Garden Grove Unified School District Health and Welfare

Garden Grove Unified School District Health and Welfare Benefits 2013 -2014

Premium for Retirees Under 65 n Retiree Only – $450 yearly n Retiree & Spouse / Domestic Partner – $900 yearly n Rates for additional eligible dependents vary by plan

Turning 65… n Classified Employees n no coverage is offered after age 65 n Certificated Employees n may elect continued coverage under AB 528 legislation

AB 528 Dental Rates (quarterly) Note: Rates shown are for Oct. 1, 2013. District Self-insured Dental United Concordia Single 440. 52 55. 65 Two-Party 794. 82 161. 46

Eligible Dependents n Legally Married Spouse n Marriage Certificate required n Registered Domestic Partner n Proof of state registration required n Children Under Age 26 (early retirees only) n Birth Certificate required n Additional premium required

Qualifying Event n Certain changes in your status allow you to change the dependents on your plan. n n n New marriage / Domestic partnership New birth / Adoption Loss of other coverage in some circumstances n Divorce or Legal Separation requires you to remove your spouse/former spouse. n All changes MUST be made within 30 days of the qualifying event.

Open Enrollment n The month of September is Open Enrollment n Open Enrollment is the time to make changes to your plan n n Add dependents (outside of a qualifying event) Change health or dental coverage n Changes become effective October 1 st

Medical Plans n GGUSD Self-Insured PPO n GGUSD Self-Insured EPO n United Healthcare HMO

Preferred Provider Organization (PPO) n Office Visit Co-Pay – $25 n Emergency Room Co-Pay – $100 n Deductible $300 person n Max $900 per family n Participating Providers – 80% / 20% n Non-Participating Providers – 70% / 30% n Plus fees that exceed allowable PPO rates n Coinsurance Maximum n $10, 000 in billed allowable charges n Pharmacy Co-Pays – $5, $10, $35

Exclusive Provider Organization (EPO) n Office Visit Co-Pay – $25 n Emergency Room Co-Pay – $100 n Deductible $300 person Max $900 per family n Must use only Participating Network Providers n Pharmacy Co-Pays – $5, $10, $35 n

United Healthcare HMO n Office Visit Co-Pay – $25 n Emergency Room Co-Pay – $100 n Hospital Admission Charge – $100 per day $300 max per admission n $2, 000 out of pocket max per calendar year n Per member n Must use only United Healthcare providers n Must choose a primary care physician n Must see only doctors within a chosen group n Referral required to see most specialists n Pharmacy Co-Pays – $5, $15, $30 n

Comparison Chart PPO EPO n Office visit co-pay = $25 n ER co-pay = $100 n Deductible = $300/person $900/family n Network n 70% / 30% of allowable n Pharmacy co-pay n n n 80% / 20% n Out of network n n n HMO $25 ER co-pay = $100 Deductible = $300/person $900/family Network only = 100% Pharmacy co-pay n n Office visit co-pay = n n $5, $10, or $35 n $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 n $5, $15, or $30

Dental n Garden Grove Self-Insured Dental n United Concordia

Garden Grove Self-Insured Dental Plan (Fee for Service) n Choose your own dentist n Use network for additional savings! n Annual deductibles n $25 individual n $75 family maximum n Annual limit – $2, 000 n Coverage – 90% / 10% n Orthodontia n Plan pays 50% n $2, 800 lifetime max

United Concordia (HMO) n Must use United Concordia dentists n 100% coverage for most covered services n Orthodontic care (limited coverage) n Employee pays n n $1500 for banding for those under 19 $2000 for banding for those age 19 and older

Vision Service Plan n n Eye exam – $25 One eye exam per year Lenses or contact lenses every 12 months Frames every 24 months n $120 Allowance n Second Pair Benefit – $200 n Allowance toward 2 nd pair of contacts or lenses.

How to be a good consumer… n Use it don’t abuse it- we pay for it! n Urgent care vs. emergency room n Pharmaceutical- generic vs. brand name prescriptions n Call Insurance Department first if unsure n Ask questions of your doctor and pharmacist n Keep your EOBs for your records n Stay in network- includes doctor, hospital, lab, anesthesiologist, etc.

Questions? n Please feel free to contact us with any questions regarding your coverage n Crystal Qualls n n n Sylvia Mc. Millen n 714 -663 -6523 cqualls@ggusd. us 714 -663 -6523 smcmillen@ggusd. us District Insurance website n www. ggusd. us/departments/insurance/