have a short term prescription filled.
Express Scripts Inc., offers the choice of a Mail Service Prescription Program. The Mail Service Program is a convenient and cost effective way to obtain your maintenance medications through the mail. Maintenance drugs are those drugs taken for an ongoing or chronic condition such as high blood pressure, heart disease or a thyroid condition.
How to Protect Yourself Against Medication Errors
- Make sure you understand all of the instructions and follow them.
- Dispose of drugs once their expiration date has been reached.
- Always keep medications in their original containers. Although it may seem practical to store a few prescription pills in an old vitamin bottle during your vacation, you might end up swallowing a drug when you meant to take a vitamin.
- Turn on the light when taking medications at night. It's alarming how easy it is to mix pills up in the dark.
- Give your healthcare providers a list of every drug you take, including herbal remedies or over-the-counter products like aspirin. This will greatly reduce the chance that a doctor will prescribe a drug that clashes with one of your other medications.
How Much Things Actually Cost
Knowing what you’re spending and keeping an eye on healthcare costs are important parts of keeping healthcare affordable for all of us. Ask for FDA-Approved generic instead of more expensive name brands.
Make sure you’re getting the right treatment, and always ask your doctor if you have any questions.
Review all medical bills for accuracy, and ask about any costs that you don’t recognize or understand.
Did You Know?
- The national average cost of an MRI is nearly $2000
- Heart Bypass surgery costs about $57,000
- The average cost of a 30-day prescription of one
name brand drug is $71 compared to $22 for the generic equivalent
Rising medical costs are a challenge facing everyone from hospitals and physicians to health plans, and consumers. Until recently, many of us have been largely shielded from cost increases; but that is changing. By understanding what factors are contributing to rising costs and learning some basics about health insurance and how our health plans work, we can all play a role in keeping healthcare affordable.
309 S. K Street, Oxnard, CA 93030 | 