For Your Health
We offer a wide variety of comprehensive medical, dental, and vision plans for our active employees. To compare your 2012 plan and prescription features, click here. For in depth information on a specific plan (i.e. Evidence of Coverage), click on the name of the plan.
*Enrolling in a vision plan is a two-year commitment. Therefore, if you elect a vision plan in the 2012 plan year, you are not eligible to change that plan until the 2014 plan year.
Employees who work at least half of a full-time regular assignment in one classification are eligible. Employees must be in paid status to continue participation in District sponsored benefits unless unpaid leave of absence was protected through the Federal Family Medical Leave Act.
Special rules apply to Adult Education employees, half time employees, substitutes, and teachers’ assistants. Click here for details.
You can also sign up your eligible dependents including:
- legal spouse or qualified domestic partner
- dependent children up to age 26
- dependent children of any age who are permanently disabled and who were continuously enrolled in the District's plans before age 19; or who were first enrolled as eligible full-time students prior to the disabling condition
- your domestic partner's child who you have adopted or have been declared the child's legal guardian. You must be registered with the State of California.
- court-ordered child who is included in your tax return
To maintain benefits coverage, you must remain in paid status. If you do not receive any pay for work in a particular pay period, District contributions for the cost of benefits will stop. If you lose benefits coverage, you will receive a COBRA package that offers the option of continuing your coverage by paying the premiums yourself.
- If you are a permanent employee in a regular assignment, and become unpaid for an entire pay period, your coverage will be cancelled. Note: employees on unpaid leaves of absence under the federal Family Medical Leave Act retain District-subsidized coverage for up to 12 weeks. Click here to learn about FMLA and other leaves of absence.
- If you are a substitute who is eligible for benefits based on your previous year's work, the District will continue to pay its share of the costs for your coverage provided you work at least one day in each pay period. If you have worked the last pay cycle of the school year (June) and receive pay in July for the June service, your health benefits will remain active for July, August, and September.
If you do not elect to pay the costs under COBRA, your coverage will be cancelled. To resume coverage you must re-enroll when you return to work. Coverage will be effective the first day of the month following the date on which Benefits Administration receives your completed application.
If you are a new eligible employee or recently have met the eligibility requirements, you and your dependents can sign up at any time. Your coverage will begin on the first day of the month following the date your properly completed enrollment form is received.
Currently benefited employees can make changes to existing selections during the November Open Enrollment period. Any changes made during this time will take effect January of the following year. After the Open Enrollment period ends, mid-year plan changes can only be made if you experience a qualifying major life event.
At this time, the District covers the cost of premiums and therefore employee contributions are not required. Participants are only responsible for co-pays, coinsurance, etc. when receiving medical care.
Special rules apply to half time employees; click here for details. Teacher Assistants' please see the 2013 Teacher's assistant enrollment form for details.
There are different forms depending on who is enrolling. Choose the applicable form, provide any required documents, and submit according to instructions.
Active employees: Health Benefits Enrollment form
Eligible dependents: Change of Dependent Status form (same form applies to delete dependents)
Domestic Partner: Domestic Partner Enrollment material
Teachers' Assistant: Teachers' Assistant Enrollment form
Half Time Employees:Half Time Enrollment Form form
For a list of health plan providers, click here.
Why do some drugs require prior authorization?
Prior authorization is a patient safety process that ensures members get the safest medications with the best value and are approved by the Food and Drug Administration (FDA). Medications selected for prior authorization are based on at least one of the following criteria:
- Have a high potential for abuse
- Require laboratory tests/monitoring for safety reasons
- Are part of a step-care guideline
- Used for indications not approved by the FDA or the plan
- Has high potential for “off-label” or experimental use
- Benefit exclusions or limitations may apply
How do I obtain a prior authorization for medication on the Formulary or Recommended Drug List?
The pharmacy will let you know if additional information is required. You or the pharmacy can then ask your doctor to call a special toll-free number provided by your medical plan. This call will initiate a review that typically takes one to three business days. This is a common practice for pharmacies and physicians.
Is dual coverage allowed if both spouse/domestic partner are District employees?
If both you and your spouse/domestic partner are District employees and eligible for District sponsored health care benefits, you may each enroll in medical, dental, and vision plans. If you both enroll in the same plan(s), you may not cover each other as dependents. Similarly only one of you may cover your eligible children under the plan(s). If you enroll in different plans, you may cover each other as dependent spouses and both of you may cover your eligible children.
You may opt-out of a medical plan and receive cash back while receiving coverage as a dependent under your spouse’s/domestic partner’s plans. In any instance of dual coverage, your children will be enrolled as a dependent under the plans in which the older parent is enrolled.
Will the District ever cancel my District sponsored health benefits?
The District will only cancel your health benefits if you are no longer in paid status or re-assigned to an ineligible status/classification. That means if you become unpaid for an entire pay period your benefits will be cancelled and a COBRA package will be sent to you. Benefits are also cancelled upon termination of assignment.
Are there limitations on pre-existing conditions if I change health plans?
No, there are no limitations on pre-existing conditions.
Can I use any health care provider when I need care?
Medical plans: The only medical plan that allows you to receive care from any medical provider is the Anthem Blue Cross EPO plan. However, your out-of-pocket costs may be higher when you do not use providers contracted within their network.
Dental plans: The only dental plan that allows you to receive care from any provider is the MetLife Dental PPO plan. However, the greatest benefits is provided when an in-network dentist is used.
Vision plans: Both EyeMed and VSP allow for in-network and out-of-network providers. However, VSP pays greater benefits when out-of-network providers are used.
How do I change doctors or dentists during the year?
To change providers, call your plan directly. Your plan will tell you when your provider election will become effective and the Plan will send you new identification cards, if applicable. Click here for plan contact information.
How do I change my address?
For active employees, you must fill out a Change of Address form.
How are the costs of health benefits address?
Health & Welfare cost are managed through the Health & Welfare fund. Plan design changes are defined by the Health Benefits Committee with recommendations from the Benefits consultant who negotiates the rates with the health care vendors.
What happens when providers raise fees above the contribution cap?
If fees are raised above the contribution cap, the Health Benefits Committee must introduce plan design changes in order to remain within the Health & Welfare budget.
I've got Medicare related questions. Where do I go?
For Medicare related queries, click here
I need information on Domestic Partners. Is there any information available?
Sure! click here
What do I need to know about Medical Opt-Out/Cash-Back Plan?
If you are an active employee and do not want to be covered by any of the District medical plan options, you can waive coverage and receive $3,000 annual cash back. This amount will be considered taxable income and be paid in installments in your regular payroll check. If you opt out of District medical coverage, you may still elect dental and vision care coverage. Your benefits are not permanently forfeited and you stay eligible for retirement benefits. You will be eligible to enroll in medical coverage again during the next Open Enrollment period or earlier if you have an applicable Major Life Event. If you and your spouse/ domestic partner both work for the District, one of you may elect the Medical Opt-Out/Cash-Back Plan and be covered as a dependent under your spouse’s/domestic partner’s medical election.
