Document Sample
					                        SOUTH BAY UNION SCHOOL DISTRICT
                             2010-2011 Insurance Benefits
                           The Open Enrollment period begins October 27, 2010
                                      through November 10, 2010
                                      The new plan year begins January 1, 2011

           You are invited to the Health Fair & Flu Clinic at Burress Auditorium
                 on Wednesday, October 27th, from 2:00 p.m – 5:00 p.m.

                                                Your Insurance Benefits

South Bay Union School District is a member of VEBA, the Voluntary Employees Benefit Association, for medical
health plans, Keenan & Associates for dental and vision plans, and the San Diego County Office of Education’s Fringe
Benefit Consortium for other programs. To comply with VEBA’s plan year, our medical plans have a January 1, 2011
start date. In this brochure we outline the cost of benefits to employees. There are rows that refer to what the District
pays and what the eligible employee pays and both are based on negotiations settlements.

Eligible employees are provided a comprehensive package of benefits described in this brochure. Currently, the one-
year agreement has the District paying up to the 2010 premium for Kaiser, and the full 2010 cost of dental, vision and
group life insurance. Beginning January 1, 2011, the District’s contribution to health (including dental, vision, and
group life insurance) benefits will revert back to the 2009 premium rates (health at the Kaiser rate).

The following pages are provided as a summary of each plan and contain information about the general provisions of
each of your insurance benefits. Several voluntary programs are available as outlined on page 4 of this brochure. You
are urged to become familiar with these benefits so that you and your family can take maximum advantage of the

Beginning January 1, 2011, any qualified adult child up to age 26, regardless of employment, student status or
residency, will be allowed to be added as a dependent. They must not have or be eligible for health insurance
elsewhere. Grandchildren are NOT eligible dependents without court approved legal guardianship.

The new Performance HMO will be replacing the current Pacificare plan. We will now be offering Pacificare under
tiered rates. The premiums due will be based on the amount of employees and dependents insured. Also, the
Pacificare POS plan will no longer be available. All Pacificare HMO and POS subscribers will need to enroll in the
new Pacificare Performance HMO plan or change to Kaiser.

You may be able to waive medical insurance if you have other health insurance. You will be required to sign a waiver
and submit proof of other coverage.

All employees will have to log on to the VEBA website for online enrollment. All employees, even if you are not
changing plans will need to enroll online. You will need to verify if all the information is correct.

If you have any questions, please contact Margie Cordero in the Human Resources office at extension 81698.

                                        Carol A. Parish, Ed.D, District Superintendent
                                                      Board of Trustees
 Elvia Aguilar    -     Chris Brown      -     Nick Inzunza       -       Althea F. Jones   -   David Lopez
                                                                    HEALTH PLAN COMPARISON
                                                VEBA Plans Phone Number 619-278-0021/Web Site

                                                          PacifiCare Performance HMO                                                    Kaiser $10/$10
 Carrier Phone                                                   1-800-624-8822                                                         1-800-464-4000
 Numbers/Web Sites                                                                         

 Co-Pay                                                       Network 1- $10 copay
                                                                                                                           $10 Office visits Class/Cert/Mgmt
                                                              Network 2 - $20 copay                                        $10 Medication Class/Cert/Mgmt
                                                              Network 3- $40 copay

 Certificated                 Certificated –Single            Certificated -Two Party         Certificated - Family        Premiums Tenthly- Super composite
 Tenthly Premium              Network 1 - $594.68             Network 1 - $1,173.24                                                Classified (10 mos) $1,048.81
 Tiered Rates                                                 Network 2 - $1,242.92           Network 1 - $1,652.72
                              Network 2 - $629.83                                             Network 2 - $1,750.37                         Cert (10 mos) $1,114.32
                                                              Network 3 - $1,253.34
                              Network 3 - $634.60                                             Network 3 - $1,764.25                       Mgmt (10 mos) $1,098.65

 Certificated                 Certificated - Single           Certificated- Two Party         Certificated - Family        District Pays - Super composite
 District Pays                Network 1 - $594.68             Network 1 - $887.51             Network 1 - $887.51                      Classified (10 mos) $928.68
 Tenthly                      Network 2 - $629.83             Network 2 - $887.51             Network 2 - $887.51                             Cert (10 mos) $887.51
                              Network 3 - $634.60             Network 3 - $887.51             Network 3 - $887.51                           Mgmt (10 mos) $887.51

 Certificated                 Certificated – Single           Certificated – Two party        Certificated – Family        Employee Pays - Super composite
 Employee Pays                Network 1 - $0                  Network 1- $285.73              Network 1- $765.21                      Classified (10mos) $120.13
 Tenthly                      Network 2 - $0                  Network 2- $355.41              Network 2 - $862.86                      Certificated (10mos) $226.81
                              Network 3 - $0                  Network 3- $365.83              Network 3 - $876.74                            Mgmt (10mos) $211.14

 Classified                   Classified – Single             Classified – Two party          Classified – Family
 Tenthly Premium              Network 1 - $594.68             Network 1 - $1,173.24           Network 1 - $1,652.72
 Tiered Rates                 Network 2 - $629.83             Network 2 - $1,242.92           Network 2 - $1,750.37
                              Network 3 - $634.60             Network 3 - $1,253.34           Network 3 - $1,764.25
 Classified                   Classified – Single             Classified – Two party          Classified – Family
 District Pays                Network 1 - $594.68             Network 1 - $ 928.68            Network 1 - $928.68
 Tenthly                      Network 2 - $629.83             Network 2 - $ 928.68            Network 2 - $928.68
                              Network 3 - $634.60             Network 3 - $928.68             Network 3 - $928.68

 Classified                   Classified – Single             Classified – Two party          Classified – Family
 Employee Pays                Network 1 - $0                  Network 1 - $244.56             Network 1 - $724.04          All Chiropractic services provided
                                                                                                                           through American Specialty Health
 Tenthly                      Network 2 - $0                  Network 2 - $314.24             Network 2 - $821.69          $10 copay/30 visits per calendar yr
                              Network 3 - $0                  Network 3 - $324.66             Network 3 - $835.57          800-678-9133
 Management                   Mgmt – Single                   Mgmt – Two Party                Mgmt - Family
 Tenthly Premiums             Network 1 – $594.68             Network 1 - $1,173.24           Network 1 - $1,652.72
                              Network 2 – $629.83             Network 2 - $1,242.92           Network 2 - $1,750.37
 Tiered Rates                 Network 3 - $634.60             Network 3 - $1,253.34           Network 3 - $1,764.25

 Management                   Mgmt – Single                   Mgmt – Two Party                Mgmt – Family
 District Pays                Network 1 - $594.68             Network 1 - $887.51             Network 1 - $887.51
 Tenthly                      Network 2 - $629.83             Network 2 - $887.51             Network 2 - $887.51
                              Network 3 - $634.60             Network 3 - $887.51             Network 3 - $887.51
 Management                   Mgmt - Single                   Mgmt – Two Party                Mgmt - Family
 Employee Pays                Network 1 – $0                  Network 1 – $285.73             Network 1 - $765.21
 Tenthly                      Network 2 – $0                  Network 2 – $355.41             Network 2 - $862.86
                              Network 3 - $0                  Network 3 - $365.83             Network 3 - $876.74

 Hospital Benefits            Paid in full Network 1/ $500 copay per admit Network 2/ 20% copayment Network 3              Hospital paid at 100%
 Emergency Room               $100 copay Network 1/$200 copay Network 2/ $300 copay Network 3 (waived if                   Emergency Room copay $50.00
                                                                                                                           (waived if admitted)
 Maternity Care               Paid in full Network 1/ $500 copay per admit Network 2/ 20% copayment Network 3
 Prescriptions                 Retail (30 day supply)     $3/$15/$30 Network 1                                             Prescriptions $10.00 copay
                                                         $10/$25/$40 Network 2                                             up to a 100-day supply
                                                         $10/$25/$40 Network 3
                              Mail Order (90 day supply) $6/$30/$60 Network 1
                                                            $20/$50/$80 Network 2
                                                            $20/$50/$80 Network 3
 The outline and summary do not create nor confer any rights. It is a brief outline of the plans and is not to be accepted or construed as a substitute
for the provisions of the Master Policy. Benefits are paid on eligible expenses.
                                                   DISTRICT-PAID BENEFITS
DENTAL                                                                         VISION
Tenthly PPO Monthly Premiums        Class/Mgmt $80.03 Cert $116.55             866-723-0513            
District pays Tenthly               Class/Mgmt $80.03 Cert $113.07             Tenthly Monthly Premiums                            $10.81
Eligible Employee Pays Tenthly      Class/Mgmt $0      Cert $3.48              District Pays Tenthly                               $10.81
DHMO Tenthly                        District Pays 100% All Empl                Eligible Employee Pays                                   $0
                                                                               Vision care benefits are provided thru Eye Med Select Plan
Dental Benefits provided thru Met Life Dental PPO                              Deductible
Your dental benefits include:                                                  $15 copay for exam in Network
    Classified/Mgmt/Certificated - Deductible $25 per year - In Network/
                                                                               Up to $18 reimbursement for Out of Network
    $50 per year - Out of Network
    Class/Mgmt/Certificated - Annual Max $1,500 year one, $1,750 year          Benefits
    two & $2,000 year three - In Network/ $1,000 max - Out of Network          Vision exam                 every 12 months
    Class/Mgmt/Certificated – Orthodontia Lifetime Maximum: $1,000 -           Lenses                      every 24 months
    In Network and $500 - Out of Network                                       Frames                     every 24 months
    Class/Mgmt/Certificated - Cleanings, x-rays, and exams 100% PDP            These services may be secured from any Eye Med Vision Care
    Fee - In Network/100% R & C Fee - Out of Network                           Select doctor or from a doctor of your choice. If the services
    Class/Mgmt/Certificated – Fillings, extractions, root canals, gum          are provided by an In Network provider you will have a less
    treatments 80% PDP Fee – In Network/70% R&C Fee – Out of                   out of pocket expense. If you see an Out of Network provider
                                                                               you can submit for an Out of Network reimbursement. This
    Class/Mgmt/Certificated - Crowns, cast restorations, bridges, dentures
    80% PDP Fee - In Network/40% R&C Fee - Out of Network                      benefit can be coordinated with your HMO for additional
    Class/Mgmt/Certificated – Orthodontia 50% PDP Fee - In Network/            savings.
    40% R&C - Out of Network
                                                                               MASTECTOMY NOTICE
                                                                               Special Rights Following Mastectomy: A group health plan
PDP refers to Participating Dentists/R&C refers to Reasonable & Customary      generally must, under federal law, make certain benefits
You will be eligible for Prosthodontic Benefits after you have been enrolled
continuously under the contract for 12 months                                  available to participants who have undergone a mastectomy.
                                                                               In particular, a plan must offer mastectomy patients benefits
Dental HMO (DHMO) The DHMO is a managed dental plan                            for:
requiring you to select a Primary Dentist. The Primary Dentist will
direct all y our dental care needs, including referrals to specialists.        Reconstruction of the breast on which the mastectomy has been
There is no annual plan maximum under the DHMO and some of                     performed:
your out-of-pocket expenses may be lower than on the PPO.                      • Surgery and reconstruction of the other breast to produce a
However, the DHMO has a much smaller network of dentist that the                   symmetrical appearance;
PPO.                                                                           • Prostheses;
                                                                               • Treatment of physical complications of mastectomy.
Term life insurance coverage is paid for by South Bay Union School             Our Plan complies with these requirements. Benefits for these
District during active employment, through age 75. Coverage is                 items generally are comparable to those provided under our
$30,000 until age 70. At age 70, life insurance is reduced to                  Plan for similar types of medical services and supplies. Of
$19,500. At age 75, life insurance is reduced to $15,000. Coverage             course, the extent to which any of these items is appropriate
is provided through Mutual of Omaha.                                           following mastectomy is a matter determined by consultation
You may change your life insurance beneficiary at any time                     between the attending physician and the patient. Our Plan
throughout the year.                                                           neither imposes penalties (for example, reducing or limiting
                                                                               reimbursements) nor provides incentives to induce attending
DUAL COVERAGE                                                                  providers to provide care inconsistent with these requirements.
If you and your spouse/ domestic partner each have the same dental
or vision benefits, you may qualify for dual coverage. When                    BEHAVIORAL HEALTH CARE BENEFITS
utilizing these benefits, have the provider submit a claim in each             You get behavioral benefits through Optum Health as long as
social security number and this could eliminate deductibles and co-            you receive care from a Optum Health network provider. A
pays.                                                                          mental health provider can help you explore problems,
                                                                               understand the cause of the problems and learn self-
SWTA Only: DISABILITY INSURANCE                                                management techniques. Your conversations with your mental
This benefit is for SWTA members only.                                         health provider are always confidential. 24 hrs a day/7 days a
The long-term disability plan provides income protection in case               week for pre-authorization of services, call 888-625-4809
you become totally disabled due to illness or injury. Benefits begin           Web: Click Find a Mental Health
after you have been totally disabled for 90 days. The maximum                  Clinician. You must call Optum Health for pre-authorization.
monthly benefit is 2/3 of your monthly salary up to $5,000. You                Your dependents are also eligible for behavioral health care
must be a full-time employee at the time you are totally disabled to           benefits.
qualify for this benefit
                              DISTRICT-SPONSORED VOLUNTARY BENEFIT
                                  Premiums paid through Payroll Deduction
Tax Sheltered Accounts                                COBRA Coverage                                        Participation is available to employees
Fortify your retirement by                            You may be entitled to continue                       throughout the year. For a comparison
contributing to tax sheltered/                        your medical coverage at your                         quote, the District’s Liberty Mutual
deferred compensation accounts                        expense under this program after                      number is: 619-370-6667
known as 403(b) and 457 plans.                        certain Qualifying Events.
See representatives at the Open                       The Qualifying Events are:                            Hyatt Legal Plan
Enrollment meetings.                                  1. The        Primary      Enrollee’s                 Coverage is provided through Hyatt
                                                           termination of employment,                       Legal Plans, a Met Life Company. The
Long-Term Care Insurance                                   other     than     for     gross                 employee premium is $23.10 tenthly.
Long-term care is assistance for                           misconduct,       or      his/her
people who are unable to care for                          reduction in work hours to less                  Coverage provides legal representation
themselves independently because                           than the minimum required to                     for a variety of services including wills,
of an accident, illness, or advancing                      be eligible under this program;                  trusts, estate planning, identity theft
age. Care may be provided either                      2. The Primary Enrollee’s death;                      defense, consumer protection matters,
at home or in a licensed facility.                    3. A divorce or legal separation                      real estate matters, debt collection
                                                           from the Primary Enrollee;                       defense; as well as unlimited telephone
Coverage is provided through                          4. An enrolled dependent child’s                      advice for attorneys, office consultations,
UNUM Life Insurance Company.                               loss of eligibility as a                         and document preparation.            Once
Voluntary long-term care insurance                         dependent;                                       enrolled, you must stay in the plan and
may also be purchased for your                        5. The Primary Enrollee qualifies                     continue payroll deductions for the full
spouse, parents, grandparents, and                         for Medicare benefits.                           plan year.
your     spouse’s     parents  and
grandparents. Spouse coverage is                      Voluntary Term Life Insurance                         IRC Section 125
paid by payroll deduction. Other                      You may purchase additional life                      This IRS program is designed to help
family members pay the provider                       insurance for yourself, your spouse,                  reduce the amount of taxes you pay.
directly for their coverage.                          and your dependents. Coverage is
                                                      provided through Mutual of                            There are three areas of Section 125:
New employees are offered a Base                      Omaha. Premiums vary by type of                       1. Pre-tax medical premiums if you
Plan (Facility only benefit, $1,000                   plan and amount of coverage.                             select one of the PacifiCare or Kaiser
per month benefit, $24,000 plan                       Employee can elect amounts in                            options that has a copayment;
maximum).                                             $10,000     increments,     up    to                  2. Flexible Spending Accounts
                                                      $300,000 not to exceed 5 times                            a) Medical reimbursement accounts.
Subscribers can elect buy-ups that                    salary. Spouse can elect amount in                            Maximum reimbursement is
include simple inflation, Home                        $5,000 increments, up to $100,000,                            $2,400.
Health Care Benefit, a longer                         not to exceed 50% of employee                             b) Dependent care reimbursement
duration (4 years or unlimited) and                   amount.                                                       accounts. Maximum dependent
a larger monthly benefit up to                                                                                      care is $5,000;
$6,000.                                               Liberty Mutual                                        3. Improve your benefit portfolio by
                                                      Liberty Mutual Insurance Company                          adding certain voluntary insurance
Premium costs vary by type of                         offers employees a program called                         plans provided through American
plan/coverage and age. Coverage                       Group Savings Plus, which                                 Fidelity.
may be continued if you leave the                     provides discounts on auto and
District.                                             homeowners insurance. Coverage                        Strict IRS guidelines apply to this
                                                      includes:                                             program.     Your selection cannot be
Accidental Death & Dismem-                            * A group discount off Liberty                        revoked or changed during the plan year
berment Insurance (AD&D)                              Mutual’s auto and homeowners                          except due to a change in family status.
Coverage is provided through                          insurance rates
Mutual of Omaha. Premiums vary                         * Additional savings based on your                   For more information, contact American
by type of plan and amount of                         age, driving experience, and more                     Fidelity at 1-866-523-1857 to schedule an
coverage. Subscribers may elect                        * Convenient payment plans,                          appointment.
the Employee Only or Family Plan                      including payroll deduction                           Representative: Jason Czajkowski
and amounts up to $300,000, in                         * Rates guaranteed for 12 months
$10,000 increments.                                   24-Hour claims service and
                                                      Emergency Roadside Assistance

      The information in this brochure covers important features of your benefits, but does not create nor confer any rights. This is not a replacement of
      the official plan documents which legally govern the plans. These documents are available upon request in the Human Resources Department.

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